Guidelines Miss The Reality Of Self Harm (Part 1)

Those who have self-harmed should receive assessment and treatment within 48 hours, new guidelines from the National Institute for Clinical Excellence and the National Collaborating Centre for Mental Health (NCCMH) have recommended in a guideline for the NHS in England and Wales. The guidelines cover acts of self-harm that express personal distress and where the person directly intends to injure themselves, for example through cutting or overdosing. But Phil Barker and Poppy Buchanan-Barker believe there has been a complete lack of imagination in developing these guidelines. In this article they highlight the absence of mental health nursing input and call for new thinking about different ways of responding to problems that have not been successfully dealt with in the past

Self-Harm and Co.

Self-harm has been a hot topic for as long as people have known about it, or been willing to own such knowledge. Now that various 'celebrities' have been included in the self-harmer list - from Princess Diana to Johnny Depp - what once was taboo and disgusting has become almost morbidly fashionable. The virtual avalanche of books published on the subject over the past few years, seems to support this trend towards talking about self-harm, if not actually 'talking it up' (Conterio and Lader, 1999; Levenkron, 1999; Strong, 1999; Turner, 2002).

However, few modern-day practitioners, reared on the psychobabble of 'borderline personality disorder', and related attempts to pigeonhole this phenomenon, might appreciate the complex dynamics - intra-psychic, interpersonal and social - that frame self-harm. It is almost 70 years since Karl Menninger (1938:1985) first discussed the 'war' that humans wage against themselves, for all sorts of different reasons. People who self-harm - especially those who dramatically carve the story of their distress on their bodies - belong to a disparate group of people who use a primitive instinct, designed for self-preservation against others, as a means of defending themselves against an abstract enemy that lies within. Regrettably, many professionals still dismiss people who self-harm as a health care nuisance.

It may be unpopular - and some will say, unscientific - to sketch the membership of such 'self-warring' peoples. However, self-harm seems to have much in common with many people who are suicidal, abuse alcohol and drugs, overeat, starve and purge themselves, or are exercise junkies, many of whom become health care statistics, sooner or later. All such behaviour is, at least indirectly, intentional and results in the 'primary gain' of changing how one feels within the body, if not also about oneself. Regrettably, psychiatry chose to adopt the term 'deliberate', with all its moralising overtones.

At the same time, society cultivates more and more people who are 'unhappy' with the shape or size of some part of their anatomy, or even of their 'self-esteem' or 'self-image' (cf Furedi, 2004). This new breed of 'self-haters' or at least self-dissatisfied people, may well lie at one end of a continuum, which extends through the eating disorders and addictions, to conclude with self-harm and suicide. Some authorities (e.g. Favazza, 1996) would even include all forms of body-modification alongside self-harm - through body piercing etc - although it was not clear whether he was pathologismg the former or normalising the latter.

Taken from a 6 Page Essay written by Phil Barker and Poppy Buchanan-Barker, 2004

Community Psychiatric Nurses Association Nov 2004
Over the next 6 weeks I will post it in parts or you can read the original article here.