At work there is a program called Illness Management and Recovery (IMR). It was developed for the Substance Abuse and Mental Health Services Administration (SAMHSA) and consists of 10 modules on managing mental illness. I am not trained to teach it, but have been working through the modules myself to learn more. Most recently, the assignment was to explain a symptom to others. I wasn’t sure which symptom to cover, until I spent 5 nights back in the inpatient unit last week. I’ve struggled a lot with suicidal ideation and urges to self-harm over the past three months, and reached a point where it was beyond time to take a breather from life and go somewhere safe where I could focus strictly on taking care of me.
While there, I began reading The Buddha and the Borderline by Kiera Van Gelder. It is a memoir of her experience of Borderline Personality Disorder and her path to recovery via Dialectical Behavior Therapy (DBT) and later delving into its roots in Buddhism. Early in the book there were some fairly graphic descriptions of self-harm, which I only felt okay with reading because I was in a safe place. It turns out, it wasn’t entirely safe. They do the best they can with keeping dangerous objects out, but those of us who self-harm can get pretty creative. At one point I found something dangerous that was built into the architecture. I showed it to a nurse and she said she would report it to the director of the unit and that I should come tell a staff member if I was feeling tempted. One night I did. I’d been feeling anxious during visiting hours and when my mom left I called the same nurse over and told her I felt tempted toward the thing I had shown her previously. I also handed over my statistics folder mom had just brought for me and asked her to please remove the staples from the packets of notes.
The nurse told me to stay put, but it didn’t totally register and after a different staff member handed back my folder without even speaking to me I started to get overwhelmed by the noise in the main commons and moved to a smaller area near my room. The nurse came rushing in and happened to see some recent scratches on my arm from before my admission, which led her to exclaim, “Did you hurt yourself? I told you to stay put!” I explained that the scratches were older, and she told me that they would like me to sleep in the quiet room that night so they could keep an eye on me. The quiet room? That’s the nice term for seclusion room, which is the nice term for restraint room. The only furniture was a bed in the center of the room, with restraints built in. The lights were controlled from the outside, there were cameras monitoring the room, and there was no handle on the inside of the door. Now on the bright side, they really just were putting me there for the cameras, and the door was not fully shut. I was allowed to get up and leave to use the bathroom or go to the water fountain or ask for sleeping medication. It was still rather intense.
It was also completely warranted. The dangerous item I had found wouldn’t do serious damage, but it was in a place where no one would see and stop me, and I could have hidden the marks had I acted on my urge. So why self-harm? It can be many things. It can be a punishment. It can be a release of psychological pain in physical form. Those are the main two things for me. If I’m hurting intensely, it’s less painful to transfer that into something physical. I’m also usually tempted toward it when I feel shame, which unfortunately I feel frequently and for sometimes inexplicable reasons. The important part to note is that, while many people both self-harm and feel suicidal, the act of self-harm is not a suicide attempt. Severe acts of self-harm could result in death, but it’s different if death is not the intent. Self-harm is a coping skill, just not a very healthy one. Some people come home from a hard day and have a glass of wine or eat a comforting meal or go exercise intensely for an hour, and all those things reduce the pain somewhat. Self-harm does the same thing for some of us, and therapy (such as DBT) is about replacing that with a healthier way to reach the same end result.
I finished reading The Buddha and the Borderline last night, a couple of days after my release from inpatient, and toward the end the author asked one of her Buddhist teachers if suicide was the same as killing another person. Likewise, is self-harm the same as attacking another person? The conclusion was that it is impossible to fully practice loving-kindness toward others if you cannot love yourself. I can’t say that I will never slip and act on those urges again, as that’s much too simplistic to think a line from a book is going to undo decades of experience, but the book did inspire me to look more into Buddhism. I am not a spiritual person. I am even less a religious person. I have, however, found myself drawn toward Buddhism over and over throughout my adult life, and have benefited immensely from DBT and the elements of Buddhism Marsha Linehan incorporated into it. So I am steering my upcoming focus on reading toward books on the topic, to discover if it is something I want to explore further.