Shotguns for the Suicidal?
The field of mental health has, to me, always been a profession where we help people to both learn to help themselves and protect them from harm, so it was with a degree of both dismay and incredulity that I saw an article in The Sunday Times of London, February 5, 2006.
It seems that a debate among nurses in Great Britain will be taking place shortly and that's something I would have missed if it weren't for the topic to be discussed: giving blades to self-harmers. My thinking is that would be tantamount to advocating for shotguns for the suicidal. I don't intend to sound like I'm taking this lightly, I can assure you.
One of the nurses interviewed stated that self-harm patients (aka those who engage in SIB or Self-Injurious Behavior) need clean, sterile blades for their cutting rather than razor blades, dirty knives, broken glass or tin cans. This poses another question in my mind: Do SIB patients intend to cause flesh injuries or start an infection that could endanger their lives? I don't believe they do intend to cause an infection and it is unlikely that they would choose particularly dirty implements. The few SIB patients I saw in the hospital all used clean, new razor blades or kitchen knives. All of them let other patients and staff know they had cut themselves and were given immediate medical care.
The rationale also used to advance this proposal is that we provide clean needles for drug addicts, so why not clean blades for SIB patients? I do see a connection, but it's a bit beyond my reach to explain in terms of the neurobiology behind it. SIB patients may, in some way, be addicted to this behavior. We do know that, when interviewed about why they cut themselves, they will say because it makes them feel better and they have a sense of relief after the cutting. I once saw a woman who had so many cuts on her arms that both of them were covered in straight white welts from just above her wrists to the beginning of her shoulders.
One advocate not only favors the clean "sharps," but believes it would be a good idea to sit there as the patient carves away. Even further, there is a suggestion that a nurse could facilitate where and how deeply to cut. I find this very disturbing and I'm curious as to where the research providing support for this approach can be found. If there is no research, then what do these nurses propose to do? Perhaps they want to explore new ground, but it concerns me as both a mental health professional and a caring human being.
Now, I come to yet another question: Is or isn't SIB a form of mental disorder and can a person with such a disorder make a rational judgment about their safety? The question of civil liberties has been brought into this discussion here in the US where patients are seen as having a right not to take medication or accept treatment, unless they are deemed a danger to themselves or others. Unless someone makes that determination, they can do as they please.
What do you think?
Related Topics: Self-Injury: One Family's Story, When Scab-Picking, Cutting Becomes Addictive, Self Harm: Support Group
It seems that a debate among nurses in Great Britain will be taking place shortly and that's something I would have missed if it weren't for the topic to be discussed: giving blades to self-harmers. My thinking is that would be tantamount to advocating for shotguns for the suicidal. I don't intend to sound like I'm taking this lightly, I can assure you.
One of the nurses interviewed stated that self-harm patients (aka those who engage in SIB or Self-Injurious Behavior) need clean, sterile blades for their cutting rather than razor blades, dirty knives, broken glass or tin cans. This poses another question in my mind: Do SIB patients intend to cause flesh injuries or start an infection that could endanger their lives? I don't believe they do intend to cause an infection and it is unlikely that they would choose particularly dirty implements. The few SIB patients I saw in the hospital all used clean, new razor blades or kitchen knives. All of them let other patients and staff know they had cut themselves and were given immediate medical care.
The rationale also used to advance this proposal is that we provide clean needles for drug addicts, so why not clean blades for SIB patients? I do see a connection, but it's a bit beyond my reach to explain in terms of the neurobiology behind it. SIB patients may, in some way, be addicted to this behavior. We do know that, when interviewed about why they cut themselves, they will say because it makes them feel better and they have a sense of relief after the cutting. I once saw a woman who had so many cuts on her arms that both of them were covered in straight white welts from just above her wrists to the beginning of her shoulders.
