Kharre's SI coping tips

This is a collection of extremely useful ideas about how to deal with the urge to self harm. They were originally posted to the bodies-under-siege list and are used by permission of the [1]author. All of them are great, but the section on [2]how to react to a loved one who self-injures is fantastic, probably the best advice I've seen that's directed toward family and friends of self-injurers.

Contents

[INLINE] First: People SI for many different reasons. In my particular case I SI to deal with severe stress and pain, and to express emotions that overwhelm me. Also, when I first began trying to stop I found that there were two different motivators for my cutting. One was that I felt I needed to, but the other was because I wanted to.

When I feel I need to cut I ask myself the following questions:

1. Why do I feel I need to hurt myself? What has brought me to this point?
2. Have I been here before? What did I do to deal with it? How did I feel then?
3. What I have done to ease this discomfort so far? What else can I do that won't hurt me?
4. How do I feel right now?
5. How will I feel when I am hurting myself?
6. How will I feel after hurting myself? How will I feel tomorrow morning?
7. Can I avoid this stressor, or deal with it better in the future?
8. Do I need to hurt myself?

The questions differ a little bit every time, but I will not cut if I cannot answer them. At first I would write them down, but now I run through them in my head. The most important questions on the list are #'s 4 to 6. In the beginning I would give myself little half-assed answers, but as each month passed my answers to myself became more detailed and I began to learn things about myself. I also found out that I can lessen or avoid stress, rather than running blindly into it. It also used to be that #8's answer was always 'yes', but now it is way more often a 'no'.

What this exercise is doing is helping me learn how to identify my emotions and stressors, which is a very important part for me, because those are the things that drive me to SI.

Realistic Acceptance

I did two things that ended up being VERY important.

First, I accepted cutting as a good thing. It helped me deal with things I otherwise could not deal with. It gave me a fast and easy release valve anytime that I needed one. It allowed me to swim where I would have once drowned. (I primarily did this because SI is a never-ending circle. I would cut and then I would feel like I was bad. The guilt and shame was incredible, and I would cut again to ease the guilt - I was continuing the circle.)

Second, I acknowledged it as a harmful behaviour. I do not say "I want to cut" anymore. I say "I want to hurt myself".

Understand the difference?

I sometimes want to cut, but I don't ever want to hurt. By replacing the rather impersonal word "cut" with "hurt" my mind was forced to acknowledge this as a harmful behaviour.

We say "cut the Turkey", not "hurt the Turkey", and I was implying that I was an unfeeling thing to be carved up.

I AM NOT JUST CUTTING MY FLESH - I AM HURTING MYSELF.

A letter to SI

I wrote a letter that went something like this.... (I'll write another because I have found that it helps me to write these occasionally):

Dear Cutting,
Thank you for being such a great friend.
Thank you for always being there for me.
Thank you for helping me out when I couldn't continue on my own...

I'm sorry, though, because I don't need you anymore, Cutting. I don't want this type of help that you give me. I don't want to hide in a dark bathroom anymore while people are outside laughing. I want to be one of the ones who laugh.

I don't have the time to give to you anymore, and you are too greedy, you keep wanting more and more time.

I am all grown up now, and yet you make me feel like a frightened little child. Swimming through tidal waves isn't good enough for me anymore, I want to learn how to fly.

See, I have discovered that you're not just an anti-anxiety pill...I have discovered that you are also a very dangerous one. You are eating away my insides, taking away what little control that I have, and I can't afford to lose anything more that belongs to me.

I don't need what you give me, because what you are taking away from me is even more important to me.

