Thursday, 15 January 2009
Self harm minimisation - Part 2
I knew there was something else going on but I just could not actually articulate it. In the previous post I mentioned the eight different types or motivations for self harming and these were:
1. Gang behaviour tattooing type of self harm
2. To make self feel real. Dissociation, detached from reality. Cutting closes the gap.
3. To make self feel something. No feelings at all just numb
4. Tension relief and pressure stress build up
5. Physical expression of emotional pain. Cutting provides concrete evidence of pain
6. Cutting as self nurturing. Allows caring of self. Munchausen Syndrome
7. Self punishment and self hate
8. Manipulation and to get attention
I have had a question in my mind since first considering the oxymoron of harm minimisation for the self harmer. If a person who self harms has the harm minimisation information would they use it and if they did what does that actually mean?
The self harmers that are the type from number 2 to number 7 one could say when they get to the point of actually cutting, one could draw this sort of ego state diagram for them.
They would be seen to be in a regressed state and in a highly emotional state of mind. Even if that emotion is numbness or dissociation. To actually consciously cut oneself with a blade of some kind one has to have quite a distressed Child ego state.
Harm minimisation information is going to be by and large an Adult ego state exercise. That is why I wonder if they would use it because at the point of cutting the Adult ego state is so decathected and the personality is dominated by the Child.
I think most who work with self harmers would agree with this. So there is almost an experiment to conduct here. Provide a self harmer with the harm minimisation information and see what happens. If such individuals did use the harm minimisation information then that means at the point of self harming it is less of an ‘out of control’ act than the theory would currently describe. It is a more calculated act than many would currently believe.
Despite this with this oxymoron one may have inadvertently ended up with a method of treatment for the self harmer. Without a doubt when many people cut them self they are in a highly emotional state. The self harmer maybe able to learn to use the harm minimisation information over time at least on occasion.
For instance, provide the information and then the person goes away and cuts. After that discuss what was going on in the person’s mind at the point of cutting and how did they not use or only partially use the harm minimisation information. Then go through the same process the next time the self harming happens.
This could have two effects. If they just think of and even use the harm minimisation information at the point of cutting then that means they are cathecting more Adult at the point. This could be seen as a good thing because it means the individual will tend to be drawn more out of their regressed state and more out of the Child into the Adult. That in therapeutic terms that would be seen as a healthy move.
I have an old saying for psychotherapy “Work with the pathology not against it”. Hence I do things with my anxious clients like getting them to have a panic attack in the counselling room with me. Thus I am working with the pathology, not against it at least at that juncture. Or I get my bulimic clients to make homework contracts to throw up this week.
A common type treatment of the self harmer could be doing things like confronting the thinking errors at the point of cutting self. Getting the person to say in their own mind or even out aloud, “Don’t do this”, “You are worthwhile” and so forth. Whilst good options at times they are of limited use.
If a self harmer does employ harm minimisation information when they cut what does that mean? Well it means they are harming self less and thus that would mean that they are valuing self more. So one is working with the pathology to allow more self affirmation. By the very act of cutting self in a different way one is achieving two things. The urge to cut self is satisfied and ones sense of worth is increased. Eros and thanatos are both satisfied in the one single act!
In addition many self harmers report a loss of control and may even say that they are addicted to cutting and they can’t stop them self. If such a person cuts self using harm minimisation information then they are cutting self in a controlled way. Thus one gets more of a sense of having some control over what they are doing.
Graffiti
09:05 Permalink | Comments (16) | Email this
Comments
Tony?
While i was at my first TA101, there was a moment when i was not aware of what i was saying or doing. Just one moment and it was strange.
It was as if i was standing there talking to another person (bodily) I can see the concept in my mind and i also simultaniously was aware of it. But for that moment it was as though i shut my eyes and turned away while another me spoke.
The other me was emotional and i could sense that. The other me was loud and passionate about what i was saying. It was an urgent fearful thing and i was aware of that also. But it was almost as if I and this other me, had conferenced and what actually took place was pre-organised. Kind of like a batten passing thing... while one holds the batten, no one else can talk unless the batten is passed to them.
Well i was talking and then suddenly another me was talking but when i try to remember it, it was like a dream or past memory or something. So strange.
Like during so many performances - i know what happened, yet i can't really remember from between the beginning through to the end of the song or set or what ever it is. When i do recall i wonder if it really happened or now - so dream like. But then again, some dreams are so real, its difficult to remember if they were actually a dream or not.
I remember a dream... I think i dreamed we were at soft ball presentations. I was around 14years old i guess. I dreamed that i won the best and fairest trophy. After waking up in the morning, dressing and breky, i looked every where for that silly trophy. It was so real - so strange.
Needless to say, i won the thing several years running after that so i didn't need to find it anymore. So totally over the trophy thing. We've a box in the shed full of them. I assume we keep them incase our sons may want to show them off to their kids or something. My hubby really likes to keep them. Dust collectors.
Gosh! That was a rave and a bit. I think i intended to comment on the post. I wonder...
