Psychological Self-Help

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clean up the blood and wear long sleeves. I got to the point that I was cutting every
day, it felt like I was an addict. I got a high cutting, a real buzz. But I also hated
myself for doing it and I got scared as it became dangerous. Eventually, my Dad saw
the scars and took away my knives and razors. It was terrible when people at school
found out. They watched me and asked me why I did it. I really wanted to die then
and took a big overdose. I’ve been in treatment at Mental Health ever since. I’ll be
graduating in 6 months; I’m doing OK in school. I’d really like to be a journalist.” 
The selection of a method—injury or suicide?
Just as there are many causes of psychological pain, there are many ways to
self-injure. Perhaps the most common method is self-cutting, most often on the arm.
Another method is taking an overdose, i.e., taking drugs until you get sick or even
lose consciousness, such as drinking until you pass out. Note: the kind of harm done
in self-injury attempts is usually different from suicide attempts. Firing a large bullet
into your brain or jumping from the tenth floor is definitely suicidal. Cutting your arm
or foot is not a common method for suicide but it is a common method to relieve the
emotional hurt one is experiencing or to let others know they are very unhappy.
Some methods may serve either purpose, e.g., taking an overdose of drugs is a
common method for both self-injury and suicide. Besides cutting and overdosing,
self-injury includes burning yourself, hitting a wall, jumping from somewhat high
places, hitting yourself, self-choking, and sometimes getting others to hurt you. Most
self-injury victims clearly differentiate in their minds between self-injury and making
a suicide attempt (most self-harmers have had thoughts of suicide in the past but at
any one time the intent is usually clear). People wanting to self-injure may, of
course, miscalculate the risks (and they are well aware of possible errors) but they
often think of self-injury as a way of relieving their extreme emotional distress and,
thus, reduce the chance of dying right now. I don’t want to imply that the distraught
self-harmer always has a clear intent in mind—to die or not to die. There are people
who injure themselves seriously and are willing to leave the outcome up to chance or
fate or to whatever powers they believe in. 
To those of us who have never experienced the absorbed obsession associated
with intentionally injuring our bodies and have never gotten emotional relief in that
way, the whole idea may seem incomprehensible and, frankly, rather grotesque.
One’s first thought may be that this is a thinly veiled suicide attempt; i.e., they are
really trying to kill themselves but won’t admit it. But as we understand the situation
better, we realize that for many self-abusers the act is self-protective, not self-
destructive. They don’t want to die. They want to deal with their troubles and
unhappiness; they would like to find more constructive and effective ways of
escaping psychological pain instead of self-injury. But until they discover better ways
of coping, when they feel painfully distraught, the urge to self-injure returns. My
Self-Help Forum friends helped me understand that situation. I appreciated that. 
Like so much human behavior, self-harm is, at first, hard to understand. Each
victim of self-harm is unique, has a different history, a different set of personal
problems, and a different means of hurting him/herself. There is sometimes a well
remembered and understandable original experience with self-injury followed by a
long history of using similar self-injury techniques over and over. A therapist may
believe (I think wisely) that the therapeutic task is more to develop some effective
methods for dealing with the currently overwhelming emotional troubles rather than
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