Bipolar and Self-Harm
Firstly, I want to safeguard anyone who may find the topic of self-harm a trigger. I want this article to raise awareness, increase understanding and encourage empathy, but to do this I have to be very honest. I will therefore be mentioning methods of self-harm, why people self-harm and my personal experience. Please consider your personal safety before reading any further.
I have thought in depth about writing this article because I remember how I felt about the words ‘self-harm’ prior to my diagnosis seven years ago. In all honesty I felt very uncomfortable. My thoughts consisted of, ‘Why would anyone do that to themselves,’ ‘It’s mutilation,' ‘It’s a cry for help,’ and, ‘Attention seeker.'
I had no knowledge or understanding of self-harm and certainly didn’t consider it a coping strategy for mental distress. To summarize, I was completely ignorant and I’m not afraid to admit it.
According to Mental Health America: “It is estimated that about two million people in the U.S. injure themselves in some way. The majority are teenagers or young adults with young women outnumbering young men.”
And these are just the reported cases.
An Expression of Distress
We need to talk about self-harm. Conversation and support can force open the doors that currently shut away this secretive and seemingly shameful behaviour that in truth, is a clear expression of distress.
You will note I use the term ‘expression of distress.’ I learnt the importance of this from volunteering to share my personal experience on Mental Health First Aid England training courses. Self-harming is not attention seeking nor a cry for help. Who on earth would intentionally injure themselves to gain somebody’s attention? The behaviour is personal and often hidden and indicates a desperate need for relief from intense emotional pain and overwhelming feelings.
We all know what it’s like to have a bad day at work or an argument with a partner and reach out for a glass of wine. We might have one glass, or two, or maybe the bottle. It’s our way of coping because we feel stressed. My vice is smoking and I hate it. I have cut down and I’m focused on giving up but when I can’t cope, I reach for the packet.
What about substance misuse? Smoking marijuana to relax? Taking drugs at weekends to escape? Maybe the ability to cope has developed into addiction? Although the aforementioned are negative on the mind and body, they may be the only things that enable someone to function in day to day life.
I am sure we can relate to some of these examples because they are part of everyday life. Yet the thought of self-harming through cutting, inserting objects into the skin, burning, banging or hitting, skin picking or poisoning seems so foreign. The underlying reason for all is the same. We can’t cope and our self-harming behaviour is an expression of our stress.
I also want to confront the misconception that self-harm and suicide are similar. They are not. Self-harm is a coping strategy to stay alive whereas suicide is the intent to permanently end a life. However, regular self-harming can increase a person’s risk of suicide.
I distinctly remember the first time I self-harmed.
My life was out of control and had spiralled at such speed into a web of confusion I was struggling to get through almost every moment. My mental health had deteriorated over the previous two years due to family issues, a relationship breakdown and stress at work. I developed an eating disorder and binged on drugs on the weekends to escape. As a result I was forced to leave my home, my work and the town I lived in to move back into my parents' place.
When I was taken to see a doctor, I was petrified. I don’t remember making eye contact and I heard no words. I was lost in translation. I was diagnosed with clinical depression and given anti-depressants. However, it was not long before I experienced consistent thoughts of suicide and after finally admitting to them my anti-depressants were stopped and I was prescribed a different type. The repercussions were colossal.
I was diagnosed with serotonin syndrome, a rare drug reaction that poisons the nervous system. Over the next six weeks I fitted, seized, felt crawling under my skin, couldn’t sleep and had crucifying bowel pains, to name but a few of the physical symptoms, as well as frightening psychotic symptoms including hallucinations, and distorted thoughts of reality such as the belief my head was on backwards and distrust towards my family and friends.
I was supported by emergency services and crisis psychiatric teams, but had lost grip on reality. They said I wasn’t recovering and feared the trigger of bipolar disorder, which was later confirmed. A few months before I had been living a ‘normal’ life and now this scary, unpredictable, mental turmoil had taken over.
So there I was in my room and it had been a bad day. I believed my mum was trying to poison me and I had shut myself in my room. Thoughts of who I used to be, who I had become, my loss, grief and hate for myself grew into a ball of panic where the walls were closing in on me and I couldn’t stop them.
I hated myself, I couldn’t cope, I couldn’t take it. My eyes were scouring my room. I wanted to hurt myself, it was my fault, I had done all this to myself. The blame for this overwhelming mess lay on my shoulders and I wanted to punish myself. Within a split second I picked up the metal nail file next to me and rubbed as hard as I could across my wrists.
Pain. Anguish. Gone. I felt nothing. I felt no pain. I felt blank. It was pure relief.
Then shame. Sadness. Why? How could I have done that? Do I tell someone?
This is private. This is for me. This is my way of taking control. This is how I cope.
And that’s how it started.
Many people in the hospitals I stayed in self-harmed. One man repeatedly scratched his face, a woman cut and burnt her wrists and another punched her thighs black and blue. Some showed on display, some hid, some people asked for help, others didn’t. The notion of attention seeking didn’t apply. Whether serious or superficial, self-harm indicated emotional pain that we needed proper treatment for.
If an action gives you a temporary sense of relief you are likely to repeat it in a crisis. Of course I knew self-harm was not a permanent resolution to my problems but when my sadness hit me in waves to the point I couldn’t escape, it became my fateful friend. Remember that in moments of despair and panic we often do what is considered irrational.
If Someone You Know is Self-Harming
So how do you spot someone you think may be self-harming? There are obvious warning signs but remember, self-harm can be secretive and hidden. Anyone with low self-esteem, emotional difficulties or family, work or school problems could be at risk, particularly young adults.
However, sometimes you can spot unexplained injuries including cuts and burns, or unusual behavior like wearing long pants and sleeves in warm weather.
If you talk to someone you suspect is self-harming, be considerate and caring. Never ask someone to stop. Imagine clinging to a rope – the only lifeline you have – then someone cuts you down. You are lost, you have nothing and your control has gone. The panic is stronger, more consuming and the person is at risk of doing something even more harmful.
Ask the person if they are ok. Stay calm, encourage them to get help, signpost them to helpful references (see recommendations below) and reassure them they will be ok. In more serious cases, emergency treatment may be necessary. Don’t panic or make them feel guilty as this will exacerbate any distress.
If You Self-Harm
If you self-harm you are not alone, and it will be ok. Talk to those you trust or health professionals. I told my psychiatrist and he taught me the safe self-harming technique of pulling an elastic band on my wrist. It hurt and blocked my pain but it didn’t cause injury.
It worked for me whilst I underwent therapy for my eating disorder and bipolar management and over time my self-harm was replaced with other things. I wrote diaries, poetry, started exercising but ultimately started to rebuild my self-esteem and manage my ‘new’ life. Over time I didn’t need to self-harm and I haven’t for years.
Let’s talk about self-harm to help ourselves and others but let us be mindful. This is a very complex and emotive topic.
For more information about self-harm or for help in a crisis situation, see:
- 1-800-334-HELP – 24-hour crisis hotline in the U.S.A
- 1-800-273-TALK – 24-hour crisis hotline in the U.S.A
- 01708 765200 - SupportLine in the U.K.
- 866 246 9224 - Self-harm hotline in Canada