One advocate not only favors the clean "sharps," but believes it would be a good idea to sit there as the patient carves away. Even further, there is a suggestion that a nurse could facilitate where and how deeply to cut. I find this very disturbing and I'm curious as to where the research providing support for this approach can be found. If there is no research, then what do these nurses propose to do? Perhaps they want to explore new ground, but it concerns me as both a mental health professional and a caring human being.
Now, I come to yet another question: Is or isn't SIB a form of mental disorder and can a person with such a disorder make a rational judgment about their safety? The question of civil liberties has been brought into this discussion here in the US where patients are seen as having a right not to take medication or accept treatment, unless they are deemed a danger to themselves or others. Unless someone makes that determination, they can do as they please.
What do you think?
Related Topics: Self-Injury: One Family's Story, When Scab-Picking, Cutting Becomes Addictive, Self Harm: Support Group
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15 Comments:
Dr. Farrell;
I do like your title as an exaggeration of the rationale behind the clean blades for cutters idea.
I have no experience with cutting; however, I do know someone who began down that road and fortunately did not go far. I've read many posts on WebMD boards from cutters. My impression is they do use clean and sharp devices to cut (maybe it is not that way in the U.K.?). Also, the posts I've read say that they cut when they are alone; in the middle of the night sometimes, after their families have gone to bed. So, I can't imagine someone making an appointment to go to a clinic to get a sterile instrument to use while there to cut. It would be like asking bulimics to come to a clinic to vomit.
The nurses would coach the person as to where and how deeply to cut?
That idea is just absurd. That isn't health care to me, it is advocating and encouraging unhealthy behavior. Can you imagine? Do they have such an abundance of nurses there that there is personnel available for this? Send them here.. we need nurses!
I think self-harm a form of a mental disorder. I think it is way of avoiding psychological pain by making the pain a physical pain. That makes it something real, something that can be seen. If it can be seen maybe it can be understood; conversely, a psychological pain can't be seen and can't be understood (by the self-harmer).
I can't articulate it the way I want to, but I think it is comparable to the alcoholic numbing his psychological pain with alcohol; the drug user doing the same with drugs; the overeater doing the same with food, etc.
How about having these nurses read your blog on the effect of human touch and instead of providing sharps and cutting advice, they could provide some warm human touch instead?
~Tasker
well to me, the idea of providing self injurers with clean blades and then having someone tell them where they can cut is absolutely absurd!
I myself self harm amongst many other destructive behaviours. You will not catch me walking in somewhere to trade in for a clean blade or have someone tell me where I can go ahead an do it. For me, it is rather im[pulsive in nature and the mere idea of having someone say where and how would throw me over the edge. Then another thing that strikes me from my studies of anatomy it that everyone differs slightly anatomically. Where an artery should run and at what depth is not consistent, so could this nurse then acicdently facitlitate an unintentional suicide?
I will admit, my sharps are not always the cleanest, but I do care for the wounds and typically streralize them after use. Walkig into a place to get so called clean blades would feel dirty. I would be wearing my shame clear to the outside. I think i would go further underground.
Seriously, as horrible as this sounds, if I intend to do any severe damage I can and will. I have the knowhow and the means. My self harm is not usually open news to people. A few do know about it and others are concerned but as I have said it to all, dont worry. If I am not intending to make irreperable damage if assistance is needed I will seek it out. Sure I have set myself strict guidelines on what 'requires help' but it is there. And if I am to develop an infection I would do soemthing about it. But you wouldnt catch me going in for some clean implements. As another person said why dont you just have me go and puke my dinner while I am there. And perhaps they would provide a gym for my to exercise to excess under medical supervision.
i want to feel alive at tiems. Mostly I live in a frightened numb state. I rarely feel. I learned to turn off those feelings long ago. The only time I feel I have a connection to my self is when I am self harming or using my eating disorder. It also serves as a means of communication for me. I seem unable to verbalize what it is I want to say. I cannot articulate my point and as i have learned through years in the sciewntific world, have a point and get to it else, shut up. So it becomes my voice. I do not want some nurse 'controlling' my voice. If I were to allow that, then I would truly have no hope at ever finding my actual voice and would be left always waiting for someone or some behaviour to spelll it out.
