Cutting Club

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Many people reading this blog about cutting will understand just how others feel who cut. They may have cut themselves in the past, have a friend or family member who cuts, or be contemplating the next cut at this very moment.

Cutting is the act of deliberately inflicting a wound, of self-harming and differs from a suicide attempt per se. It could be said that while cutting serves many purposes it is often a way of coping, a way of dealing with emotional distress. It may be that the person cutting feels deep sadness, acute anxiety or emotional numbness. Sometimes cutting can be a way of relieving stress or trying to feel in control. For some, “X” marks the spot, just like a cross on a map, it can signify the presence of something hidden or buried deeply. For some cutting can be a “ritual of purification.” This type of “blood letting” can release perceived “badness,” and it may be a way of inflicting punishment on oneself.

The term “Cutting Club” might be a good metaphor for what young people look for – a “connectedness” with others who may feel alienated from family, peers or society. Cutting becomes a statement and others may identify with them, perhaps forming a friendship group Alternatively, it might be the entry requirement to joining the group itself.

It is not just cutting itself that bonds members of this club together, other forms of self harm serve  the same currency. Scratching, burning, picking, tearing at skin, pulling out hair, swallowing poisonous or toxic substances, even breaking ones own bones, all share the same characteristics with often the same painful underlying themes.

In my experience as a therapist, cutting is frequently linked to underlying child abuse, in particular sexual abuse. It is more common in girls, but boys cut too. While I have seen boys and girls as young as 12 cutting, in my opinion the vast majority of those who do so, are in the 16 plus age group.

It may also be related to depression and anxiety. Quite often those, who cut may also turn to eating disorders or drugs as a way to cope. Sometimes it can be linked to conditions such as post-traumatic stress disorder. Sometimes, perhaps as a result of trauma, individuals feel ” dissociated” or ” numb” and this can be a way of feeling. For some people who have difficulty in regulating their emotions, cutting can be a way to cope when they do not have the personal resources to do so. It is not unusual for people to think about suicide when they are cutting, but it is not often meant as a suicidal act. The biggest danger is that the person cuts through an artery accidentally, seriously endangering their life.

I have seen cutting in all parts of the body including breasts and genitals, however, the most common injury sites are wrists, arms, thighs and sometimes stomach. I would not regard tattoos and body piercing as self- harm, unless of course, it is done deliberately to cause harm.

In most cases cutting is done secretly, often in the privacy of the home and mostly it is done where it can be covered up, perhaps by pulling down sleeves and hidden beneath layers of clothing.
Frequently, people who self- harm tell me that no one knows about this behaviour.

It can be very difficult for parents to deal with because they are so emotionally involved. Often they may blame themselves, sometimes they become angry, often because they feel both helpless and worried.

In my clinic I go to great lengths to try to understand what it is that underpins this behaviour. I know that it often signifies s deep emotional distress. It is a way of coping and I make sure to tell the person cutting that they are not bad and that this is not bad behaviour but merely a way of coping.

I explain that I am not judging them and neither am I going to take away this means of coping. Instead, I suggest that either working together to resolve the underlying conflict and/or providing them with a wider range of coping skills is really the best way to help.

It is very difficult to stop cutting because it can become a habit and ultimately an addiction. The very act of cutting releases “feel good” hormones known as endorphins, or to use the full medical name endogenous morphine.
Identifying the triggers is a key task and then teaching coping strategies other than cutting. Sometimes the addition of medication such as an antidepressant can help greatly. Having an opportunity to talk about the deep problems to a professional within a safe and confidential setting can really help. Sometimes having access to clean dressings and medical help may be needed, particularly if wounds are more than superficial.

If you are concerned about yourself or someone you know,make an appointment to see your doctor. Alternatively you  may find that there is a young persons counselling service near you, and if you are at school or college there may be someone you can talk to in confidence. Please feel free to email me in confidence via my website and I will try to find help in your area.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist.

Visit our health blog – www.stevecliffordcbt.com                                                            Like us at Facebook – www.facebook.com/yourmentalhealthmatters                            Tweet us @ cbt4you

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Cup Cakes Cure the Blues.

