When each scar is a cry for help


One thing all young self-harmers have in common is TVs in their bedrooms, according to a leading expert, writes KATE HOLMQUIST

A TEENAGE girl has been secretly cutting or burning herself in her bedroom for months. The first her horrified parents hear of it is when the school phones. Their daughter has confided in a friend, who has told her own parents who in turn have contacted the school, which phones the self-harmer’s horrified parents and recommends counselling.

“Self-harm can go on for months and the parents don’t notice,” explains Joan Freeman, author of Cover-Up: Understanding Self-Harmand founder of Pieta House in Lucan, Co Dublin.

The first question parents ask is, “Why?” Ask a self-harmer if they were trying to kill themselves and they look at you with wide-eyed disbelief, says Freeman. The body is a canvas on which the self-harmer expresses suppressed emotion. “Each wound has its own story,” she says.

Amy Winehouse, whose body is scarred and tattooed, has admitted to self-harming from the age of nine. The youngest self-harmer Freeman has met was six years old, and the oldest 80 years old.

Self-harm is a solution to inner turmoil, an external expression of internal anguish in the same way that people may drive too fast, drink too much and comfort eat. Self-harmers say that a feeling of calm descends on them when they injure themselves, distracting them from their emotional pain.

Methods include pulling out hair, eyelashes, eyebrows, picking at the side of the nail, and cutting or burning themselves in places, such as stomach and thighs, where the wounds go unseen.

Boys may punch walls and throw themselves down stairs, then say it was an accident. “There’s no ‘kick’. They feel ashamed, which is why they keep it secret,” says Freeman.

Some overdose because they want to black out and not have to think. AE doctors presume it’s a suicide attempt, just as GPs treat people for alopecia when they’re really pulling their hair out.

Some children discover self-harm through the media and then begin to practise it because it gives them an identity.

One thing all young self-harmers have in common is TVs in their bedrooms and, often, internet access as well. These children’s family homes are effectively a collection of bedsits. Sitting down to a family meal and conversation together with the TV off rarely, if ever, happens.

Pieta House, which specialises in treating self-harm, has recently seen a disturbing 60 per cent rise in cases compared with this time last year.

Summer is usually a quiet time, but in June and July this year, Pieta gave more than 1,000 counselling hours to 275 “active” clients, while conducting 160 new assessments on top of that.

“We’re hearing that it’s about the recession. The stress caused by lack of money and the lack of jobs is filtering through families. There’s a despair,” says Freeman.

Nine out of 10 self-harmers have no psychiatric history and are usually reacting to a life event, such as bullying in school. They tend to be sensitive children who don’t fit in with their peers. “What’s happening with girls now is that they attack each other, assault each other,” Freeman says.

When they end up in A&E as a result of self-harm, they may get little sympathy, she adds. With medical staff working intensely to save lives of people who have had terrible accidents or sudden illnesses, some staff may see girls with self-cutting or overdoses as “spoiled little wagons” who are attention-seeking when, in fact, self-harm is a way of communicating emotional anguish.

Pieta House is a voluntary organisation that costs €800,000 per year to run – only €70,000 of which is contributed by the HSE.

Clients are not charged for services and fundraising is a core activity. Freeman says she prefers it that way because she can train her psychologists without interference.

Located in an ordinary three-bedroom house in Lucan, Pieta House doesn’t feel like an institution and has a conservatory blooming with geraniums where visitors and clients are immediately given a comfortable chair, a cup of tea and a biscuit.

During the assessment process, the therapist sits on a low stool while the client sits on a sofa at a higher level. This is symbolic of Pieta House’s philosophy, which is about empowering the client – no matter what the age – to feel respected rather than helpless.

All 26 therapists are registered and qualified with the IHIP, the Irish Association for Counselling and Psychotherapy or the Psychological Society of Ireland.

Pieta House retrains them because, Freeman believes, being effective with self-harmers requires “the complete opposite of what they learned in college”. She trains her psychologists to hold the client’s hand when it’s appropriate and to give directive advice. “If something was wrong with your car, you wouldn’t want the mechanic to look at it then ask, ‘Now what do you think?’”

Some clients have come to Pieta telling of “harm minimisation” treatments they have experienced with other qualified therapists, such as breaking a raw egg on the thigh to simulate the feeling of oozing blood, snapping a rubber band on the wrist to synthesise cutting and holding ice-cubes against the body to cause burning pain. When one client was asked the significance of always cutting her left arm and not her right, she explained, “I’m left-handed.”

It’s harder to spot self-harming among boys because they are almost expected to get into fights or to injure themselves playing sports. One young lad had been to AE 27 times with broken bones before medical professionals realised he was injuring himself on purpose.

“People who self-harm are the gentlest of people,” says Freeman. “They say, ‘I don’t want to hurt anyone else’. They’ll tell you that instead of being verbally abusive when they’re angry, ‘I go home and cut myself. I’m punishing myself because I’m to blame’.”

Cover-Up: Understanding Self-Harmis published by Veritas