A-Z

Liz

Age at interview: 52
Brief Outline: Liz’s middle daughter started cutting when she was 16. She later developed an eating disorder and took an overdose. Liz thinks it is important for parents to let their child know that they want to help and to find a way to communicate.
Background: Liz, 52, is a research assistant, married with three daughters. Ethnic background: White British.

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Liz thinks her daughter Jane (not her real name) had been cutting herself for about a year before Liz knew about it. When Liz realised what was happening she wanted to talk to Jane about it, but Jane was reluctant. They went to their GP, who referred them to PCAMHS (Primary Child and Adolescent Mental Health Service which offers brief support). Li remembers being incredibly anxious while waiting for Jane to be seen. One night Jane cut her thigh very deeply. Liz was shocked at the extent of the injury. She taped up the wound and took her to A&E. They eventually saw a doctor who sent them home as Jane had an appointment with PCAMHS in a few days’ time.

Jane did not harm herself in the last three weeks of her PCAMHS contact, so at the final session the therapist claimed that the behaviour had stopped. Liz was very unhappy about this as she thought the root of the problem had not come out and that Jane was still very distressed. She felt that the therapist did not listen to her when she told them this.

The next few months were a very anxious time as Liz was constantly watching for signs of self–cutting. Jane was ashamed of the behaviour, seeing it as a sign of failure, and was very secretive. Liz found this hard to understand as she had not reacted in a horrified way or implied any criticism. Liz feels you need to respect that teenagers like to be on their own in their bedroom but she found reasons to go in, which made Jane cross. Now Liz says that to preserve your own sanity you have to think ‘I’ve done all I can’ and wait until the child is ready to come and ask for help.

Jane then developed an eating disorder which became much more worrying than the cutting, and took a serious overdose. She phoned Childline and handed her mobile phone to Liz so the Childline person could tell Liz about the overdose because Jane felt too embarrassed to tell Liz herself. The Childline lady was ‘lovely’. Jane had phoned them two or three times before, which Liz was pleased about as it was a means of coping Jane had found for herself. They spent a ‘very long and very horrible’ night at the hospital. Liz was made to feel like a pest. A charge nurse suggested that Jane could send a blank text message to Liz if she was feeling low but couldn’t talk about it. Liz says ‘He gave us something that for the rest of the time she was ill, actually worked’. After the overdose Jane was admitted to an adolescent inpatient unit for about three weeks. Liz was pleased because they needed some time apart when Liz wasn’t going on at her about her eating. However, although staff knew she was at risk they allowed her to have needlework scissors which she cut herself with. Liz was deeply angry at this. 

Gradually Jane overcame her eating disorder with ‘fantastic help’ from the CAMHS (Child and Adolescent Mental Health Services) team. She went to study in London, but was very unhappy there and started cutting again. Liz saw a photo of her wearing a Tubigrip and suspected that something was wrong. Liz said she had learned a lot during the last few years, especially about picking the right moment to bring things up, so she waited until they were together to ask if Jane was cutting herself. She asked why Jane couldn’t have told her, and Jane said ‘Because I’ve failed you’. Liz thought this was so sad, because Jane hadn’t failed anyone, she was feeling rough and reverted to the one way she knew of coping. Jane’s GP referred her to a local service offering cognitive behavioural therapy. After this she was more able to talk to Liz when she felt low, and has not harmed herself since. 

Liz’s husband was shocked at first, and desperately sad that Jane felt so bad. He is now very protective of Jane. Both he and their younger daughter were angry at the disruption to family life, though this was more in relation to the eating disorder. Liz says the family communicate better than they would have done, and her three daughters have become much closer. 

Liz’s GP was very supportive, and the CAMHS team were excellent. Liz thought the PCAMHS system was unsatisfactory for longstanding problems because it only offered six sessions. She says it’s important to say if a relationship with a particular therapist isn’t working. It was helpful for her and her husband and youngest daughter to see the family therapist without Jane, so they could express anger in a safe environment. Liz did a lot of reading about self-harm, which she found useful. She would have liked to attend a group for parents of children who self-harm. 