Things that help me to avoid hurting myself

  • I jump on the computer and find someone to email. We talk about everything and anything, and I try to avoid mentioning self-injury.
  • I do productive things that keep me busy and active. I clean the back porch, a closet, or mop the floors.
  • I walk a lot, and think.
  • I write about self-injury. (Like now.) I write about my failures and successes both and it helps, if anything, just to keep me busy.
  • A great tip a friend gave me: TREAT YOURSELF NICE, EVEN IF YOU FEEL YOU DON'T DESERVE IT! Once someone told me that her therp had suggested doing something nice for herself after SI'ing. So I tried it. I cut one night, and then afterwards I took a bubble bath, and took a cup of hot chocolate and a good book to bed early. It really did help. And then one day.....I thought......If doing something nice for myself after self-injuring makes me feel better, then maybe it would help if I did something nice as a treat for NOT cutting. It makes sense to baby ourselves when we feel bad after hurting ourselves, so doesn't it also make sense that it would help to do it before we cut when we are feeling our worst? So when the cutting urge is strong, I try doing something I like. Visiting my mom, painting, reading, bubble bath in the dark with music playing. My gift to myself for not cutting. It doesn't work all the time, but it does work a lot.
  • Make an emergency box. Suggestions on what to include:
    • Crayons, or paint, and paper.
    • Little toys (happy meal toys) that you like.
    • A puzzle.
    • A word game book.
    • Your favourite book.
    • A tape of your favourite songs.
    • Pictures of friends.
    • Letters that are special to you (or cards).
    • A book or tape of inspirational messages.
    • A list of phone numbers and addresses of friends. (Make phone calls, or write letters.)
    • Stories about your special memories.
    Only open your emergency box in an emergency, or it loses it special-ness. About once every two or three months entirely change the contents. Have an SO or a friend, or your child pick something special to put into the box while you're not looking so that there will be a surprise for you when you do have to open it.
  • Are you sure you're going to self-injure?
Has it taken over your thoughts like it does with so many of us? Can you picture it in your mind? Can you see yourself self-injuring? Imagine every step of the way? When I want to cut I can see it all in my mind. Many of us can. You have to get it OUT!!!! So start writing!!!! Write it all out. Be very descriptive, describe every little step. Only do this when you feel you are SURE you will be hurting yourself, otherwise you may trigger yourself into doing it when you don't want to. Go back and read it again. Get another piece of paper, and write it all over again, only this time leave out the vivid physical description, and instead write only about emotions. Begins sentences with: "I feel....", "I want to feel.....", "I don't feel.....", "when I _____, I feel...". This may release the tension (having someone else actually read it sometimes helps, if you need to you can send it my way, or take it into your therp's office). It may just emotionally exhaust you so that you don't have the energy to hurt yourself. And if it doesn't work you have a written record of your emotions that you can look back on later that really could help you get a better insight into your self-injury. The key is to learn how to identify your emotions, triggers, and stressors, so that you can learn how to better deal with them in the future, or how to avoid or lessen them. Allow yourself to hurt and to be angry and to feel guilt, but also remember that you have to learn how to deal with these things and how to ease them.

Important:

Every one of us is different. We all SI for different reasons and in different ways. If none of these suggestions work for you, then don't give up. Change them. Try something totally different, or do the same things in unusual ways. Individualise your coping methods. Tailor them so they fit you snuggly and comfortable.

Maybe instead of writing you can use a tape recorder.

Or instead of doing something nice for yourself, do something for someone else. There are many ways for us to heal, and not everything that works for someone else works for us.

Don't give up. Keep trying, and remember to try each thing you think of more than once, because it takes time to get used to new habits and get rid of the old.

And no one is perfect, but if you can go three days, or eight, or thirty without SI'ing, then remember that you may have SI'ed, but you went without it for a time. Every bit of progress is great, but too often we don't recognise it as a forward motion. The fact that you went 8 days without SI'ing is much more important than the fact that you did end up hurting yourself.

The three things that help me not to cut the most:

1. Wearing long sleeves. See, I rub at my scars a lot, and sometimes looking at them makes me want to cut. I have problems bathing when I am in a cutting mood, because it means I have to see the cuts. I have found that keeping them covered, even at night, helps me avoid cutting.

2. Writing about self injury helps me. Either writing about it, or writing out coping methods (like now). It doesn't really bring any special awareness, but it does keep me busy, especially mentally.

