A student shares her story
Confused and distressed during a traumatic period aged nine, one evening I accidentally injured my foot. As I felt physical pain, I realised that I hadn't been focusing on my emotional pain. And so I started to self-injure. Naively, I thought I was the only person to think like this.
This cycle of behaviour would entrap and ensnare me in shame for the next 17 years. It would hurt those around me as well as myself, and hold me captive (2 Timothy 2:26), preventing me from accepting Christ's forgiveness.
As I tried desperately to hide these shameful acts, the adversary enticed me into a hideous tangle of secrets and lies, as I tried to justify my behaviour to myself. I pretended it was something God could overlook. I refused to ask people for forgiveness when my behaviours affected them too.
I didn't fully own up to the issues, so never felt truly forgiven. I thought they (God or others) can forgive me so much, but if they knew exactly how far I'd gone, they wouldn't be able to really forgive me. So I continued trapped by thoughts and behaviours, never knowing how freeing it is to feel fully forgiven.
how and why I self-harmed
What I did depended on what I had access to (or could hide). Cutting, burning, scalding, biting, rubbing bleach into wounds, and overdoses. I did it predominantly for release when I felt overwhelmed by emotions; it was a means to an end to get me out of that. Sometimes it was an escape from hallucinations, or sleeplessness. I knew if I overdosed, I would not think or feel much. I was so exhausted by my emotional turmoil (to the point of feeling suicidal) that an overdose was a final effort to try to stave off a suicide attempt by giving me some release. I didn't care whether I did permanent harm to myself - it was a desperate survival technique.
I have had (and continue to have) complex and enduring mental health problems from a young age. Sometimes I've been well enough to work with children with special needs, or as a physio assistant, and to do nurse training; at other times I've been consumed with depression and hallucinations with extended periods in psychiatric hospitals.
My primary diagnosis is bipolar affective disorder with post-traumatic stress disorder. I used to be upset when doctors disagreed on my diagnosis and how best to treat me. But now I take a more rounded view; I am a person who struggles with mental health issues, not just a label. Recovery is about changing negative attitudes and behaviours, accepting what I can't change at the moment, and functioning as best I can, as I try to put Christ at the centre of all I do.
I'm learning to put God's attitudes towards my thoughts and behaviours higher in my mind than those others, which vary widely. Some nurses, doctors and therapists have gone 'above and beyond the call of duty' to care for me. Others have been hostile and cynical - particularly when I have had to attend A&E with more severe self-harm, and have been called a liar because they can't appreciate that I don't always remember what has happened, and frequently been referred to as a 'time waster'.
on the other side of the fence
Working in the NHS presents its own challenges. Though I don't want to have secrets or lies, it isn't always wise to talk with colleagues, and I haven't always discerned well when and how to do so.
Some scars can't be hidden with a 'bare below the elbow' uniform policy, meaning that both patients and colleagues may make their own assumptions. I have to be careful not to worry about what other people think of me and remind myself how God views me.
So, what made me stop self-harming after 17 years of being trapped in a vicious cycle? I have been under eleven different psychologists and psychotherapists, and been advised about relapse planning, and distraction techniques. Some of these have had short term benefits, but none addressed my underlying thought processes deeply enough.
It wasn't until a close sister in Christ rebuked me (not for the first time), that the Spirit really worked in me to make me realise that self-harm is actually a sin in God's eyes. For years I had seen it as part of my illnesses. The Spirit made me realise that it is my choice whether I dwell on my thoughts. That was a very difficult thing for me to hear, because seeing them as part of an illness made me an innocent victim in my eyes, rather than a human accountable for my actions before God.
But praise God that he was powerful enough to free me from this trap. It took five more months to completely break free. When ill again last year I had the odd episode or two, but praise God I did not fall back into the deliberate self-harm (DSH) cycle again.
Knowing Scripture is a massive weapon in the battle against self-harm. Both my grandma and church encouraged my to memorise Scripture. This has been so helpful when I've been too ill to read the Bible due to poor concentration, or when I have been an inpatient. Sometimes non- Christian staff have claimed that I have been having 'religious delusions', but I have been able to back up my faith directly with verses from the Bible (itself a witness to the staff). Though traumatic, my inpatient admissions have presented opportunities to do Bible studies with women from a variety of backgrounds (including Jewish, Jehovah's witnesses, and Rastafarian) who I would probably never have come into contact with otherwise.
