Self-harm, the Perils of a Stereotype by Charlotte When we think of the phrase ‘self-harm’ or ‘non-suicidal self-injury’ (NSSI), there is a stereotype that comes to mind, a single “type”, a small number of similar methods, each with the same outcome, scarring to arms (and occasionally elsewhere). This is not only the public’s perception, but what we are taught as healthcare professionals, and if not explicitly, it is certainly reinforced in practice. When I was working as an Health Care Professional, I had this stereotype in the forefront of my mind too. My role, whilst not a specialist, meant I saw a lot of patients in distress with their mental health. Those experiencing NSSI all appeared to fit nicely into this box, thus reinforcing that belief, that understanding, as to what self-harm was. I like to think I was open-minded, and I always strived to take any “harm” seriously, but I know, full well, I never actively explored any potential other methods when that stereotype didn’t fit. Then, with little warning, I became an expert by experience. One day, out of the blue, I suddenly had those intrusive thoughts, those urges, that need to harm myself, punish myself, in some way, and I was so underprepared for all that encompasses. I had no idea, no real comprehension or true understanding of the power intrusive thoughts to harm have over you, how controlling they can be and how nothing else will satisfy that need. I had no real idea that all and any attempts to ignore those urges, not to self-harm, means a building of distress to the point of being overwhelmed. I had no idea that NSSI could go beyond an expression of mental distress and can actually be a very valid way to keep safe, a way not to push that risk, that urge to harm oneself, to the point of life-threat. I learnt these lessons quickly. In my distress, I knew I had to act but was terrified of what that might mean, what others might say and the judgement that might come with it. I also was desperate to keep up appearances, not to let my mask slip, and that meant that any visual self-harm methods were out of the question; I needed something I could punish myself with that others wouldn’t see. Due to my physical chronic health conditions/disabilities, this wasn’t that hard a mission to complete. I have horrendous chronic pain that impacts my ability to function, so I worked out that doing anything I could to make that worse, would temporarily satisfy that need to harm. This led to exploration of further techniques, further ways to provoke symptoms and suffering, and quickly I had a range of self-harm methods causing me real pain, real harm, that other’s wouldn’t be able to see. Even better, they were hugely “normal” activities or actions and that means I can do them quickly and easily, in plain sight, without judgement or anyone stopping me. This was all very well and good, until I tried to reach out for help. Don’t get me wrong, I wasn’t naïve to the challenges of getting support for mental illness or injury, having supported others in crisis for years with my professional hat on, but I wasn’t prepared for the gaslighting and dismissal to come. As an undiagnosed (at the time) autistic, masking is my absolute normal and it took a lot of effort to confide in others about the harm I was causing myself, but somehow I did it. I took a deep breath and outlined, in detail, how I’d been harming myself on purpose for years, how I knew this was unhealthy, how it often stopped me acting on suicidal ideation, and how I desperately needed some help with these ever intrusive urges. I wanted help, I needed help, and I was lying myself bare, begging for help. I was fully expecting to be taken seriously, for the very real harm I was causing to be of concern, and was fully unprepared for their response of “but you are not cutting, are you?”. I didn’t know what to say, or how to react. I reiterated that no, I didn’t do that, but was harming myself in other ways, and was instantly dismissed. They made it abundantly clear that my NSSI methods were not of concern, were not deemed harmful and therefore I was not a risk. That immediate dismissal and disbelief of need, of suffering, was further compounded by the written assessment clearly documenting “not self-harming and no risk of doing so”, as well as stating that I wasn’t suicidal, neither of which were true. I didn’t know what to do or say. I tried to persevere, to keep seeking help, but each and every time I was told this wasn’t self-harm, either bluntly to my face or via the general dismissal of my needs. The more I pleaded, the more I needed urgent intervention, the more I was gaslighted and the more I was labelled as “manipulative” for trying. The more my clinical records reflected “no NSSI” and “no suicide risk”, the louder those urges became and the more I wanted, no needed, to “prove them wrong”; it became the overwhelming thought, need, and simply acted to fuel my ever increasing risk. I started thinking, believing, that no-one would ever listen until I was dead or seriously harmed in some way. I started to believe that I wasn’t doing real harm and, therefore, I needed to find ever riskier ways of satisfying that need to harm, to punish, to be believed. This is a problem that sadly continues to this day. As I sit here reflecting and writing this, I have to laugh (or cry) at the additional harm and trauma caused by the refusal to accept that NSSI comes in many forms and is individual to the person. I have to acknowledge the irony of the very real and ongoing harm done to my physical health and my mental health by further gaslighting and refusal to listen or believe, but I shouldn’t have to. I put my professional hat on and use that to say “I need help” and “I deserve help” and “I shouldn’t be treated like this”, but it is ever increasingly harder to believe. Perhaps I don’t? Perhaps I’m not really harming myself and am therefore just wasting everyone’s time? Perhaps I am the “manipulative” pathetic excuse of a human they keep telling me I am? Or perhaps, just perhaps, we need a real culture change in healthcare. Perhaps we need better education on the realities of self-harm and how it is actually anything that causes that individual person pain or distress. Perhaps we need more of us to speak out, and shout from the rooftops “just because you can’t see it, it doesn’t mean it isn’t doing me harm”. Perhaps we need professionals, of all backgrounds, to stop telling us our experiences don’t matter, or, more dangerously, haven’t actually happened. Perhaps we just need to be believed. So to anyone out there whose self-harm doesn’t fit that stereotype, I hear you, I see you, I believe you. No matter how you harm yourself, your suffering is real and valid. No matter what satisfies that urge, whether it can be seen or not, you deserve real help and support. You are not alone. And to all and any healthcare professionals, family or friends of people like me, please, just please, believe us and help us get the care we need.