Health: Why I have to hurt myself

What can be done to help people whose inner turmoil leads them to mutilate themselves? David Batty finds out

CUTTING yourself seems an unlikely way to prevent suicide, but Sharon LeFevre found this the only way to release the distress she had bottled up for so long. Years of physical, sexual and mental abuse had left her unable to express her feelings. At her lowest point, she thought that death would be the only release from this constant anxiety. She made several abortive attempts to hurt herself, on one occasion trying to slit her wrists with blunt scissors. Six years ago she finally succeeded, smashing a mug against her bedroom wall and cutting open her left palm with the broken pieces. But to her surprise, and despite her pain, she felt relief.

"I felt a connection with a part of myself that I'd shut away for so long," recalls Ms LeFevre, 43, from Dolgellau in North Wales. "At last I seemed to have reached the traumas I'd buried so deeply, which gave me a strange sense of achievement."

Over the next few months, Ms LeFevre learned how to cut herself more safely. "I soon realised you could guide a razor blade better than broken crockery - the cut was cleaner and healed better," she explains. "I also tried to make sure I had bandages or a towel handy to mop up the blood, and would shut myself in the bathroom where I wouldn't be disturbed. Getting into a routine helped me to control the need to harm myself, and my injuries became less serious."

Despite her care, Ms LeFevre eventually needed medical help after misjudging a cut. "I was bleeding heavily, so a friend took me to the local Accident and Emergency department," she recalls. "But the doctors and nurses were immediately hostile, telling me I was just an attention seeker and wasting their time. In fact, I tried to only cut myself when I was alone and always hid my scars. But no one asked me what was wrong, or showed any concern. They only seemed interested in punishing me. On another admission, I was even stitched up without anaesthetic. It was so painful, I didn't realise what was happening at first. I was crying and screaming but the staff completely ignored me."

Yet Ms LeFevre continued to harm herself and was eventually transferred to a psychiatric unit. "I encountered the same negative attitudes," she says. "If I wanted to get counselling, I had to agree not to injure myself, and if I tried explain why I did, I was told to shut up. I didn't see how it could be separated from my sexual abuse, they were so bound together. But the staff seemed to hope by ignoring my self-harm that it would go away. Without any release, my anxiety was unbearable. So, I decided to act like a `good patient' to get discharged and be able to cut myself again. Of course, that soon became a vicious circle."

Then in 1993, Ms LeFevre was referred to Dryll y Car, an eight-bed support unit in Gwynedd, which aims to empower clients to take control of their lives. Although encouraged to develop other means of expressing her pain, through art therapy and counselling, she was not criticised for cutting herself if she felt unable to cope otherwise.

"The staff recognised that self-harm was my survival strategy. "They accepted it wasn't something I could just snap out of, so tried to help me minimise my injuries. The agreement was that I used clean razor blades and had access to a first aid kit, which reduced the risk of my wounds becoming infected."

Having this responsibility for her actions enabled Ms LeFevre to manage her self-harm more effectively. "It was such a relief not to be judged," she says. "The abuse I had suffered had left me with little self-worth, and the punitive treatment I received in hospital just confirmed my belief that I was a bad person and didn't deserve compassion. But the staff at Dryll y Car helped me see it more positively, accepting it as a coping strategy. I didn't feel such a failure and began to get back on with my life."

Ms LeFevre now runs workshops in A&E departments across Britain, with the hope of challenging the medical profession's attitude towards self- harm. She has also written a book, Killing Me Softly, based on her own experiences, which describes self-harm as an intermediate language for traumatised individuals.

While she admits she still has not fully recovered from her traumas, she believes that learning to manage her self-harm has allowed her to get on with life. "It may not be a great way of surviving but it has kept me alive," she says. "I've been able to complete a drama degree and start a PhD at Aberystwyth University, so no one can say I'm a waste of space anymore."

how self harm can be a survival. strategy - and where to get help

Since Princess Diana admitted she tried to cut her wrists, others have been encouraged to talk about their own experiences.

For some teenagers, self-harm is taking the place of eating disorders. Up to one in 50 adolescents hurt themselvs badly enough to warrant medical treatment or counselling.

"Self-harm is used as a survival strategy," says Mike Greenwood, acting nurse manager at Dryll y Car. "People only harm themselves when extremely distressed and are much calmer afterwards. It's a way for them to express unspeakable emotions, often related to traumas like sexual abuse or voice hearing. So, forcing clients to give up self-harm removes the only control they feel to have over their lives. With no outlet for their anxiety, they feel helpless and may harm themselves more seriously. But if you give them responsibility for their actions, they can become less reliant on professional support. Most of our clients have reduced the level of their self-harm and a few have stopped it altogether."

Mr Greenwood admits that harm minimisation is a radical approach, but contends it is the only realistic one. "You cannot stop people from harming themselves but you can take measures to prevent them from accidentally severing an artery or tendon," he says. He runs training sessions on self-harm for health professionals and has helped produce a new workbook Working with Self-Harm, due out in March. The work is part of the National Self-Harm Network's campaign for better understanding of self-inflicted injury. The organisation recently launched an incident report to assess how self-harmers are treated in A&E departments

The National Self-Harm Network can be contacted via Survivors Speak Out, 34 Osnaburgh Street, London, NWI 3ND. For Working with Self-Harm, contact Community Integrated Care on 0151 420 3637. For information on workshops, contact Sharon Lefevre on 07341 423263