A particular verse which I frequently call to mind when tempted in a variety of ways, is Colossians 1:21-23:
'And you, who once were alienated and hostile in mind, doing evil deeds, he has now reconciled in his body of flesh by his death, in order to present you holy and blameless and above reproach before him', if indeed you continue in the faith, stable and steadfast, not shifting from the hope of the gospel that you heard, which has been proclaimed in all creation under heaven' (ESV)
I frequently feel worthless and evil, but these verses clearly state that because of Christ's sacrifice I am now holy, blameless and above reproach before God - what an amazing truth!
Other helpful scriptures include those speaking of refining like silver and gold (Isaiah 43, Malachi 3). I studied silversmithing and metalwork at night school. To refine silver, it needs to be held in the hottest part of the flame until all the impurities are burned away. The refiner knows that it is pure only when he sees his reflection in the silver. Christ has put me through many fiery trials, but it is only recently that I am starting to see the tiniest bit of his reflection appearing in my life.
'No temptation has overtaken you that is not common to man' (1 Corinthians 10:13, ESV). I need to remind myself of this amazing truth every time things get tough. I know that Christ has overcome darkness in the world and individuals (John 1:5; 1 Thessalonians 5:5). God's grace is amazing (Ephesians 2:8; Hebrews 4:16; 1 John 1:9), and we have assurance that '...suffering produces perseverance; perseverance, character; and character, hope. And hope does not put us to shame...' (Romans 5:3-4).
Many Psalms reassure me that I am not the only person who has felt this bad, and that God is always there, rescuing and comforting his flock (Psalms 34:18, 40:2, 42:5, 51:16-17).
A scripturally-based paragraph from the 'Lysamena project on self-injury' website, reminds me that self-injury is a symptom of relying on myself to deal with my problems; of leaving God out of the picture. Yet he offers me a better escape - under the shadow of his wings (Psalm 91:4).
a massive step forward
The August 2015 CMF summer camp was really encouraging for me. The theme was working with vulnerable patient groups, responding to Christ's words: 'I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me' (Matthew 25:26, ESV).
I'm now training to be a mental health peer support worker, so the camp helped me think practically about how to be Christ's hands and lips with the service users I will be working with. It was a reminder and encouragement to pray for each one of my service users, whether they are at the sowing, reaping or harvesting phase when it comes to acceptance of the gospel. Key ideas in peer support are to encourage the service user to have 'hope', become more 'resilient' and to view their 'recovery as a journey'. I pray that this will bring opportunities to help service users think about where their hope lies and what that means for them.
The camp also helped me realise that I can now face some of my former triggers. The one time I became slightly distressed, my first response was actually to discreetly go somewhere quiet to pray, breathe and recoup. Not once did I want a blade, nor did I automatically dissociate, or go straight to other people for comfort. I turned to God first, and that is a massive step forward in my life.
We are grateful to the author for such a frank, honest and challenging account of her illness. The medical profession often doesn't handle selfharm well; I hope these words help our response to be compassionate, understanding, and loving.
Self-harm is common. Exact figures are understandably hard to come by; some suggestions are as high as one in twelve teenagers. A recent Student BMJ survey confirms that medical students often have significant concerns about their own mental health; we should all remember that studying medicine does not confer immunity from any illness, physical or mental. Self-harm is of course a widely recognised symptom of a number a psychiatric problems, and has its own set of ICD10 codes.
In my own clinical experience, there is often a cycle of negative thought and behaviour which can self-perpetuate, and is often difficult to manage. For this author, the witness of other believers was powerful in breaking that cycle; but this witness was rooted in the certainty of Jesus' promises of grace and forgiveness. Although we think of self-harm in a medical context, we might be just as likely to be dealing with it in a friend, or even ourselves. We'd strongly encourage anyone struggling with these problems to seek help from their GP, as well as within church if possible. The BMA also has a list of resources for doctors in difficulty. Another resource we'd recommend is CCEF's 'Self- Injury: When Pain Feels Good'.
We hope this article encourages you to think carefully about how you deal with self-harming patients. Of course, we must ensure that we do appropriate medical and psychological assessments and offer treatment; we hope these words have reminded you to think about spiritual elements as well, and to pray for insight and appropriate words to use when helping such patients.
Lysamena looks at the gospel, Bible teaching about self-harm, and practical and spiritual ways to help break free from the vicious cycle.
Sidran has clear, easily accessible information on dissociation and dissociative disorders, useful for medics and patients. In my experience, dissociation is often the most misunderstood part of my illness.
Lastly, I would encourage you to be gentle with anyone who self-harms (this may include yourself!). Yes, there may need to be times of rebuke, but there also needs to be much support, love, encouragement, and reminding of the gospel. Remind them that God has a better way to deal with suffering than through DSH, and of the price he paid to ransom them from captivity to their thoughts and behaviours.
Stopping is not at all easy, but it is possible in Christ.