Liz is guardedly positive about the future, though she thinks Jane is still vulnerable to any knock to her self-esteem. Liz says she has to trust Jane and let her go her own way, but knowing that she can come back without any threat of criticism or condemnation of her behaviour. 

Liz’s advice for professionals is to listen to parents. She advises other parents not to be critical, and not to show their shock or disgust, but to let their child know that they want to help them and find a way to communicate. She says ‘Don’t let the self-harm become the whole focus of your relationship. They’re still your child. What they are doing is an expression of something. It’s not them.’
 

Liz said her daughter hated herself and ‘defacing herself’ was the only way she could find to express that.

Liz said her daughter hated herself and ‘defacing herself’ was the only way she could find to express that.

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I think that, basically, was what her self-harm behaviour was about. It was she hated herself. She thoroughly hated herself and the only way she could find of expressing that was to deface herself, if you like.

So that’s it really. That’s her story, my story.

When it first started and was there any particular trigger to it do you think or how had she heard, I mean how would it become part of her thing that she could do?

It’s very difficult to say and I never really asked her. I never really asked her what started, at the very beginning, what started that behaviour, why. Her older sister, who also had an eating disorder and was also very depressed, said to me a long time later that she tried cutting herself. I don’t quite know what that means but that it didn’t do it for her. Those were her words. She said, “I tried it but it didn’t do anything for me.” So she didn’t get any of the positive reinforcement that clearly the other one was getting. My other daughter was was getting something from it, some stress release or some expression of anger or something she was getting from it. My youngest daughter also cut herself a little bit. She was aware of her older sister and whether there was some kind of, “I’m feeling angry. It obviously worked for her.” I don’t know. I don’t know what it was with her but the behaviour stopped much quicker. It never became entrenched in the way that my middle daughter’s behaviour became very clearly a way of her coping with distress and it didn’t with the other two. But I don’t know what started it. 
 

Liz can’t remember how she first knew her daughter was cutting herself, but when she started self-harming again Liz recognised the signs and could talk to her daughter about this.

Liz can’t remember how she first knew her daughter was cutting herself, but when she started self-harming again Liz recognised the signs and could talk to her daughter about this.

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Well, I can’t exactly remember when I first knew that she was self-harming actually because it it’s quite a secretive behaviour and I think it was happening for a long time before we knew.

Yes.

It was probably, I think, about a year after she started that it became obvious to us. She was then cutting herself and she was cutting the top of her thighs so we didn’t see it. She became quite secretive about getting dressed and undressed and, if we were on holiday, one year we were on holiday and I remember she… we go to Cornwall where it’s cold and she put her wetsuit on very quickly. So she was, she was hiding it.

She wasn’t public with it at all and I honestly can’t remember. It wasn’t a light bulb moment. It wasn’t a moment of great discovery. It was something that became obvious and that I felt I needed to talk to her about and she refused first of all.

I think that was really the turning point of her harming behaviour, except then it started again. She was treated for her eating disorder. She slowly recovered from her eating disorder. We had some fantastic, fantastic help from the CAMHS team and gradually, she got over it and she finished at school and she went off to London and was very unhappy and the behaviour that I thought had stopped, started again. And she, this time round, didn’t tell me but that was because she felt like a failure. It wasn’t because she was embarrassed of it because she was, by then, cutting herself on her arm so it was it was clear and she, we went to see her in London and I didn’t know. She had a long sleeved cardigan on. I didn’t think anything about it. She was telling me how unhappy she was and that she felt she needed help and I just didn’t think to probe about was she harming herself?

The next time I saw her, she’d got, in fact, no, I saw a photo of her that a friend had taken and I noticed on her wrists she had tubigrip and I thought, “Uh oh, I don’t like the look of that.” And, by this time, I’d learnt, I’d learnt a lot during the passage of these few years and it’s about picking your moment to bring things up. I didn’t jump in, which is what I would have done two years previously. I waited I waited until we were together. She was relaxed and I said, “Are you cutting yourself?” And she went, “Yeah.” And I said, “Could you have not told me?” And she went, “No.” And I think it was, well, I said, “Why why could you not have told me? With all that we’ve been through, why could you not have told me that you were doing it again?” She said, “Because I’ve failed you.”

