TW for self harm (naming specific methods, but not going into greater detail), mention of eating disorder.
I had the idea for this post last week, but then it was more of a thought exercise. Now it’s turned into a debriefing. The original idea would have been preferable.
I thought of another scale. For the last six months or so, I’ve woken up wondering how likely I am to cut or otherwise harm myself that day. Prior to – let’s say, late November – I didn’t think I would actually act on it. I had stopped regularly self harming in the latter half of 2007, when I was 22. Since then, it had been a less than once-per-year occurrence. The very brief lapse in January 2014, during the week following the death of a friend, had been easy to dismiss as a moment of madness when I had good reason to be highly distressed. There was no reason to think it would get out of control again.
I conveniently forgot a couple of things. The latter half of 2007 was when the last major relapse into anorexia started, so the fact that I had also stopped cutting regularly at that point should have told me something. Until last autumn I was still a bit underweight. It wasn’t entirely deliberate: my hunger cues and digestive system are still fucked so it’s hard to eat enough, and after being dangerously underweight for a few years, achieving any definition of healthy seemed pretty damn impressive at the time. Even so, this may have been keeping my anxiety and mood swings dampened down a little, because I’ve felt a lot less stable and able to cope since gaining a few extra pounds. The other thing I managed to ignore was that over the last few years I WAS still self harming on a semi-regular basis when I was upset or agitated, but as I was ‘just’ biting or hitting myself, I convinced myself it didn’t count. Story of my life, really, that mix of denial and defensiveness – I feel like I’ve been running around for the last six years shouting ALL BETTER NOT TO WORRY at anyone who implies concern, only to finally run out of steam and slump in a corner, whispering to myself: okay, fuck. Maybe worry after all.
I spent yesterday afternoon in the accident and emergency department of the city hospital, the first time I’ve had to seek medical attention for something self inflicted since 2007. I felt ashamed enough having to tell people that I had started self harming again at the end of last year, but this was exponentially more humiliating. Nobody else contributed to that – I was worried that the staff would treat me like a time wasting attention seeker (my brain thinks this is true so why wouldn’t other people see it the same way?), but they were all lovely. The member of staff from the psychiatric liaison team was particularly nice, and sent me home with a stack of self help materials and crisis numbers. She emphasised that I shouldn’t put pressure on myself to promise it would never happen again just because I was mortified, because in all likelihood, this particular method of coping is going to be difficult to leave behind now I am minus the eating disorder.
This sort of message gives me mixed feelings. On one hand, even being aware of the likelihood that it will happen at some point in the not-to-distant-future is a huge disappointment to me after many years of very infrequent self harm, so if I’m feeling vulnerable already, the sense of ‘fuck it, it’s inevitable’ could possibly tip me over the edge. But then again, the last six years of investing in the idea that I will never do it again have only resulted in denial, minimisation and vast oceans of shame when I have self harmed, which has the added bonus of making me feel compelled to lie about my actions to preserve my sense of identity as A Recovered (ha) Person who is responsible and stable and not at all crazy.
I think a fair amount of the shame is down to the fact that I don’t really understand my self harm. I don’t mean intellectually, because I’ve been reading books and research on self harm since I was a teenager, and I could give many coherent descriptions of how it might begin/become habitual: neurological processes, the role of attachment and trauma, similarities and differences to addiction, common meanings of behaviours, conditions it is often associated with and why, etc. But the actual internal experience of being an adult who cuts and burns themselves is so very resistant to rationalisation. My experience is one of self-contempt and terror and so much shame I can’t get my head around it.
An example: when does an urge become an intention? A came to A&E with me yesterday, which made so much difference. I’d never had company before; in my teens and early 20s I always chose the right time of day to take myself off to hospital so no one would miss me, which added to the dissociation-inducing illusion that nothing had happened. Anyway, while we were waiting to be seen by the doctor, she started helping me write a harm minimisation plan, so I could do my best to avoid that particular type of injury happening again. One of the stumbling blocks was that I had no idea – even after eighteen years of experience – how to tell when an urge was just a random thought that wasn’t going to lead to anything, and when it was something more serious. I made a guess that if the urge persisted for more than three hours, or occurred on two or more days in one seven day period, I should take it seriously. And I probably should, it seems like a sensible guideline. But intensity, frequency or duration of urges is not at all the whole story. Whether there is any intention to act on them is missing.