Bah, I make no sense. And if you want to know my brain workings, I now think I should be punished because I could not articulate myself.
Gosh, I have heard some silly off the wall and saddening ideas over the years but this i think is the topper. Perhaps it is time to open self harm institutes where people can go to hurt themselves and be directed and supervise....
Well, what an interesting idea.
As a self-cutter (former? its been nearly 10 months), if someone were to hand me clean razor blades, I would probably think "Gee, I guess it's okay to cut myself as long as I use these blades." The only half-way reasonable way I can think of this working is if someone were to come into a hospital or treatment center with an infected wound.
The part about 'supervised self harm' is also unthinkable. So many of us do it in private because it feels like something we should be ashamed of. We are already feeling terrible enough about ourselves to be cutting our own skin, and being told how to do THAT would be just degrading. Also, sometimes the self harm is about controlling the pain - how can we control supervised self harm???
Have the people who came up with this brilliant idea actually talked to any self harmers??? Why are they spending their time trying to come up with 'better' ways to self harm, instead of concentrating on how to help us deal with our pain in a way that does NOT involving self harming???
As far as the diagnoses of self harm.... I've been told (and have read) that self-harm is a coping mechanism. I have to say that I think that seems pretty logical. It seems like most of the time, there is another mental disorder that the person is trying to deal with by self harming. It's hard to say if a person who is hurting themselves is able to make decisions reguarding their safety. I guess it depends on the persons stability at the moment. I've been able to make choices about how far I go on most occasions, but I've also been taken to the hospital by friends/loved ones when they though that I was not able to take care of myself, and I thank them for that.
Sorry this is such a long comment. Such a sensitive topic deserve the time and though.
THIS IS ONE OF THE MOST INSANE THING I'VE HEARD OF. HECK COME INTO THE BATHROOM WITH ME WHEN I'M HAVING A BM. OR CHANGING A SANITARY PRODUCT. THE THOUGHT OF BEING IN A CONTROLLED ENVIRONMENT IS ABSURD AND JUST AS DISGUSTING AS WHAT I'VE MENTIONED.
i don't find this article in good standing whatsoever.
I can see that there's a lot of agree with me on this one and I appreciate all of your posts. I just hope that some who work with cutters or who are themselves self-cutters will attend this meeting in Great Britain. I wonder if any nurses will speak up on behalf of themselves as self-cutters. Serious stuff and long posts, I agree, are necessary when the topic is this weighty.
Thanks for your thoughts.
I read an article on this elsewhere online and although I'm not sure I agree with this idea but I think it's worth while pointing out that the nurses who are proposing this program are talking about using this approach on inpatient people only. These are patients who no matter what the hospital does or what the nurses do the patients will still find ways to hurt themselves. Why not open the door of communication with these people? That's what I got from this proposal...
I find this very disturbing. it is ok to cut as long as you follow the rules. come on, we're dealing with an addiction here that most of us want to quit. we don't want someone handing us a blade and saying it's ok to cut. we don't use rusty blades or dirty objects. we have our stash of blades or use clean kitchen knives. we clean up after we are done as well. we don't need cutting to be condoned. we need help in stopping.
the project is doomed for failure any way. cutting is not like alcoholism or drugs that are done in public. cutting is a very secretive practice. we do it alone. we hide that we do it. cutting is a way of releasing the pain inside of us. it is not something that we can make an appt for and then go to the doc to do it. we cut when we feel the need. we do not cut on command. then to have someone watch us telling us how to do it. that goes so against the reason why we cut. we don't plan to cut. it just happens. what are they going to do? who is going to put a 24/7 watch on us cutters so they can be there when we need to cut? also telling us where and how much or deep to cut. that also is not an option. we cut until the pain goes away. it could be one or two cuts or it could be many.
cutting is not something that can be dictated or orchestrated. we do not need people facilitating our cutting behaviors. our cutting implements are clean and we clean the wounds afterwards. what we need is people who understand us. not like these nurses who have no clue what it's like to be a cutter. we need people who can help us to stop cutting. not by just telling us to stop but by understanding the pain that lies beneath the reasons we cut. help us to stop cutting. don't facilitate us.
