Raj Persaud: The desperate desire to turn mental suffering into physical reality

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The Independent Online

The recent dramatic rise in self-harming and suicide attempts in Britain has much more serious implications than usually realised. Many often think of a self-harmer as someone who is an "attention seeker" or the act is viewed as an overly dramatic or hysterical "cry for help".

The recent dramatic rise in self-harming and suicide attempts in Britain has much more serious implications than usually realised. Many often think of a self-harmer as someone who is an "attention seeker" or the act is viewed as an overly dramatic or hysterical "cry for help".

These acts may not be perceived as that dangerous, and indeed patients may receive short shrift from frustrated casualty staff. Yet the latest medical research suggests that self-harm is the just the start of a journey, at the end of which some months later is often actual suicide.

Recent psychiatric studies also confirm that men move much more rapidly through that journey, with the time from first suicidal acts or communications to completed suicide being just 12 months on average, compared with 42 months on average with women.

Despite how ominous these rising figures are for self-harm in terms of what they predict for our future suicide rates, there is no one theory about why they are climbing.

Surveys have found that young Asian women have become a particular risk group for suicide and self-harm due to alienation from parents, often over issues around arranged marriages.

In my clinical experience of seeing patients just referred from casualty departments, they will often divulge that cutting themselves, or taking an overdose, somehow makes concrete and physical their suffering. It is difficult to get attention for despair while it remains a purely mental phenomenon - but once an actual physical wound has been created, something tangible can now be comprehended and considered by others. Self-harm might be a mechanism for externalising anguish that might otherwise go unheard.

The creaking mental health services my colleagues and I battle in remain formidably unable to capture and treat effectively the earliest signs of depression - so the illness now tends to progress into something worse before the NHS is galvanised to act. These climbing rates would therefore suggest that we live in a society where it seems increasingly difficult to be heard, and where emotional turmoil is so uncared for by our busy friends, family, colleagues and even doctors, that we need to translate it into a physical reality before it will even begin to be noticed.

Professor Raj Persaud is consultant psychiatrist at the Maudsley Hospital in London

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