How sad is that? How sad is that? And, of course, she hadn’t failed me. She hadn’t failed anyone. She was feeling rough and she reverted to the one way she knew of coping.
 

Liz describes her husband’s mixed reactions to his daughter’s self-harming and her eating disorder.

Liz describes her husband’s mixed reactions to his daughter’s self-harming and her eating disorder.

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And how about your husband? How did he react?

A whole variety of emotions, as you would expect. Initially, completely and utterly shocked. Totally, I mean literal shock. The cutting made him very sad because, obviously, it was leaving scars and to him, it was his beautiful girl. The overdose made him incredibly, incredibly desperate that she should feel that desperate. Anger, definite, definite periods of anger, as we’ve all felt I think. Probably me less so. I think I’ve felt the least, in fact, I don’t think I’ve really felt angry, if I’m honest. I don’t think I’ve felt angry. He has felt periods of extreme anger on how it’s affected our lives but, then again, this is all wrapped up with the eating disorder, which actually in practical terms, affected our life much more because on a day to day basis an eating disorder affects your life tremendously. Self-harm probably less so. I think he feels incredibly protective of her now.

To his relationship with her I think. So yeah, and shock that he, he thinks he’s produced these three beautiful girls and he can’t understand why they feel so awful, enough to not eat and to harm themselves. And it is hard to understand I think. I think it is hard to understand really, the behaviour.
 

Although there were mixed reactions to self-harm, Liz’s family became closer and communicated better.

Although there were mixed reactions to self-harm, Liz’s family became closer and communicated better.

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So the effect of the self-harm, [sighs] it’s very difficult to say. Certainly, it’s made her younger sister, she’s had periods of extreme anger, extreme anger both with how her sister was and why she felt that it was okay to behave that way. 

And periods of extreme insecurity when she first moved away to London, the one that was left at home was saying, “How do you know she’s okay? How do you know she’s going, is she going to be okay and shouldn’t you be ringing her every day?” And a completely over the top reaction. Normally, I’m sure, when a sister, one goes to university it’s like, “Yes, I I’m at home on my own and how great is that.” But very insecure. I think, if there are any positives to come out of it, which I think you have to look for some kind of positive, we all communicate very much better than I think perhaps we would have done, considering we’re only, we’ve still got a teenager and we’re only just moving through the teenage years, which are notoriously difficult and notoriously turbulent, particularly, I think, I only know about girls, but particularly with girls very turbulent. And I think, coming through all of it there’s, there has emerged a closeness, particularly oddly between the three siblings. They and maybe it would have happened anyway. How do you know? How do you know how they’d have ended up but they are very, very close now.
 

Liz’s family now communicate better and her daughters are closer.

Liz’s family now communicate better and her daughters are closer.

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I think, if there are any positives to come out of it, which I think you have to look for some kind of positive, we all communicate very much better than I think perhaps we would have done, considering we’re only, we’ve still got a teenager and we’re only just moving through the teenage years, which are notoriously difficult and notoriously turbulent, particularly, I think, I only know about girls, but particularly with girls very turbulent. And I think, coming through all of it there’s, there has emerged a closeness, particularly oddly between the three siblings. They and maybe it would have happened anyway. How do you know? How do you know how they’d have ended up but they are very, very close now.
 

Liz felt ashamed that she couldn't help her daughter more.

Liz felt ashamed that she couldn't help her daughter more.

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Within the wider circle of friends I have to say, if I’m honest with myself, there is an element of shame because it’s like I, it’s almost like a weakness. Why could I not help her more? Why did she have to do that? Why could I not?

And I’m sure they wouldn’t think that but that’s how I think they would think. So yeah, close circle of friends, yes, but not very many.
 

Liz felt her daughter should have been on a children’s ward. Liz had a ‘thoroughly unpleasant time’ but a ‘lovely’ charge nurse was extremely helpful.

Liz felt her daughter should have been on a children’s ward. Liz had a ‘thoroughly unpleasant time’ but a ‘lovely’ charge nurse was extremely helpful.