I like the others totally disagree with this proposal. Cutting for me is a lot about control and punishment. If someone is telling me how, when, and where to do it, then I have no control over it and there is no punishment if I am not controlling it. Most nights when I feel like cutting, I would perfer a nice, warm, non-judgemental hug instead of my knife, but since I don't have that I settle for my knife. So instead of handing out clean blades why don't they hand out hugs. Mostly all we need is someone to understand us and comfort us. Most of us have been through horrible childhoods that have caused us to want to self harm. All we need is for someone to care. But that is just my 2 cents you can take it or leave it.
SR
The idea behind needle exchange programs is harm reduction. That is the key to these programs (as opposed to handing out needles). I agree that harm reduction programs should be developed for those who self harm. But, I don't think handing out a blade is the way to accomplish this. Plus, not everyone who engages in self harm behavior does so by cutting. Having people around who won't judge someone who engages in self harm and can provide information on how to heal sounds like a step in the right direction to me.
The ACLU has caused so much grief in America. For the sake of the mentally ill who are suffering, their loved ones and society at large, some people SHOULD be mandatorily medicated, most especially if they are a harm to themselves or others. WITH that medication comes the need for mandatory counseling, so that people who CAN live a normal life without medication and without hurting themselves or others have that opportunity. In the US we have a multitude of people on disability who we, as working citizens, pay for their rights to sit home and do nothing but have more time to self-injure. I have friends in this position. They sit home and collect disability, get food stamps and pay their utilities with stipends, yet refuse medications and counseling with impunity. Guess what? I have anxiety and depression and many of my own issues. I refuse to surrender myself to a system that seems to work so illy for so many and to become a part of a taking machine that makes no sense whatsoever. Don't give us clean blades. We aren't sharing them. This is not a group activity, unless you are playing at being "Goth" at some ridiculous party. Give us the counseling and medication we need. Thank you for reading this.
Maybe just maybe the issue brought up by these UK nurses is working already !
While they carve....away. Well, as a past cutter, and recent cutter, after three years of no cutting, i finally gave into the stress and cut myself 8 times on my wrist, yes, it was stupid, yes for the time being it felt really good, and yes i may end up doing it again, but the think about cutting is it is not a game, it is a habit, i feel that even if i were not to cut for 10, 20 years, it would still be there in the back of my head, b/c once someone cuts, they always are a cutter, and i think it is absolutely ridiculous from experience, to give self harm patients instruments to cut themselves. Like one person said most cutters do not openly inflict harm on theirselves, but mostly at night, or alone, i've never heard of anyone openly cutting with someone around, unless their were mentally impaired. But, i do agree self help groups are helpful but, not the U.K.'s ideas, definantly not.
It is interesting to read about self harm from those that self hrm rather than from people that hypothesise from a clinical point of view.
As someone that self harms, I also SH to release emotional/psychological pain and yes, it is a coping mechanism, although at the time I am not conscious that it is. For me, I tend to harm when the emotional pain is totally overwhelming that the self harming brings me back into the present. I am almost habitual and do the same thing with the same type of blade every time. I can be pretty sure that I would never do it in the presence of another person, let alone have someone give me a 'clean blade' and makes suggestions about where, how, etc, especially given that for me it is a method of regaining control.
Frances
WOw, and I thought my parents were stupid!
Anyone who advocates "safe cutting" should not be around patients of any kind, especially those who are having mental problems. What a joke, a doctor or nurse actually wanting to help people hurt themselves(what a bunch of quacks) As was already mentioned people who cut or self harm in anyway don't need a way to do so "safely" they need help to learn to cope in a different way.
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