Mary
Mary’s son has been self-harming (minor cuts and scratches) for several years. The cutting became worse after he started university, and he now lives at home. He still cuts himself intermittently and threatens suicide. Mary accepts the cutting as something he needs to do
Mary thinks her son had been self-harming in a mild way for some years, starting with twanging himself with elastic bands. This escalated to cutting, which became worse when he went to university, and after a year he returned home to live with his parents. He does not cut himself so much now, but reverts to the behaviour when there is a crisis. The cutting is fairly mild scratching; Mary sees it as a coping strategy and tries to sympathise but remain relatively calm and concentrate on making sure her son keeps his knife clean.
Initially Mary was horrified and very distressed by her son’s cutting, but now she just feels really sad and sometimes impatient. She says when he cuts in a very obvious place it feels a bit like blackmail. She was concerned about scarring, but his skin heals easily so she has learnt to be relatively calm about it. Mary is much more worried that her son might kill himself. She says he obsesses about suicide and she has spent hours talking him down. He doesn’t like pain, so Mary and her husband try to convince him of the damage which can be caused by a suicide attempt which does not result in death. Mary doesn’t know how you can tell if someone is serious about killing themselves.
Mary worked part-time while caring for her mother for many years, and was looking forward to time for herself and her husband once their son had gone to university, so she sometimes feels angry and resentful that her son’s needs are dominating her life. She has spent the last four years dealing with this, and finds it very tiring.
There is a history of depression in several family members, so Mary thinks her son’s problems may have a strong genetic element.
Mary’s son has been reluctant to trust mental health professionals after an experience at university when he was put on a locked psychiatric ward under section. He completed a ten week CBT course, which Mary says wasn’t enough, and is on medication though he doesn’t respond to antidepressants. He had an unhappy experience with the complex needs service where he felt there was a betrayal of trust. Mary thinks that her son would have benefitted from intensive psychological treatment when his problems began, instead of a progression through the cheapest options. Mary says that although the mental health services have given them help and support, this takes the form of lots of assessment with very little actual treatment, and no advice on what to do about the self-harm, which is treated as just another symptom, or on how to discourage suicide. When Mary asked what she should do, she was told that if someone is going to kill themselves there’s nothing you can do to stop them.
Mary would have liked a group she could attend to learn techniques for handling distressed people. She has now discovered Rethink, a charity which runs courses like this, and has provided a volunteer mentor who visits their son once a week. The charity Mind has been helpful in providing information about benefits available for carers. It also runs local recreational classes which their son might attend. She has not used the internet to search for items on self-harm, but has picked up information from the radio and television. She would have liked a leaflet explaining how common self harm is, what you need to worry about and what you don’t, with advice on hygiene and avoiding infections.
Mary and her husband have supportive friends and neighbours, with whom they can talk about their son’s troubles. Mary thinks it is important not to stigmatise mental illness by keeping it secret. She was helped to get her son’s self-harming into perspective when she confided in a neighbour whose daughter had serious mental health problems. The neighbour approached this in a very practical way and acknowledged that there is little that parents can do to stop their children self-harming. Mary sees self-harming as a continuum from behaviours like biting one’s lip in frustration or anger, and deferring pain by pinching oneself.
Mary is resolutely optimistic about the future. Her son is one of those very intelligent people who are rather immature emotionally and find the transition to independent adulthood difficult. He is now cutting himself much less frequently, and she hopes that he will eventually grow out of it.
Mary’s message to clinicians is not to dismiss self-harm, but to give practical advice and reassurance to families who have to deal with it. She advises parents not to panic, especially if the self-harm is to relieve tension and not causing serious physical damage, but to continue talking to their child and reassuring them. Keep calm and carry on.