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So both of us went, my husband and I and her and then began a very long and very horrible night at the hospital. Because she’d told me fairly quickly that there was a delay before they could take blood tests or anything because she told me within probably half an hour of taking them. So we went up and they put her in a bed. At this point, she was, her eating disorder was probably at its worst. She was terribly thin. Her heart rate was terribly low. The monitor kept going off and all they kept doing was coming in and turning it off.

It was just a thoroughly unpleasant time. We were then transferred to what was called then the clinical decision unit. She was seventeen at the time I think. It think she was seventeen so she was young to be on what was really an adult ward and they were still waiting, they’d taken the bloods and then they were waiting for the blood results to come and she just curled up on her side, faced away from me and I don’t I don’t know if she slept or not. I don’t think she was asleep because there was so much noise going on. There was a woman with very, very bad dementia in the bed opposite and she was ranting and raving. They had to put the bed sides up and it went on for about two hours. I was sitting in the chair beside her. I was never offered a drink. I was never offered anything. Of course, my husband had gone home to deal with my other daughter so I just sat feeling not entirely welcome. Feeling not really part of the equation at all, I have to say. It it was, I felt we were in the wrong place. I felt she was too young to be in that environment, very distressing, this woman with dementia. 

And, eventually, I went to the nurses and said, “Look, I don’t want to be a pain but either we’ve got to be moved or she’s got to be moved because it’s very upsetting.” And, in fact, then the doctors came along and sedated her and it was it was all right but it was, I felt that we were in the wrong place then. I couldn’t understand why we weren’t on a ward for young people. I wasn’t it wasn’t entirely made clear to me what was happening. I had to keep asking what was happening and I felt I was being a pest.

And [my daughter] was just disengaged with the whole thing. She was lying on her side, facing away from me, completely just disengaged with everything. And that night, I’m talking a lot about that night because it was very, it’s, it was the lowest, I think the lowest of the low really. But then they said we needed to wait for an assessment. It was the weekend as well so we needed to wait for an assessment and we waited and we waited. I don’t think she cared where she was. I don’t think she didn’t really care. She didn’t really care about much so I waited and I waited and a lovely, lovely charge nurse came on the ward, when everybody was having breakfast and, of course, she didn’t want any because she was full of her eating disorder and definitely, that was not on the cards. No attempt was made to encourage her or to help her or to find anything she maybe could have eaten that, people with eating disorders have very strict rules with themselves about what they will allow themselves to eat and when and nobody came and said, “Would you try this or would you try a yoghurt or whatever?” But this lovely charge nurse came on and he sat on the bed and he had time to talk to her. He, well, he made time. He made time to talk to her and me and he was just gently, he was the first person that had actually talked to us about something that wasn’t medical. He was, he was not a psychiatrist. He was a nurse and he said, it, you know, did she think there was anything she could have done to alert me that that was how rough she was feeling? And because, I don’t know whether it was because he was somebody she’d not seen before or whether it was his manner, she talked to him and she said, that she was in a such a bad place, she couldn’t talk about it and he said, he was once looking after a little boy who felt very sad and very low sometimes and he couldn’t tell his mum. He was much younger, this little boy apparently and what they had was a special teddy and when he wanted to tell his mum that he was feeling rubbish, he would appear holding the teddy and she knew not to ask questions, not to try and discover what it was, but just to distract, to sit, to cuddle, to put the telly on, to do something. And he said, “Do you think you, you and your mum could work out some kind of way that she, you could tell her so that she knows not to ask. You don’t want to talk about it but just that you’re feeling really rough.” And we didn’t then but subsequently, we talked about that same thing and we worked out that if she sent me a blank text, I knew that she was feeling rubbish.

She didn’t need to say anything in the text, but a blank text and I knew that she needed some company or that she needed a cuddle or she needed distracting and it worked. That one lovely charge nurse, who was not a psychiatrist, he was not a psychiatric nurse, he gave us something that for the rest of the time that she was ill actually worked.
 

Liz thought ‘the root of the problem had not come out’ when her daughter was discharged after six sessions with a mental health team providing short term treatment.