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Mothers at Eastbourne Clinic Peri-natal Mental Health Unit had an enjoyable time this week in the company of Alice Harland, Occupational Therapy Student. Cakes a plenty were made amid laughter and fun. Others in the clinic, myself included, had to suffer the tantalising aroma of cakes baking throughout the morning. Investigating the source of the aroma and the frivolity, I was amply rewarded with smiles and a delicious cup cake.

The benefits of engaging in occupational therapy through activities like this cannot be underestimated. For mothers with Post-Natal illness, or indeed anyone with mental health difficulties, time spent in the kitchen baking with another person offers an opportunity to engage in conversation and meaningful activity. It can help enormously in increasing self-esteem and self-worth.

As on this occasion, given the freedom of choice regarding selecting what to bake and how much input they are able to give, can be really empowering. As a group, our mothers supported each other, sharing and caring.The end result was a successful outcome which went beyond the baking itself, as they were able to offer staff and relatives the lovingly made cup cakes and feel justifiably proud of their achievement.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist

Visit our health blog – www.stevecliffordcbt.com                                                            Like us at Facebook – www.facebook.com/yourmentalhealthmatters                            Tweet us @ cbt4you

Proposed A & E Changes.. will they benefit mental health?

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A huge shake up of A & E provision was announced this week by Professor Bruce Keogh, the top doctor in the NHS. Will these proposed changes be any more effective than a sticking plaster in terms of the actual benefit for mental health service users?

Given that rapid decline of a person’s mental health should be recognised as a mental health emergency, what of emergency mental health services? It is hard enough for people in mental health crisis to know where and how to access urgent healthcare, without this proposed tiered system adding to the confusion. How will patients who are mentally unwell know where to turn for help if they are unable to access out of hours mental health services? New super A & E, standard A & E, evening/night GP surgery, 111, paramedic? The list of options is mind boggling. I ask myself the question,if I were psychotic, paranoid, manic or deeply depressed, would I be able to adequately access urgent help when I may need it most?

The solution is to improve access to specialist support, to lessen distress and prevent crises; by this I mean 24/7 crisis resolution and home treatment teams in all parts of the country. In particular, rural communities and areas where the demand stretches existing resources such as inner cities, and at weekends and public holidays. Improvement need to be made to existing services such as A & E to provide a seamless net to ensure immediate access is available. Really, we need to be looking at improvements to the urgent care system for both physical and mental health, for young and old alike.

I do hope that thought is given to this sector of the public and their specialist needs. I really do not want to see mental health relegated to a “bolt on” or simply a sector that will have to “fit in.” Any redesigning of the infrastructure of the NHS ought to be reconfigured to meet the needs of this often overlooked and vulnerable sector of our society.

Your thoughts and comments on this subject would be most welcome.

According to Steve Duggan, Chief executive at the centre for Mental Health, the quality of care that mentally ill people receive when they are at their most vulnerable is “unacceptable”.A report from four national inspectorates found that police cells were used under section 136 of the mental health act, some 9.000 times as a “place of safety.” Surely, they are only meant to be used as a last resort?

When it comes down to accessing care; The Health and Social Care Information Centre estimate that mental health service users attended A & E departments at twice the average rate, compared to the general population. So where are the dedicated psychiatric A & E departments?

Until Next time, Steve Clifford, Cognitive Behavioural Psychotherapist
Visit our health blog – www.stevecliffordcbt.com                                                              Like us at Facebook – www.facebook.com/yourmentalhealthmatters                              Tweet us @ cbt4you

Main Ref:

*Duggan, S (2013) Leadership in Mental Health, Health Service Journal. June. www.hsj.co.uk/opinion/blogs/leadership-in-mental-health/2007653.bloglead [Accessed 13/11/13]

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Prostate Cancer Awareness – The emotional cost.

November, or Movember as it has become known in certain circles, is an opportunity to raise awareness for one of the most common cancers in men, prostate cancer.   All over the country, men (and women) are growing (and sporting) a moustache for charity.  As a somewhat hirsute therapist I feel rather at home when others are sprouting facial hair around me!

Seriously, this is a very common cancer and no laughing matter. It affects some 40,000 men and approximately 10,000 will die from it. That represents one man per hour.* As a psychotherapist I know how it impacts on men at both a psychological, as well as a physical level.

Hearing that you have a diagnosis of cancer can be devastating. Having been told you are suffering cancer is very traumatic, and the shock waves can reverberate throughout the entire family. Friends too may also be deeply shocked.

