Covering the basics: Self-injury

TRIGGER WARNING
This article is a piece about self-injury drawn from lived experience and research. No acts of self-injury by an individual are described but multiple types of self-injury are mentioned. Any advice given is general so there will be situations it is not suitable for. If you have serious concerns about a person’s welfare please seek professional medical advice.

Self-injury is a subject that makes a lot of people uncomfortable. We spend so much time and effort trying to prevent pain and distress it can be very confusing when we realise that someone around us, perhaps someone we care for, is injuring themselves.

But self-injury is surprisingly common, and, despite what you may have been told, can be used by people of all ages, genders and backgrounds. It comes in many forms from compulsively pulling hairs and skin picking right the way through to severe gouging and poisoning.

Some people use self-injury in a ritualistic way, others not.
Some use it daily others only rarely.
Some have special tools while others reach for whatever’s nearby.

There are a lot of different things covered by the term ‘self-harm’.

To try to get your head around self-injury it’s quite useful to think of the not-so-helpful things people commonly do when they’re finding life challenging: drinking too much alcohol, overeating, punching walls, having risky sex… There are a lot of harmful behaviours we use when we aren’t coping and self-injury is something that comes from a similar place.

Self-injury might be an unhealthy coping mechanism, but it is still most often a coping mechanism that people use to deal with experiences they don’t have other tools for.

It might seem odd to think of pain as a positive but for someone who’s feeling numb or overwhelmed the release of self-injury can work in a similar way to having a drink at the end of a stressful day.

MYTH BUSTING
Self-injury is most often NOT attention seeking

Most self-injury comes with a sense of shame that means the person doing it is more likely to hide the injury than show it for attention. When it is attention seeking that represents significant need and should still be taken seriously.

With there being such a wide range of behaviours included in self-injury the way you support someone who’s using it will vary a lot from person to person, but here are a few broad dos and don’ts that might help.

• DON’T try to stop someone self-injuring unless their lives are in danger. Yes, that does mean you might mean you have to sit by while someone makes themselves bleed. It’s tough, but it’s important. Self-injury allows a person to process things they can’t deal with in other ways. If you stop them doing something relatively small it increases the chance of them doing something more serious.
  Having said that, if someone is at risk of serious injury be prepared to get them to hospital or otherwise call for help, just don’t put yourself in harm’s way doing it.
• DO acknowledge if you’ve noticed a fresh injury, even if it’s uncomfortable. Use open questions like ‘how did you get that cut?’ rather than ‘did your cat scratch you?’. Don’t push if you can see that the person doesn’t want to answer or is clearly covering it up. You’re just letting them know you’ve noticed and you’re concerned.
• DON’T tell the person using self-injury that they are stupid, silly or selfish. Self-injury is often related to feelings of guilt and shame so making someone feel bad about the way they’re coping is only going to make things worse.
• DO check that the person is being hygienic, has appropriate dressings for any injuries, and whether or not they need to see a doctor. None of this needs to be a big deal – think of what you might do it if they had burned themselves while cooking.

MYTH BUSTING
Self-injury is NOT a ‘failed suicide attempt’.

A history is self-injury does mean that a person is more likely to experience suicidal thinking, but self-injury itself is often a tool to avoid slipping towards suicide rather than actually trying to take your own life

Hopefully that clears a few things up, but what are we meant to do when we see signs of self-injury in rehearsals or on set?

First of all keep this in mind:

Just because someone has used or currently uses self-injury doesn’t mean they aren’t capable.

Scars, while they might look serious, are injuries that have healed. A person with scars may not have used self-injury for a long time and may have made a full recovery from whatever issues led them to use it. For those currently using it, we need to remember that self-injury is essentially a coping mechanism so it might actually be helping someone to function normally rather than stopping them.

You cannot assume that scars or injuries will prevent a person being able to do excellent work.

Fresh injuries could indicate that the person is finding the environment stressful in some way but it may well be caused by something completely separate from work. It’s good to approach this in a similar way to seeing someone covering the fact that they’ve just been crying – they’re going to need to you be caring, respectful and non-judgemental. Be prepared to listen but don’t demand answers if they’re not ready or able to give them.

Most of all just remember that this is a normal person who, for some reason, is using something unhealthy to get by. They’re not weird, they’re not dangerous, they’re just trying to do their thing the same as anyone else.

There are lots of great resources around self-injury available:

The Mental Health Foundation produced this BOOKLET about young people and self-harm (though a lot of the information is relevant to any age group).

Lifesigns is a user-led charity with information and downloadable resources available.

While it’s now quite an old book (so some of the numbers are out of date), Healing The Hurt Within by Jan Sutton is easy to read and gives a wide range of perspectives.

There is also information available on the websites of the charities Mind and Rethink