OH YEAH! So about the thing at my TA101 - is that what happens when the child is happening? When we feel out of control and we do things without really thinking about it? Like when stressed, i go into archaic Child ego reaction/habit, rather than objective Adult ego. But by bringing in the logical/objectivity of 'how to self harm safely' we have catheted (i think thats how it's said) the Adult and not so much the Child?
So that's like the umm... whats it called...
...you know... the impass thing... kind of builds (or is) a bridge over the impass thing? Yeah? Maybe? Am i even close?
This probably should have been a few comments, but i already make so many!
Whatever... Happy day - its Friday! I'm studying like that crazy tasmanian devil on a Warner Bro's cartoon! Fair dinkum! Every bodyduck!!
Posted by: roses | Thursday, 15 January 2009
Yeah, this is the impression I get from most people who do it. That's why I wrote this... it seems to me like a compulsion type behavior. Anxiety/sadness/whatever is the thought, and the thing that relieves it is this activity. Not to mention that it probably does bring an endorphin rush, at least a little.
It's sort of like doing heroin...they know it is bad, but at the time it provides a relief or good feeling, which at times is irresistable. I don't think many heroin users would decline clean needles. At the same time, they know they are out of control and doing harm to themselves. It is just that at the moment, they are unable to withstand the urge.
Though now that you mention it, there ARE the types who do it for attention, and they might be able to misuse this information to make more dramatic injuries.
Possibly, the name "self-harm" confuses the issue. I'm not sure the intent is always to "do harm" to the self - or often maybe it is the first time, and then the relief comes and it is repeated. If it were called something more under an OCD or addictive rubric, there might not seem to be such a contradiction between "self harm" and "harm reduction."
And Langer's lines aren't ALWAYS the best place or direction to cut...that's important too. Example: the knee. That direction would pull stuff apart with movement. That's a factor too. Knee surgeries are done with vertical incisions. Skin that won't get stretched is better than skin that will.
And the benefit here is only cosmetic - no difference in actual tissue damage or anything.
But now you make me wonder if I should take the post down, or at least that part of it.
Posted by: s | Thursday, 15 January 2009
Yeah, this is the impression I get from most people who do it. That's why I wrote this... it seems to me like a compulsion type behavior. Anxiety/sadness/whatever is the thought, and the thing that relieves it is this activity. Not to mention that it probably does bring an endorphin rush, at least a little. It's sort of like doing heroin...they know it is bad, but at the time it provides a relief or good feeling, which at times is irresistable. I don't think many heroin users would decline clean needles. At the same time, they know they are out of control and doing harm to themselves. It is just that at the moment, they are unable to withstand the urge.Though now that you mention it, there ARE the types who do it for attention, and they might be able to misuse this information to make more dramatic injuries. Possibly, the name "self-harm" confuses the issue. I'm not sure the intent is always to "do harm" to the self - or often maybe it is the first time, and then the relief comes and it is repeated. If it were called something more under an OCD or addictive rubric, there might not seem to be such a contradiction between "self harm" and "harm reduction." And Langer's lines aren't ALWAYS the best place or direction to cut...that's important too. Example: the knee. That direction would pull stuff apart with movement. That's a factor too. Knee surgeries are done with vertical incisions. Skin that won't get stretched is better than skin that will.And the benefit here is only cosmetic - no difference in actual tissue damage or anything.But now you make me wonder if I should take the post down, or at least that part of it.
Posted by: s | Thursday, 15 January 2009
Damn, why did it remove all of my paragraph breaks?
Posted by: s | Thursday, 15 January 2009
Roses what you are describing about your experience at the TA 101 could have been a bit of what is known as derealization. There is a sense of being there but there is this sort of gap between you and reality out there. This will tend to happen if the person is in a stressed place or state of mind
If it was in fact derealization that often people will report it as a disturbing experience. It happens to all of us from time to time and is not a problem unless it happens repeatedly.
The other one that some people experience is depersonalisation. One is just standing there talking to someone and all of a sudden they get this sense that their body (person) is in someway distorted. They may feel like they are three foot tall or that their arms are two meters long.
Derealization and depersonalisation can also occur during panic attacks but obviously that was not happening with you
Graffiti
Posted by: Tony | Friday, 16 January 2009
I would certainly agree with you Sara on the parallels between self harming and addictive drug use. As drug uses say to me sometimes - no one wants to be a drug addict as it is a horrible life style but some still live it.
No one wants to cut self with a knife but some still do it habitually.
Yes it is politically incorrect at least in this society to say that a motive for self harming is to get attention. And as a consequence people get bad treatment because the ‘helpers’ refuse to state or even see the obvious at times. That girl whose arm you repaired. As a consequence of cutting she got mothers attention, your attention, the plastic surgeons attention, the nurses attention and I assume a number of others attention as well.
Without a doubt there are those who cut very secretively and they are obviously not doing it for attention. There are clearly some who do it so they will at least get a great deal of medical ‘attention’.
To my mind the bit that needs to change is how some people tend to view such an ‘attention seeker’ as sort of a bad person. The person is obviously in distress and they are doing the best they can with what they have at the time and they just need to be treated in a different way but not a more derogatory way.
I have collected much more information on self harm minimisation techniques and will put out there into the public arena. I will also state that there are some who may benefit and there are some who may not.
