interesting article in today's guardian about SI:
http://www.guardian.co.uk/comment/story/0,3604,1272404,00.html
The new guidelines on how to treat self-harmers will do little to increase public understanding
Nick Johnstone
Friday July 30, 2004
The Guardian
One evening when I was 19, I deliberately cut my arms with a razor blade. I didn't know it then, but this was to be the first of many acts of self-harm. A report published this week to much fanfare by the National Institute for Clinical Excellence (Nice) aims to set new clinical guidelines for NHS treatment of "intentional self-harm" by healthcare professionals such as GPs, social workers and psychiatrists. But, from the perspective of a recovered self-harmer, the guidelines are hopelessly off the mark.
Take this, the first one: "People who have self-harmed should be treated with the same care, respect and privacy as any patient." The language used contradicts the goals of the report, implying that self-harmers are somehow not like other patients and therefore not entitled to the same standards of treatment.
The report, which was researched by Nice in association with the National Collaborating Centre For Mental Health (which included input from the British Psychological Society, the Royal College of Psychiatrists, Mind and Manic Depression Fellowship), does draw attention to the often insensitive treatment self-harmers receive at accident and emergency units, but fails to take into account the opinions of those seeking treatment.
Most self-harmers would do anything to avoid seeking medical attention. In the four years that I regularly cut myself, I always had a tube of Savlon and a pack of Band-Aids to hand. A surf around self-harm websites will tell you that this kind of meticulous self-doctoring is common practice. Safeguarding against infection is also a way of avoiding healthcare professionals. During my battle with self-harm, I never sought out medical treatment nor did I broach the subject with the GPs and counsellors treating me for depression. Like most self-harmers, I kept my practice secretive and private.
Although Nice estimate that 170,000 people seek medical attention at A&E in Britain each year, they do not attempt to put a figure to the vast majority who never seek out medical attention. As a result, the impression given to healthcare professionals and the public is that all acts of self-harm require hospital treatment. This kind of sensationalistic sloppiness reinforces stereotypes of self-harmers as dangerous, out of control, crazy.
Granted, a small minority do inflict severe self-injury but most, the majority who are ignored by these new guidelines, cut, burn, scratch or pull their hair: minor acts of self-injurious behaviour that do not require medical attention.
In most cases, self-harm is an act of self-preservation, a way to cope with overwhelming mental pain. It is not an act of self-destruction, attention-seeking or time-wasting. The report, while acknowledging that self-harmers require "immediate psychiatric assessment", does not state the obvious, which is that self-harm is a morbid behaviour typical of depressive illness and other psychiatric disorders. As one disclaimer conveniently concedes, the report "does not seek to explain self-harm". With that approach, quite how NHS workers are going to overcome the widespread misin formation and ignorance surrounding the subject is anyone's guess.
Rash connections are made between self-harm and suicide. The report states: "Those who have self-harmed are 100 times more likely... to die by suicide in the subsequent year. One half of the 4,000 people who die by suicide each year will have self-harmed at some time in the past." This is rather like saying that smoking pot will eventually lead to crack addiction. If there is one stereotype that all self-harmers despise, it is that self-harm is a half-hearted suicide attempt.
The report misses the fundamental truth of self-harm: people do it to feel better, the injury triggering a release of endorphins, bringing a much-needed "high" in the midst of depression or other mental illness.
Another guideline that shows this report was composed by those treating, not those being treated, states: "Include family or friends if the service user wants their support during assessment and treatment." Considering most self-harmers live in terror of their family discovering their habit, this is bizarre. I only found the strength to tell my family eight years after I stopped. I doubt very much that self-harmers who find themselves in A&E will want their family present. But Nice seem to think that they would. So now it'll be standard practice to suggest it.
But the most absurd part of the report is the accompanying "Information for the Public" which tells a self-harmer what to expect when she or he seeks medical treatment. Apparently, if you feel the guidelines haven't been followed, you should: "Discuss your concerns with your GP or other healthcare professionals involved in your care." Considering most acts of self-harm are accompanied by a dissociative state - another glaring omission from this report - and resulting from acute mental distress, it's unlikely that any self-harmer will be remotely interested in citing the Nice report and crying "foul treatment".
· Nick Johnstone writes Blue notes, a fortnightly G2 column about living with depression
www.nickjohnstone.com
a little bit of make-up worked just fine. the burns were old and just scars showing. but i was in a mock wedding party for my friend's, parent's 50th anniversary. i didn't want my scars to taint an otherwise perfect evening celebrating love.