I can rationalise being triggered, given my history and my understanding of self harm. It’s not that difficult to find some compassion towards myself when my mind is being bombarded with self destructive thoughts and images. I can even be kind to myself when some part of me feels it needs to self harm for whatever reason. But when thought, image, urge, need or whatever else I have designated as an invasion of my mind that I am not to blame for, merges with my sense of self, and I start feeling as if I want to hurt myself and that I will do it at some point soon, I am disgusted with myself. I start treating myself like I’ve crossed an invisible line from victim of an unfortunate set of circumstances to a calculating waste of space who knows exactly what she’s doing and just isn’t trying hard enough to control herself. A sense of intention means I take all the blame, that I am just a bad person. Never mind if this is true – I’m pretty sure I would never think of other people in the same situation in this way, and I’m sure no one who loves me would condemn me like that either – but that is how I feel.
My experience of intention is strange and nuanced. Going back to the ‘will it happen today’ test, on days when the likelihood seems less than 50/50 (yes/no) it’s still a possibility, but not necessarily – aside from sudden crises – a probability. That’s what around half of the days in the last six months have been like, and I can deal with that. Other days (weeks, months) are more confusing. A 60/40 split is a nebulous, non-specific intention. 70/30 means direct intention, but I still have a reasonable change of being able to distract myself until A comes home. 80/20, in which I will feel reasonably sure it will happen, will ensure a vast amount of cognitive dissonance if I do somehow manage to keep myself otherwise occupied – not harming myself will feel more like an accident than a success. 90/10 means there will be a plan as well as intention, although I will usually keep nagging at outs: do you have to? Do you still have to? Is there anything else you could do? Honestly? Come on, are you really going to do this? At that point I’m unlikely to get answers other than yes, yes, no, yes, yes (and fuck off) – but I’m always aware of a small part of me that’s still arguing.
Anything over equal in the yes direction ensures I will feel awful regardless of how intact my skin is at the end of the day. If I survive in one piece, I will feel like a fake: I didn’t really mean to, it’s not exactly a victory, I just ran out of time, maybe I wasn’t that upset after all, if I *had* to I would have. If I do self harm, I will also feel like a fraud: but surely I wasn’t that desperate, wasn’t there something else I could have done, why now when I was far more upset on [X]day, I know all sorts of other ways to cope with urges, why didn’t I use that knowledge? For every urge I have an almost-equal opposite. If I feel strongly compelled to self destruct, I will drag my heels, pull back from the edge, and then panic if I get to the end of my time alone without having acted on the original intention. If I do act on it, I will panic anyway. Many days I feel like Schrödinger’s cutter: part-way through those bad days I feel I have somehow simultaneously already hurt myself and avoided doing so, and I have no idea which way reality will assert itself until someone else looks at me. It is a huge mindfuck, and I can’t explain it any better.
Thinking about the eating disorder equivalent reminds me that there can be intention in more than one direction at the same time (which is part of what I was trying and failing to explain in my super-short post last week). The quietest that self destructive side has been was when I was originally and deliberately gaining weight; the rest of the past six years has been spent somewhere between 40/60 and 60/40. I’m currently at my highest ever adult weight, but as mentioned previously, I’ve been in a constant battle to get here for years. Some of that time I vaguely accepted I should have probably been few pounds heavier, but didn’t act in a way that made that outcome more likely. Other times I felt like I would really prefer to maintain or to be a few pounds lighter, but acted as if I was trying to gain weight. I don’t mean eating or gaining weight in a totally uncontrolled manner, more like I was being governed by a hung parliament: no part of me had overall control.
I suppose what I’m really trying to do is come up with a convincing argument for forgiving and being kind to myself. I think I’m probably going about this the wrong way, because I seem to be trying to simultaneously berate myself for acting with complete deliberation, and convince myself that I am a blameless puppet, strung to my neural pathways. Maybe I’m going about it all the wrong way, switching between the extremes of free will and determinism. Maybe I’m on the wrong spectrum entirely, and it’s too complex to fit into a philosophical concept. Maybe I’ve just internalised a hundred of the people who had some sort of caring responsibility towards me, treating me with contempt when I was forced to discuss self harm with them.
Maybe I wasn’t ever taught how to manage my emotions, instead, as a thirteen year old rapidly heading into a psychotic breakdown, being forced to make up my own system. And maybe the system of a terrified child doesn’t always age well.