In working with self harmers in a prison one finds they talk amongst themselves about the various means or ways of self harming. Some times the information they pass around is very inaccurate.
Tony
Posted by: Tony | Friday, 16 January 2009
I'd say I'm type 4 generally. Sometimes 5 or 2.
One thing I do is punch walls. But I use harm minimisation by not punching with my dominant hand.
One past therapist of mine (best one I ever had) described me as "the most calculating impulsive person he'd ever met"
Which I think sums me up very well. I plan a lot about SH and think things through so at that impulsive moment when I need it everything is carefully planned out, with the appropriate boundaries in place.
What makes me differ from many people who do it is that I don't feel the SH is out of control, just the feelings that come before it.
I think this harm minimisation idea is an interesting route to look at about treating it.
But that does assume that people will still want to stop once they're using these strategies.
Because, for me it is controlled enough that I feel no need to stop. Which causes problems with therapists since the assumption is that everyone wants to stop. When really, I want help with what comes before it.
The symptom gets treated rather than the problem.
Posted by: Lee | Saturday, 17 January 2009
That is very interesting Lee,
Your comments about harm minimization and self harm
and your therapist makes an interesting comment about you as well.
There are so many assumptions in therapy and I think you highlight another one that the only good self harmer is a lapsed self harmer. You have to stop.
If someone is cutting self and it is not life threatening I would suggest they change the term from self harming to tattooing and that's OK.
The same in drug counselling where the assumption is the only good drug use is no drug use.
I once had a client, female in her 20s, who referred to herself as a compulsive liar. She left calling herself a creative story teller just like Hans Christian Anderson.
Tony
Posted by: Tony | Saturday, 17 January 2009
Which is the symptom Lee? For some reason i see it back-to-front - the harm is the symptom to what happens before the harm action. Can you (or someone) please help me rectify my miss judgment of what is being said?
I guess i usually say... i don't understand (which in this instance means - why is it that way and not the other way around? or why am i seeing it wrong?)
Posted by: roses | Saturday, 17 January 2009
Yes, i was a tad shaken by my TA 101 experience Tony. But what i explained... the perhapsed derealisation? It wasn't frightening - i don't think it was.
It was a bit like what happens in my 'day dreams'. But generally i'm not talking or doing anything in those - they are moments that happen spontaneously for some silly reason. My only involvement in a day dream is that i'm there to watch what goes on around me as it plays out where ever i am at that time.
I think i have a lovely and exciting imagination. I like it.
Posted by: roses | Saturday, 17 January 2009
I remembered something.
I wanted to tell you.
I don't know why.
Well, perhaps i do know why.
I remember before i turned 4. My sister was just born and i don't remember where she was when this memory actually happened.
We used to live in this little tiny house that dad, over the years, added rooms to when ever he could. I guess people could do that back then - 1966 or so. In the kitchen, entry, dining room and obviously my day bed room... ( i guess) there was this lounge chair type thing. It had wooden arm rests as well as a wooden back with a lovely padded, velvet designed insert and what looks like a single bed mattress for the seat. When i think of it i have the best, most nicest feelings in my tummy.
I remember Mum and dad standing in the entrance way watching me lying on the lounge and i have a babies bottle with milk in it. It seems absurd to me. But at that age - yes i remember it being so.
They were looking at me and then at each other and though they weren't saying anything i could hear them speaking words. They said things like... it helps her sleep during the day... i guess it's ok... if it helps then that's fine... i guess she's still young enough for a bottle... stuff like that. They smile as they look at me. It's such a nice memory.
I don't ever recall remembering it before. so strange
Posted by: roses | Saturday, 17 January 2009
I have self harmed. I didn't start doing this until I was in my mid 40's. I hide it and never tell anyone, especially my therapist. I have to work really hard in order not to self harm, and I'm usually successful. (I'm a number 7 on your list by the way).
I don't consider my behavior attention seeking. It's a very embarrassing situation since this behavior is normally found in people two decades younger than me. But I definitely understand the addictive nature of it.
Posted by: Harriet | Sunday, 18 January 2009
I would agree with you Harriet,
It is usually behaviour that is of a person who is two decades younger. So perhaps you could write a blog post about it. I would be interested to read it
Regards
Tony
Posted by: Tony | Sunday, 18 January 2009
Day dream sounds good Roses,
And I had to go and pathologize it and call it derealization. The TA 101 is a good course and I am glad you enjoyed it
Tony
Posted by: Graffiti | Sunday, 18 January 2009
Oh Tony, i only just got back here to see you've answered the comment. At the TA 101, it was not the same as a 'day dream'. That's why i asked about it.
If that's what you do - pathologize things - then that's ok. If they call the TA 101 incident derealization then that's that. Its ok. And yeah, it was most enjoyable thanks.
roses
Posted by: roses | Monday, 19 January 2009
"I would agree with you Harriet,
It is usually behaviour that is of a person who is two decades younger. So perhaps you could write a blog post about it. I would be interested to read it
Regards
Tony"
Thanks Tony. I did just that. Check out my blog. Thank you for the inspiration.
Posted by: Harriet | Monday, 19 January 2009
Post a comment