Stop beating yourself up

People often talk about beating themselves up or pulling their hair out. But while most of us use the terms figuratively, and go to great lengths to avoid hurting ourselves, some people use them literally, regularly setting out to injure themselves. Cutting, burning, hair pulling and hitting are just some of the things they do.

Their reasons are as varied as their methods, according to Karl Tooher, a psychotherapist. He has specialised in treating self-injury cases and would like to set up support groups for people affected by self-injury. He is also planning a forum for people whose work brings them in contact with the issue.

In many cases, self-injury is a way of coping with difficulties, says Tooher. Just as some people will kick a chair in frustration, others will lash out at themselves to release their feelings. Sometimes, they are in such emotional pain that the physical pain temporarily takes their minds off their emotions. In other cases, strong self-hatred creates the need to hurt oneself.

Tooher has come across cases where people run into walls, insert objects into their bodies and, in extreme situations, pull their eyes out. "But that is very rare, and it's important that we do not sensationalise it. Self-injury is different for every person," he says.

Many difficulties can be traced back to what he describes as "invalidating childhoods", where children suffer emotional or physical abuse or neglect.

"This can get in the way of people learning the normal coping mechanisms. They haven't had the opportunity to learn how to deal with stress or traumatic events. It's not exclusively a childhood problem, but the majority of cases have experienced invalidating childhoods."

Because there is no forum on self-injury in the Republic, there are no clear figures on the numbers of people who self-injure here. In England and Wales, more than 100,000 people are admitted to accident-and-emergency departments each year for self-injuries. As most people do not need to be hospitalised, however, the real incidence is thought to be much higher. Tooher believes the figure is similar to the number of people with eating disorders. It is estimated that about 14,500 people suffer from eating disorders in the State.

"Here in Ireland, we are very much at the early stages of understanding what this is about, and why people do it." Many myths surround self-injury, he says. One is that self-injury is a suicide attempt.

"All self-injury acts do not have suicidal intent. The vast majority have a great will to live. Self-injury is their coping mechanism. For some people, it keeps them alive."

For that reason, the patient rather than the action should be treated. "Getting to the root cause of the behaviour and coping with it is the most important thing. Then, ultimately, the need to self-injure is no longer there.

"Otherwise, if you take away their only coping mechanism, what do they do then? People who self-injure are doing the best they can. They are not lashing out at other people. They are taking their aggression out on themselves."

Another myth suggests that self-injury is a form of attention seeking. Tooher says that most people who self-injure do so in private and go to great lengths to hide their injuries. "Some feel a great shame about it. The vast majority are not doing it to manipulate, but some people feel manipulated by it."

While it appeared to affect more women than men in years gone by, recent studies have found very little difference in occurrence between men and women.

It affects people of all ages, but most commonly those aged from their late teens to late 30s. Tooher has heard of cases in children as young as eight.

Because therapists are working with such patients in limbo, he would like to provide training for those who encounter self-injury cases. He is looking at best practice in Britain and elsewhere with a view to setting up a forum and support groups in the Republic.

Self-injury is so well recognised in Britain and the US that both countries have awareness days, and the issue has featured on programmes such as Beverly Hills, 90210 and 7th Heaven.

"The UK national self-injury day took place on March 1st," says Tooher. "We should be in a position in Ireland to run such a self-awareness day with the UK next year."

Anyone interested in getting involved in a self-injury forum or support group can contact Karl Tooher by telephone on 01-8360033 or 087-2709800 or by e-mail at ktoo@eircom.net

Karl Tooher has set up e-mail discussion groups for people who self-injure, at selfinjuryireland-subscribe@yahoogroups.com, and for those working in the area of self-injury, at selfinjuryworkers-subscribe@yahoogroups.com