Liz thought ‘the root of the problem had not come out’ when her daughter was discharged after six sessions with a mental health team providing short term treatment.

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When she first was seen by PCAMHS [Primary care Child and Adolescent Mental Health Service], she was referred to them by the GP. There was a little delay. I remember being incredibly anxious during the time when I knew she was cutting herself and before she was seeing anyone. It was it was a time for me when it was it was a very anxious time because we weren’t talking about anything.

We weren’t talking about her behaviour at all but I knew that she was doing it and she was seen by PCAMHS. They have an assessment session and then six sessions and she, during the time that she was being seen by PCAMHS, she cut herself, to our knowledge, two or three times but then in the last three the last three weeks, therefore, the last three sessions, she didn’t cut herself at all. So when it came to time for her review from PCAMHS they said, you know, “We think this behaviour has stopped. We’ve managed to talk about it and stop this behaviour.” And I felt very unhappy about it because I knew that [my daughter] was still very unhappy. I keep saying that.

Yes, say, “My daughter.”

Yeah, I knew she was very unhappy and I felt that all that had, it was a sticking plaster on on what was going on. It was it was not.

The root of the problem had not come out. But they seemed happy and they said, “If you have any more problems go back to your GP.” 
 

Liz was angry that her daughter was allowed a pair of scissors when staff knew she was at risk of self-harm.

Liz was angry that her daughter was allowed a pair of scissors when staff knew she was at risk of self-harm.

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And, while she was in the adolescent inpatient unit, she still managed to cut herself. They knew that she was a self-harm risk and they allowed her scissors because she was doing cross-stitch and she did a lot of cross-stitch at that time to try and relax and to distract and they allowed her scissors and she cut herself. Not very badly but, when she first went in she was on twenty four hour watch, so we went from being on twenty four hour watch with somebody outside her room to being allowed a pair of scissors and I was deeply, deeply angry about that. Because, obviously I was looking for someone to blame and I thought I could have done a better job quite honestly. At the very least, I wouldn’t have allowed her a pair of scissors.
 

Liz found family therapy very valuable as it provided a safe place to express anger.

Liz found family therapy very valuable as it provided a safe place to express anger.

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I think, when she was very ill, I think it was very helpful to have a situation where we could see the family therapist without her and we actually, probably could have done with more of that. We saw them with her as well but certainly my husband found those sessions very, very valuable because he was he was angry and I was making him sit on that anger because I didn’t want him reflecting it back to her. So I was containing it very much and he needed somewhere where he could express that anger safely and I think that that was very, very useful to him that that environment.

And also her younger sister, similarly, she, it was particularly useful with the anger because the anger, I was terrified always of it being reflected back to my daughter and affecting her adversely so I was very, I felt like I was spent my whole time containing this anger from both of them and there was somewhere they could let it out there, which was very useful.
 

Liz hopes her daughter is ‘building up an armoury of things she can do rather than harm herself’.

Liz hopes her daughter is ‘building up an armoury of things she can do rather than harm herself’.

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And how do you see the future?

Well, guardedly positive. I, and particularly with the middle daughter, I am aware that there is definitely always going to be a chink in the armour and it’s a weak point. Everybody has a weak point. Everybody has an Achilles’ heel and I think she still needs work on self-esteem. She’s still doing work on her self-esteem. 

I’m not sure. I’m not sure. I I’ve got to try and stop asking her if she’s all right because I don’t think that’s terribly useful and terribly helpful but I can’t help myself doing it and I’ve apologised to her. I said, you know, “You must understand that I feel very vulnerable.” She’s, at the moment, working in another country, which makes me feel doubly vulnerable but you’ve got to trust. You’ve, she’s got to go her way and she’s just got to know that she can come back if she needs to with no threat of criticism or condemnation to a behaviour that, actually, some people, they never did drugs that. You know, some people have different crutches.

This this maybe, unless she can deal with it better, it may be something that she resorts to. I hope she’s building up an armoury and that’s the way we’ve looked at it for her, building up an armoury of things that she can do rather than harm herself. So yeah, guardedly positive I think is how I’d see the future.
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