Initially numbness and confusion can make it difficult to take in what is happening. This is the time to attend medical appointments with a friend or ask if you can record consultations on your phone. Remembering, even listening and paying attention to things can be difficult when you feel “shell shocked.” Men have told me that they literally shut down when told the news, going into a deep state of denial. This is often hard for loved ones who are scared and want to mobilise them into action to help themselves.

There is nothing fair about cancer. “Why me?” is the common response. The only repost is to say, “Why not me?” A diagnosis of cancer can change your whole world view, literally flip it upside down. How you respond to it will depend on your world view, upbringing and outlook. Are you an optimist, pessimist, pragmatist or realist? Your mindset will shape how you cope and may even possibly influence the outcome of your treatment.

A diagnosis of cancer is often the rallying call to take stock of life. In other words, to look at where you have come from, where you are now, and where you are going. As you look face to face at your own mortality it may lead you to consider or even question your spiritual and religious beliefs. You may question values, assumptions, as well as deeply held beliefs.

Many, many different emotions may surface on hearing that dreaded word: shock, dismay, disbelief, denial, anger, despair, depression, grief to name but a few. Any or all of these feelings may come forth, and in no particular order.

The most common initial reaction is usually deep shock (or numbness). You may well feel sick and unsteady as you take in the news. You may feel very afraid, scared of the implications. You may be fearful of the treatment or scared of dying. You may think of others you know who have succumbed to cancer (and forget those who have survived!) you are very likely to catastrophise and imagine the worst. You may picture yourself in pain and suffering. This is all very normal.

You may question, ask yourself how you got this. You may feel guilty and wonder if this is hereditary and pass this on to family members. You may blame yourself for not noticing it earlier. You may think of your family and feel guilty for what you imagine you will put them through.

It is likely that you will feel angry. You may even find yourself taking it out on those you love. You may be spurred on to fight and actively channel your energy into seeking a “cure.” While I fully support this, I would urge caution lest you spend vast sums of money on so called “miracle cures” that leave your hopes dashed and your wallet empty. A better use of your anger and energy might be to engage in raising awareness of prostate cancer, fund raise and find out as much as you can about the best treatment choices.

You may find that initial anger turns to sadness and demoralisation. Get active, let your body work with you to promote the release of endorphins; these natural antidepressant hormones will level out your mood.

It is the most normal thing to fear death, dying and pain. Embrace rather than fight. Take up mindfulness meditation and learn to be at peace with yourself. Look at what you can do with each day and remember that the vast majority of people with prostate cancer go on to live and thrive if they accept and allow experts to treat them. Men and denial sadly go hand in hand. Go to your doctors and find out what is going on. Denial is for wimps!

It is important to remember that your family and friends  will also want to share this. As I said above, don’t deny them the opportunity to face the reality of your condition – this is selfish. This notion of “protecting them” is not helpful as it prevents them experiencing their feelings. They too may need to work through feelings and possibly access professional support. Children may need to have the support of teachers and adults may seek counselling. Counselling may well be very helpful for you. Talking things over with another who is outside of your family can really help to get things in perspective.

Work closely with your cancer care specialists -they are a team around you, who have the resources to assist you to effectively manage pain, nausea and fatigue. Managing the physical symptoms helps greatly in managing the emotional aspects that are a natural accompaniment to this condition.

If you wish to know more about any aspect of prostate cancer health contact Prostate Cancer UK on 0800 074 8383, or visit their website at www.prostate cancer.org. If you are reading this and you are not in the UK you may wish to contact the American Cancer Association on 800 227 2345 or visit their website on www.cancer.org.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist.

www.stevecliffordcbt.com                                                                                                         Like us at www.facebook.com/yourmentalhealthmatters                                                       Tweet us @cbt4you

Sources:

“Cancer affects your emotional health” – http://www.cancer.org/treatment/treatmentsandsideeffects/emotionalsideeffects/anxietyfearanddepression/anxiety-fear-and-depression-cancer-and-your-emotional-health [Accessed 8/11/13].

* “TIME to MAN UP” by Steve Morrissey published in Benhealth , the magazine for members of Benenden Healthcare Society, Winter 2013, issue 25. www.benenden.co.uk