June 12th, 2007

Yellow head

Self-Harmers and Fakers

Regular readers of this diary will be aware that I worked for many years on an acute psychiatric ward. In a recent post, I railed against those, who I believe, use the system for reasons other than health. For some, it seems that being a regular psychiatric in-patient, is an occupation and a way of life. I make a clear distinction between those who are genuinely ill and those who are skilled at manipulating the system for their own ends.

Of course, without experience, it's not always easy to sort out who is genuine and who isn't. But real mental illness is hard to fake. Contrary to popular belief, it's extremely difficult to fool those in the psychiatric profession. It takes a lot of effort to keep up a charade of psychosis or depression. I remember one guy, a heroin addict, who claimed that he heard voices telling him that people were plotting to kill him. He was adamant that these voices were real and that a white van full of thugs were about to invade the hospital in order to kill him. Yet apart from when he was making these claims, he showed no sign of distress and his concentration was good. There were no indications of thought disorder. He tended to park himself in front of the TV, watching one show or film after another throughout the day. This in itself is a sign of good mental health, as those with genuine psychiatric illnesses, tend to find TV difficult to concentrate on. Those patients who suffer from elevated moods tend to lack the patience to watch TV, while those with disordered thinking, may make no sense of the barrage of images and might even believe that the TV was referring to them personally (this a symptom is called Ideas of Reference). Depressed people might watch TV out of inertia, but for the rest, it's a pretty good rule of thumb to say that seriously mentally ill people don't watch TV.

There is a common belief that people who self-harm do it for attention and that these people aren't mentally ill. Yes, there are those who will cut, or overdose, simply in order to get into hospital (usually because they're homeless or have a court case coming up), but most don't fit into this category. Self-harming behaviour can seem bewildering and inexplicable to those who've never felt the need to do this. Why on Earth would anyone, especially a young girl, scar themselves? It's a hugely complex area of psychiatry, which is perhaps better thought of as an addiction. One man I knew, hit himself in the face and head with a hammer, leaving circular dents in his skull and smashing his nose to a pulp. No one commits an act of self-destruction this extreme, simply in order to get attention. It was manifestation of his terrible inner-turmoil. Self-harmers are often unable to offer any explanation as to why they hurt themselves and often look confused and bewildered when you ask. An inarticulacy and inability to express their distress, seems to me, to be a huge part of the problem.

So why do people cut? People cut in order to get distraction from tormenting thoughts. They find they can get relief from internal distress, by creating physical pain. Have you ever punched a wall out of frustration? The same psychological process is at work when people self-harm, the only difference is the extremity of the action and the depths of the emotional pain. The behaviour is repetitious, because the relief is short-lived, and needs to be done again if the sufferer wants further relief.