Sometimes, the unexpected happens. An unforeseen consequence of your actions; an opportunity seized by someone your actions impact. When thinking about what to write about for this blog, I remembered an occasion when something unexpected happened that had a positive benefit for the people involved. Years later, the story serves to demonstrate the importance of ‘attitudes’.

It was at the time we were filming the demonstration DVD’s for the STORM packages. I was auditioning actors to play the part of a young woman who self-injured. The person who got the part was given the scenario brief to think about over the next couple of weeks prior to filming. The only instruction I gave her was “research as much as you can about what it is like for people who self-injure, and make the character your own”. This I’ve found to be a good strategy – too much instruction can become too limiting and staged.

It was after the filming that the actor thanked me for choosing her. It wasn’t because she had been given the work, but because whilst she was researching for the part, her best friend since childhood disclosed to her that she self-injured as a way of coping. She had learned a lot about a subject that, until listening to her friend’s own experiences, had been unfamiliar to her. She also became aware of just how important their friendship was; being there for each other had been the support her friend needed to avoid self-injuring – at least sometimes.

But, what she couldn’t understand was why her friend hadn’t told her about this before. The fact was, her friend didn’t want to risk losing their friendship, and so it remained a secret – until now. It wasn’t that she was discussing the acting role that prompted her friend to open up about herself, it was how she talking about it. Her friend had the endorsement she needed to talk about herself without fear or risk.

Unsurprisingly, stigma (or perceived stigma) is one reason why self-injury is not talked about. Talking about cutting, for example, to help deal with emotional pain is likely to receive a negative reaction – this is certainly true for some who have sought help from services. The problem lies in how we understand self-injury. It isn’t necessarily a lack of understanding; learning about self-injury may help you to know the reasons why and how best to help someone, but it may not help you to ‘feel OK’ about it. It is a natural instinct to avoid danger of being hurt in order to survive, and so our feelings, and thus our attitudes towards self-injury, are challenged. It is a legitimate question to ask “why would someone want to cut themselves to help him or herself when, in fact, it is harmful?”

We know that self-injury is a coping strategy for a myriad of reasons. It is also used to punish oneself. And, although the reasons are in the main not to suicide, the correlation is too great to deny. People who self-harm (self-poison and/or self-injure) are at much greater risk of suicide within 12-months of an episode, with increasing risk in recurrent repetition. Receiving a psychosocial assessment reduces the risk of both repetition and suicide, and yet, someone who self-injures is less likely to receive a psychosocial assessment than someone who self-poisons. Notably, self-poisoning receives greater attention due to its direct link to the danger of ‘killing oneself’. Self-injury, on the other hand, gets a bad press within services with those who present repeatedly being ‘wrongly’ considered as ‘time wasters’. The fact is, anyone presenting with self-harm should receive a psychosocial assessment with both self-poisoning and self-injury receiving equal attention.

How we attend is of paramount importance. To attend to a wound or undertake an assessment with a poor attitude is just as bad as not attending at all. It is within the first moment of meeting that a person who self-injures will determine either that there is hope that things can get better, or it reinforces all that is wrong about themselves. Having the right attitude is essential, but what can we do if we don’t ‘feel OK’ about self-injury?

The challenge is to recognise the limits of our own tolerances, to recognise when our feelings are expressed through our attitudes, and when our attitudes begin to cloud our judgement. We can then understand that whilst we don’t ‘feel OK’ about self-injury, we can move beyond this feeling to see the person and what is essentially the physical expression of their emotional pain. This is our professional attitude, an attitude that helps us to engage collaboratively and to listen with compassionate and empathy.

 

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