3. Pure luck.

Things that friends and family can do to understand self-injury better, and to help a self-injurer

"Hi, how are you today? Did you cut last night?"
Please, please. I reserve this question for my husband and counselor only, and I don't want to hear it from anyone else. The truth is, if you already know your friend SI's, then if your friend ever wanted to talk about it s/he would try to approach you about it. If you sense that your friend needs to talk then ask questions. Through asking questions we can learn, grow, and maybe understand.

"How are you today?"
"How was your night?"
"How are you feeling?"
Don't treat the self-injury as anything special. It is a part of your friend, just like your nail biting habit is a part of you, and s/he already has a million people trying to tell them how awful self-injury is. On the other hand, you don't want to encourage it either.

What do you do about the neighbour's habit of chewing her lip? Your Uncle Bill's habit of tugging his moustache?
You ignore, sometimes you kindly say "don't do that". You don't preach on them, though.

Here is the number one tip if you have a friend or family member who self-injures:

Emotions.
There it is. Always remember it. Emotions.

Me: "I blew it. I hadn't cut in 14 days, and I cut really bad last night."
Someone: "That's okay. Next time won't be so bad." NO. We are creatures of sub-consciousness, and the above comment leads us to believe that there will be a next time, and it terribly undermines the fact that I went 14 days without cutting.

Me: "I blew it. I went 14 days, but cut last night."
Someone: "How bad did you cut? Are you okay? Does it need stitches? While it is okay to be concerned I would wait on questions like this. Wait until s/he feels comfortable enough with you to start telling details about self-injury and their emotions. Talking about the act itself will sometimes undermine the feelings behind the act, and very often it causes me, as a self-injurer, to dwell on it. When I think a lot about my cuts I'll cut again. Keep your friend's mind off of it for a while. If you are truly concerned then go ahead and ask after you find out if your friend is okay emotionally.

Don't ever ask to see the wounds.
They may look awful to you and you may force your friend into an unneeded hospital trip. If you do see it and it looks terribly bad I would suggest bypassing the emergency room and making an appointment with a family doctor, or someone friendly.

The truth is, your friend probably knows when a trip to the medical world is required, and if you're close enough and open-minded enough about the self-injury, then s/he may ask you what you think about it anyhow.

I would suggest steering your friend to an anonymous clinic, or a small family practise for treament. I would also suggest that until you and your friend better know the doctor/nurse to avoid most questions.

Your friend does not have to tell them what happened. Most SI'ers feel cornered, pressured to tell, so they do and end up under 24 hour surveillance in a psych hospital. Be there to help avoid the questions, or to back up whatever story your friend tells.

IMPORTANT: If your friend is in therapy with someone they trust, then call the therp before you head to the doctor's office and let your friend talk a bit, and ask the therp what the medical doctor should be told.

But I digress...We were talking about talking.

Me: "I haven't cut in 14 days, and I cut last night."
Someone: "You know you could kill yourself! You don't want to die, do you? What if the blade slipped, or you cut too deep....It could get infected and you could get gangrene." I don't know if I can even touch this. These are all statements that I have heard.
Hmmmm...
Here are my answers to these questions/statements:

1. I know I could kill myself. I am as careful as I can be, and yet I know that accidents do happen. That's why I'm trying to quit.

2. I don't want to die. I self-injure to stay alive, to deal with the unbearable. If I wanted to die, then I wouldn't be here now.

3. If the blade slipped or I cut too deep I would call my doctor and go in to see her, or ask her to come see me. If my doctor was gone I would call my counselor. If she was gone I would call mom. If she were gone I would go into the hospital. If your friend doesn't have a reliable support system, then help her/him set one up.

4. I have been cutting for 9 years and only have had one infection. It healed overnight after reopening and cleaning. The chance of another infection is still there, and know what? I KNOW. I know accidents happen, I am not a moron and you don't have to treat me like one.

