Helping someone who practices self-mutilation (idea)

Right. I'm assuming here that the person is self-mutilating (I prefer the term self-injury, but never mind) as the symptom of a mental illness such as depression, bipolar, or borderline personality disorder (much as I don't like that diagnosis), and by 'help' you mean helping them to stop.

Short answer? It's difficult. It may be that you can't. And if you wanted a short answer, quick fix, conscience-soothing easy way out, then you really can't.

Long answer?


Short Term

• If someone comes to you and they have just injured themselves, first aid will often be a necessity.
• Minor cuts: the bleeding should be stopped by applying pressure, and elevating the limb if necessary. The cut should always be cleaned out and antisepticed; infection is often a problem for self-injurers. Dress the cut if necessary.
• If the cut is gaping, deep (seeing the subcutaneous fat layer is a Very Bad Thing) or has not stopped bleeding within 30 minutes, the person technically needs medical attention. However, many self-injurers are ashamed, and worried about people finding out and/or being misunderstood. You will have to use your judgement. If the person refuses to go to hospital, England has NHS walk-in centres where cuts can be cleaned, glued shut and dressed.
• Burns should be run under cold water for at least 10 minutes, after which you should apply antiseptic cream and dress the wound with a clean, dry bandage. Large (bigger than a 50 pence piece - about 3 cm across) and serious (beyond the first skin layers) burns need medical attention.
• With serious wounds and/or blood loss, there is the risk of shock. If the person goes into shock (signs to look out for include confusion, stammering, dizziness, unusual quietness and complaints of feeling cold), get them to hospital. Shock can be fatal.

• Your attitude is important. If someone opens up to you, do not get judgemental, horrified, derisive or emotionally blackmailing.
• As LaggedyAnne points out, you cannot shame someone into stopping. Trying to guilt-trip them, or yelling at them, will probably just drive the behaviour underground - moving from forearms to thighs, for instance.
• Remember that your average self-injurer is desperate. They are physically harming themselves because it is the only way they can feel better. Eliminate words such as attention and seeking from your vocabulary.
• Ask him or her why she has self-injured. Express sorrow. Make him or her understand that you care.
• Remember that self-injury is, usually, a symptom. It is not the primary problem but, to the person, the only solution.
• Nor does self injury suggest suicidal intent. True, many suicides are also self-injurers. However, both are symptoms and results of a larger problem. Self-injury does not necessarily lead to suicide.
• The best you can do is be there for the person in a caring, non-judgemental way. Be ready to talk to them. Eco's excellent wu under suicide prevention is a brilliant crash-course in how to deal with the mentally ill and desperate.
• You're going to have to deal with a lot of shit. Cutters can be high-maintenance and really fucked up. I cannot emphasise it enough: someone who is slicing, burning or bruising their own flesh is desperate. She (and it is statistically more likely to be a female) is feeling like shit. She may be dealing with a lot of: depression, self-hatred, numbness, trauma, fear and/or anger. Self-injury is often the only coping mechanism that the person has to deal with these things. Removing, or trying to remove, a coping mechanism without at least attempting to understand the problems is a quick route to disaster. Aspirin for a pickaxe wound to the skull will not work. For many self-injurers, hurting themselves is the only way to make the bad things go away. For others, it can be the only way to feel anything at all. Either way, you are going to be dealing with a lot of shit. Good luck.

• This is the person's decision. However, if he or she wants to get help, you can assist and encourage.
• Take professional titles with a pinch of salt. You may encounter doctors, psychiatrists, psychologists, therapists and counsellors. To my knowledge, only two of these titles, doctor and psychiatrist, require a degree in medicine. Psychologists do, I believe, have a degree in psychology but are not medical doctors. Therapists and counsellors may be brilliant or may be quacks: do your homework.
• Also bear in mind that different professionals do different things. If you think drugs such as antidepressants are the way to go, only doctors and psychiatrists are qualified doctors and may prescribe them. If, however, talking is needed, you may be better off with a therapist or counsellor.
• Getting in touch with other people going through similar things may also be helpful. Bodies Under Siege is a support mailing list which can be joined at htp://buslist.org/subs; BusCentral website is at http://buslist.org. Many other support groups, for many conditions, exist both on- and offline: feeding keywords to search engines should find them.

Footnote - If you ask someone, "What the hell happened to your arms?" you may well get one of the following responses:

• "It was the cat" (hey, this excuse is just traditional)
• "Rampant, unprotected sex with a porcupine"
• "I got caught in a drive-by cutting"
• "Piranha attack"
• "I was learning to juggle knives. I'm not very good."
• "What the hell happened to your manners?"