Addiction - This being human

Most people have a tendency towards some form of self-harm when their level of emotional upset becomes too much or unbearable. Some of us bite our nails, pick at our fingers, pull our hair, eat cakes, smoke cigarettes, drink coffee, cut our arms, drink or take drugs. My clinical experience indicates that in part our chosen method of self-harm depends on the severity of our physical or psychological distress. We adopt the behaviour that is at some level “good-enough” to relieve that distress - no matter how temporarily. Often clients during the course of therapy will move from gross to less severe levels of self-harm.

Fleur

       When Fleur came to therapy she had a history of an eating disorder and using drugs and drink. She came to see me at a time when she had given up hard drugs and was struggling to stay abstinent from alcohol. As we worked together, the frequency of her lapses lessened as she learnt from each one.

The first lapse happened during a six-week break when Fleur had been away from home and her support; our project and her AA sponsor. It happened at a time when she had over-committed herself to support a group where she was a member. The actual trigger was conflict with another member of the group. Immediately after the incident, she drank a bottle of wine. She also had a few drinks over the following week. Reflecting on the incident later, Fleur was able to take on board the lack of support and the amount of stress she had put herself under.

Another lapse came after she walked out of our session at exactly the same time that a paramedic, who had attended to Fleur after one of her suicide attempts, left the adjacent room, having attended to someone else. Fleur had an association between the ambulance crew, her various suicide attempts and being taken to a psychiatric ward. Even seeing an ambulance in the street brought up negative emotions in her body. This incident was more difficult for Fleur to cope with than the previous one so this time she drank two bottles of wine. She described it later as going onto “automatic pilot”. Although her mind was telling her that this was “stupid” and “not going to help”, it felt as if something stronger had propelled her toward the drinking.

As Fleur used alcohol less and less, she used other less severe self-harming acts. She would occasionally comb her head until she broke the scalp, forget to eat breakfast and lunch but then eat junk food when her blood sugar was so low that she found it difficult to function, or forget to take her medication, and so on.

As time went on, Fleur learned to be in touch with her feelings, to understand them, to sit with them and manage them. Although her lapses stopped, when Fleur became distressed she did sometimes resort to other self-harming behaviours, but they were less severe and less frequent.

These less severe forms of self-harm have been labelled “hidden self-harm” by Turp. Although a high percentage of the population use hidden self-harming practices, they are rarely brought to the attention of professionals, because on the whole they do not disrupt every-day lives, whereas drug dependency often does. We can see that, as Fleur is more able to contain her own emotions, her self-harming practices become more hidden and so more socially acceptable. Turp, comparing what is normally thought of as self-harm with CASHAs, comments:

“There is a difference of intensity rather than one of kind. In other words, the difference resides in the level of desperation and emotional distress involved.” (p10)

Individuals may also sometimes have a felt sense about which particular form of self-harming behaviour will relieve a particular quality or essence of an emotional distress.