Scare tactics really do work, people. They scare us. They make us feel stupid for doing what we do to ourselves. They us feel ashamed and guilty. And when we feel scared and guilty and ashamed many of us self-injure and continue the cycle. Scare tactics work....Don't use them.

Me: "After 14 days, I cut last night."
Someone: "That's bad. Why don't you just stop. That's so sick.
Eew! That's gross!"
Should I even touch this?
No. If this is something you would say, then please go back and read parts one and two of this post, because you need to learn a bit about self-injury.

Try this:
Me: "After 14 days, I cut again."
Someone: "14 days? You went for two weeks? How did you get that far without?"
It is probably best to ignore the physical act. Focus on emotions.
Oh, did anything specific happen that made you feel you had to hurt yourself?
How are you feeling?
How did you feel last night?
If you want, you can call me if you feel that way again.

On the other hand, if your friend tells you she/he has avoided SI'ing...
Have you been doing anything specific when you feel you need to SI?
Is there anything I can do to help you out?
It must be very hard on you...

Remember that the act itself isn't as important as your friend's emotions.
Remember to try to figure out what your friend feels caused the SI that day, so s/he can think it over and maybe figure out a way to avoid it or lessen it next time.
Remember to care and to be gentle.
Remember your friend isn't doing this to hurt you.

Special section: From self-injurers

The best things that family/friends have said about my self-injury:
  • "I don't understand, but I'm willing to listen." It's very important to us that those around us keep an open mind and ask about that which they don't understand. If we have entrusted you with this "secret," then we also trust you enough to talk about it. Offer to be there and offer to listen.
  • "I love you anyway."
  • "How can I help?" This is the key question. Every one of us is different. Don't try to second-guess what your friend needs from you. Ask.
  • "This is hard for me to know you're doing this to yourself."

The worst things they have said:

  • "My former roommate told me to move out when she found out. She thought I was a freak."
  • "[My doctor] told me he would quit treating me if I didn't quit. So I never discussed it with him again."
  • "If you do that you have just lost a friend."
  • "Don't talk to me about this stuff...I think it's gross..." All of these statements serve only to make us feel bad, ashamed, and guilty. These statements tell us that the speaker doesn't understand and isn't willing to listen. In just a few words someone who could have been a supporter and who could have helped us get better has effectively shut the door in our face. These statements say the same thing: "You're not good enough to deserve me."
  • "...that I'm only doing it for attention, and therefore it's invalid."
  • All of those who I have talked to also hated the scare tactics and threats: "If you continue doing this I will (enter threat here)..."
What SI'ers wish that others in their life would do: Continue being supportive.

This is a list of 12 things that might help you get past the urge to hurt. Bear in mind that some of these may seem too hard when you're really severely depressed, but if just one of them is something you can do, it'll help.

1. Do something for someone -- a child, a friend, a partner.
2. Do something for yourself -- a haircut, new clothes, a massage.
3. Do something for your home -- garden, plant a tree, put on some cool music and clean your closet or a drawer.
4. Have eight people to dinner. Use your good china and best recipes.
5. Take three upbeat friends to lunch. (If you're as broke as I am, just go to lunch with three upbeat friends, or even make it a picnic.)
6. Plan a vacation. You can even make it your dream vacation; for right now, the planning counts more than the execution.
7. Exercise -- swim, dance, jog, walk.
8. Do volunteer work somewhere. Amazingly, being a crisis counselor helped me get through some rough times (and it built good feelings about myself).
9. Follow the AA formula of HALT -- take action to avoid being Hungry, Angry, Lonely, or Tired.
10. Talk to someone you trust. Join the self-harm list, and post. It's an invaluable resource.
11. Join a club or take a course.
12. Sing along to the radio -- even if you "know" you can't sing. do it as loudly as possible when no one's around.

List adapted from Kathy Cronkite's book, On the Edge of Darkness: Conversations about conquering depression. Some of the suggestions as originally presented didn't seem very realistic.

Next: Strategies to Help you Stop