Age at interview: 43
Brief Outline: Tam was born in the USA but now lives in the UK with her second husband and their son. Her 14 year old daughter started cutting herself while living with her father in the US, but came to live with Tam 4 months ago. Tam is going to access self-harm services through her GP.
Background: Tam is 43, married with four daughters aged 20, 20 (twins), 17 and 14, and a one-year old son. She works as a healthcare research contracts administrator. Ethnic background: White.

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Tam is not sure when her 14 year-old daughter started self-harming, as she was living with her father and stepmother in America, visiting Tam in the UK over the summer vacations. She was treated with antidepressants by an American psychiatrist, who Tam met once. Four months ago her daughter came to live with Tam. Her cutting became worse after her step-brother harassed her over the internet. Tam suspects that he may have abused her sexually, but is waiting until her daughter feels able to talk about this. She has told her daughter to block his internet contact.

Tam’s daughter cuts herself all over her body. Tam is frustrated that there’s nothing you can do to stop someone harming themselves. She checks her daughter’s room and school bag for pencil sharpener blades, and only gives her enough money to buy her lunch, but if she doesn’t have a blade her daughter hurts herself by picking off the scabs. Tam doesn’t think that most girls who self-harm are trying to kill themselves, but that they are trying to get help and to relieve their own pain and suffering.

Self-harm is very prevalent at the all-girls school her daughter attends. Tam’s daughter has started seeing the school counsellor for an hour a week and seems to be enjoying this. Tam thinks the teachers are aware of the extent of self-harm in the school but see it as a way of coping with pain or depression, in contrast with the American school where her daughter’s self-harm was seen as attempted suicide, her father was called in and she was encouraged to stay away from school. 

Tam’s eldest daughters are twins. One of them suffered from anorexia in her early teens and began cutting herself after an accident when she was 12. Tam was shocked when she found out about this as she knew nothing about self-harm, but was less shocked when her youngest daughter started, though she still doesn’t really understand the behaviour. Her daughters have said that self-harming helps them control emotional pain. The twin still self-harms occasionally, and was upset to hear that her youngest sister was cutting herself.

Tam’s ex-husband has Seasonal Affective Disorder. He, one of the twins and the youngest daughter are all very alike, finding it difficult to express their feelings. Tam thinks her daughter’s depression is probably hereditary. Tam and her other daughters are much more outgoing.

Tam thinks her daughter’s father treated the self-harm as an embarrassment, but Tam tells her daughter how much she loves her, and tries to get her to understand that she is beautiful and that she will later regret having scars. She says it’s important to listen to her daughter, as she has always been introverted and very quiet. Tam was pleased recently that her daughter was able to yell at her. She says that she was very permissive with the twins, and is trying to be more ‘middle ground’ with her youngest daughter. Tam finds it hard to spend quality time with her daughter as well as coping with her baby son, her husband and full time work. She thinks her husband doesn’t really understand teenage girls and he sometimes believes her daughter is a bit melodramatic.

Tam has tried to find out more about self-harm by looking at websites. One helpful site is TESS (Text and Email Support Service), run by the Bristol Crisis Service for Women. Tam has just moved house, and her daughter, who seems happier in her new home, has an appointment with the GP in their new neighbourhood. Tam has supportive friends who are psychiatrists, who have assured her that there are good services for young people in the UK. She says of her meeting with the psychiatrist in America, that she would be outraged if the psychiatrist had known that her daughter was being abused and had not told her about it. She would like to meet other parents and find out how they cope with self-harm. She suggested in a school questionnaire that she would like more information sent home about ‘typical teenage girl’ things.

Tam hasn’t had much contact with clinicians so far, but suggests that there should be information about subjects like self-harming and eating disorders in waiting rooms. Her advice for other parents is don’t give up hope, and don’t take the self-harm personally, but ask what you can do to help your child. 

Tam was pleased that her daughter felt brave enough to express her emotions when she got her to talk about her self-harm. Her daughter said she hadn’t wanted to worry her mother.

Tam was pleased that her daughter felt brave enough to express her emotions when she got her to talk about her self-harm. Her daughter said she hadn’t wanted to worry her mother.

I try to get her to talk to me and, actually, about two or three weeks ago she actually yelled back at me and she was crying and we were, you know, I was holding her and I was just telling her, you know, “I love you and I’m not sending you back [to live with her father in America] and you’re staying here and so, you know, if you’re doing this to try to, you know, whatever, get us not to love you or something.” Because she, a lot of the times when I find out about it, she says, “I don’t want to worry you. I don’t want to tell you because I don’t want to worry you and I don’t want you worrying again.”

So I try to tell her, “Well, we’re your parents and that’s our job is to worry [laughs]. When we have, when you have a child, you decide you’re going to worry for the rest of your life about these people.” And so I try to tell her that, just tell her, you know, “Doesn’t matter what you do, I’m still going to love you and so, you know, I.” But I, what I try to tell her is that it makes me angry she does it because she’s a wonderful person and she shouldn’t be hurting herself. So, because I think her dad treated it more like it’s an embarrassment to him.

So I don’t treat it like that because it’s not an embarrassment to me but I try to tell her, you know, “You’re beautiful and eventually, you’re not going to like these marks. And, you know, it’s going to cause scars for the rest of your life and so you’re going to have to live with these and in ten years, you know, when you’re an adult, you’re really aren’t going to be happy with this, you know.” So just to try to get her to understand she’s she, you know, she’s beautiful and that she’s like defacing, you know, this beautiful body. 

But after she yelled at me I noticed on her Facebook that she had put, she yelled at someone for the first time in her life and that was her response on there and it was a positive thing and I liked it [laughs] and I thought, well, good because I think her whole life she’s been the youngest of four and I think she’s always been very introverted. She’s been very introverted and I think it’s very hard. 

Tam contrasts the attitude of teachers in the UK and America towards self-harm.

Tam contrasts the attitude of teachers in the UK and America towards self-harm.

She goes to a really good school and I know they have counsellors there but she says they’re not very good. I think the big difference is, is that the school she goes to apparently a lot of the girls do it. It’s very prevalent and I think a lot of the teachers know about it and I think they don’t treat it as the big deal that it was treated in America because I think in America it’s more seen as trying to kill oneself. Whereas here, I think it’s seen as trying to cope with pain or depression or.

So it’s different. 
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