In late 2015, I sat in the front seat of my car after dropping my children off at daycare. As I had done many times before, I opened a small pouch in my handbag and took out a packet of replacement blades for a craft knife. I looked at them, opened and closed the packet, and sat with the urge to press one against my skin.
“If you do this,” I thought, “you’ll be breaking a no-self-harm streak that has lasted seven years.”
But on this particular day, I took off my shoe and made a small slice along the side of my foot. It gave instant relief. Satisfaction that the next day I could do it again without the weight of guilt from breaking any special streak. I had tangible pain that I had made and I could understand. I had a wound that was rapidly filling with blood. I watched it with morbid fascination. Then I returned the blades to my handbag, took out a Band-Aid and placed it over the cut. I put my shoe back on and drove to work.
In December 2015, I picked boysenberries from our backyard plant without gardening gloves on, letting my hands and arms get scratches all along them. My hands stung all over as I washed them in the bathroom sink that afternoon. But thanks to the boysenberry jam everyone would get for Christmas, the newest scar I had inflicted on one arm with a blade was now less noticeable. If people asked about it, I could use the plant as my excuse.
Of the multitude of reasons behind self-harming behavior, a “cry for help” is only one. As a mental health worker acknowledged to me once, it can be very effective at communicating distress. But that’s not the same as pure attention seeking. Studies suggest half, or less than half, of people engaging in self-harm will seek help; it is more likely to be hidden than to be flaunted.
Research into self-harm is also scarce, and most of it focuses specifically on young people. It’s difficult to find data around the prevalence of self-harm among adults – a result, perhaps, of no longer living with parents who may find razor blades and lighters hidden in unusual places. However, one recently published study found the mean age of patients presenting to emergency departments after non-suicidal self-inflicted injury was 28.4 years. This is not solely a teenage problem.
I had struggled with self-harm for years before the first (and only) time I presented to an emergency department with a self-inflicted wound, in early 2016. I drove there with a friend, at the insistence of my husband, because the cut on my forearm was too deep. I could see the yellow fat underneath. At 15 weeks pregnant, I wasn’t sure if I should also get a tetanus shot. I filled in my paperwork, had six stitches, and drove home again.
I’m 30 years old, married, with a postgraduate degree, a published novel, close family and plenty of friends. This morning, weighed down by the stress of three fighting children, deadlines and renovations, I flicked a rubber band hard against the tender inside of my wrist. I flicked it again and again, savoring the sting and waiting for the raised red marks to appear on my skin.
I do this rubber band thing sometimes, following the advice of a psychiatrist, who suggested it as a short-term solution to the strongest of my urges. The welt it leaves behind is gone in a few days and unlikely to get infected, but the cuts and burns from blades and lighters have left permanent scars. By contrast, unintentionally nicking an artery is a real possibility to those who cut, especially if they do so on their upper thighs.
Yes, their thighs. Not just their wrists. Self-harmers actually tend to opt for places they can hide it more easily, so that they are able to present as functional, “normal” people. Many people turn to self-harm as a coping mechanism to help them continue to live, not as a way to die.
There’s a question on the Edinburgh Post Natal Depression Scale that is used when you’re pregnant or just had a baby: How often in the past four weeks have you had thoughts about harming yourself? I had three children between 2011 and 2016, and no matter how well I was doing or how long it had been since I did cut myself, I knew that I’d have to either lie or explain my answer to the person administering the test.
“Not suicide,” I’d clarify. “I’ve thought about cutting.”
I said this each time I did the test, even when it had been many years since I last acted on those thoughts. Because, as my psychologist tells me, when a neural pathway is used many times, it becomes stronger, and my brain was remembering the hits of adrenaline that came with so many years of regular cutting. Like alcohol or drugs, one can develop a lifelong addiction to pain.
And, as my experience in the car shows, it may be helpful to adopt some of the strategies used to treat addiction when tackling self-harm. Being able to think “it’s been two years since I last did it” was like an internal sobriety coin encouraging me to keep fighting the urge. Having support people to call when at risk of “falling off the wagon” meant I could talk through what I was feeling until I felt capable of going home without buying new blades. And, more recently, my psychologist has given me information on “urge surfing”: a mindfulness technique used to combat addictive behaviors.
The other aspect of tackling the problem of self-harm is to treat the root cause. The most common motivation for self-harm is “managing emotions,” which means that it is an unhealthy coping mechanism. I have been given a vast toolbox full of other coping mechanisms – deep breathing exercises, progressive muscle relaxation, stress balls, journaling. But the goal should be to reduce stressors in the first place, and develop healthier long-term balance in our lives.
That morning, after cutting in the car, I drove to my job as a high school teacher and taught my classes.
I smiled with colleagues, picked my kids up from child care, and cooked dinner for my family. I wore a mask and did not tell a soul about my renewed cutting habits for another two months when, exhausted, I confided in a friend at church one morning.
Thankfully, my friend knew it wasn’t about attention.
I still find myself romanticizing pain. I still dig my nails into my skin when I am highly strung. When the worst of the urges hit, I still turn to rubber bands, or holding mugs of boiling water until the heat hurts my palms. I still have to pull my gaze away from blades at the supermarket. But I know there are other options. I am in therapy, and I am taking medication. I have people I can talk to, people I trust.
You can be that person for somebody.
Courtesy of The Big Issue Australia / INSP.ngo