Troubled Minds & Scarred Bodies

A Presentation by Dr Terence NiceMaidstone 2013

This Presentation

Informative InteractiveInspiring Interesting

Where are we going?

• Poem• What is Self-harm?• Wounded Narratives• Equilibrium • Video Clip

http://www.familyfriendpoems.com/poem/self-harm

It calls me closer, its calls me near "Just once and it'll be over" Death whispers in my ear Irresistible is its sweet entice Staring down, which one to slice, I observe my previous tries My unseen hurt and earlier cries No peace in my mind, no peace in my head The quiet intelligent me, long since fled Anger and rage consumes me My minds demons bursting to be free The walls of my cage finally cave "Just be still, just be brave" I slash down with an improvised knife "Forget this world, forget my life" Blood oozes and drips down the drain A slight tingle but no real pain A Calmness comes over me My last attempt please, it's got to be "Screw everyone, that's made me into this" The very same people who I'm going to miss Tears stream down my cheek, My head feels heavy, I get dizzy and legs go weak Darkness surrounds me, I get a glimpse of the abyss I embrace the darkness, then hear a shriek...

NICE 2011

• Self-harm: any act of self-poisoning or self-injury carried out by an individual irrespective of motivation. This commonly involves self-poisoning with medication or self-injury by cutting.

• Exclusions: harm to the self caused by excessive alcohol, recreational drugs, starvation arising from anorexia or accidental harm.

NICE 2011

• In a recent UK survey of 15-16 year-olds more than 10% of girls and more than 3% boys self-harmed in the previous year.

• Annual prevalence for all age groups is 0.5%.• Self-harm increases the likelihood of completed suicide

by 50-100 fold above the rest of the population in a 12 month period.

• Self-harm is highly correlated with depression, borderline personality disorder, psychosis, bi-polar disorder, drug and alcohol conditions.

Self-Harm and Suicide

• Why do adolescents self-harm and commit suicide?• What is going on in their minds?

Terminology

Self-harm

Deliberate Self-Harm

Self-Injury

Non-Fatal Self-Harm

USA

Self-Mutilation

Europe

Self-InjuriousBehaviour

Parasuicide

Self-Abuse

Attempted Suicide

Suicide

Table of Participants

12 Participants

Title 

Age Date of Birth

Gender Ethnicity TabletsTaken

Intent 0-10

School Status

A1Andy

16 13/10/93 Male WhiteBritish

100 9-10/10 College

B2Bess

15 19/11/93 Female WhiteBritish

13 2-3/10 State School

C3Carol

16 12/11/92 Female WhiteBritish

20 4/10 StateSchool

D4Daisy

16 08/09/94 Female WhiteBritish

11 3/10 StateSchool

E5Emma

13 25/05/95 Female WhiteBritish

23 6/10 StateSchool

F6Freda

15 30/01/93 Female WhiteBritish

Cut Self 

9/10 Out of School

G7Gill

16 16/07/92 Female WhiteBritish

56 7/10 Out of School

H8Harry

15 18/05/94 Male WhiteBritish

Hit Self 1-10/10 StateSchool

J9Josie

15 18/10/93 Female WhiteBritish

13 & Alcohol 2-3/10 StateSchool

K10Kay

13 11/01/96 Female WhiteBritish

28 8-9/10 StateSchool

L11Larry

16 22/12/93 Male WhiteBritish

21 5/10 StateSchool

M12Mary

15 27/10/94 Female English-Iranian

11 8-9/10 PrivateSchool

Deconstruction & Reconstruction

A1 Word by Word

Equilibrium – The Chief Construct

Master Story & Master Construct

Concept-CategoryMicro-Stories

Grounded Theory Nvivo 8 (A1-M12)

Narrative Method(A1-M12)

A1 Theme by Theme

Stories Constructs Synthesis of

findings

Primary Recurring ThemesA1 Text Themes Higher Order

ThemesPrimary

Recurring Themes

  R: What did you expect would happen?A1: Err…Just that I would not wake up really … but I just

couldn’t get to sleep because it was that painful, so…R: There was something physically painful or psychologically painful?A1: Just being sick constantly and…R: You were being sick …A1: Yeah… every 10 minutes R: Did you think you would go off to sleep and never wake up again? A1: Yeah, I was expecting it to be quite easy T: Was it?A1: No…Not as easy as I thought T: Okay…At the time of taking the tablets what was in your mind? A1: Just to hurry up and finish taking them really, okay

 Expectations  Wish – not to wake upA1 in pain Sick every 10 minutesBeing sick Expecting it (OD) to be quite easyGoing off and not waking up Thought it would be easy but doing it hardHurry up and finish taking them.  

 Wish to escape  Bodily pain  Vomiting  Harder doing than A1 thought Urgency of self-harm   

 Bodily pain of taking tablets and being sick.                 

Wounded Narratives

• R: If your cuts could have spoken what would they have said?

• Freda: Look at me, look …look at this person…shameful… • R: What would they have needed to see?• Freda: This person needs help… if my arm could have

spoken at the time it would have said ‘ow’ I’m in terrible pain, but I didn’t feel the pain because I was numb, but I could feel, my arm could feel the pain, but I couldn’t…if you know what I mean …if my arm could have spoken it would have said look everybody help this person, help her …

(R = Researcher Freda = Participant)

Four Cardinal Constructs

(1) The Upset – Affect Dysregulation

(2) Who Cares? The M/other-Adolescent Relationship

(3) The Telling- Self/Other Relations (4) Equilibrium-Disequilibrium.

Equilibrium

The Body Emotions Cognitions Life Events The Act Friends & Family

The Upset Who Cares? The Taking The Telling

Relational UpsetsSelf out of Balance

Equilibrium

Disequilibrium

Equilibrium-Disequilibrium

Diagram 11: Equilibrium and Disequilibrium I

Home Mates/Peers School

Stress Trigger

Toxic Affects

Distress

Everything’s Out of Control

Can’t Think …Too Many Thoughts

Entrapment – Get Away

Compulsion to Act -Self-Harm

Relief & Repair

Things are Okay

Tensions are building up – Too much Pressure

Can’t Cope – Mind Numbness

Attempted Suicide

Suicide

I’m Coping Much better

Moving Forward

Equilibrium – A Treatment Model

School Teacher/Class

Discharge

Home Mates etc

Adol./Parent Psychotherapy

Family Therapy

1-6 Sessions of Adolescent/Parent

Psychotherapy Then Review

Restoration of Equilibrium

No Change No Change

Applications

• A Tripartite Self-harm Training (Introduction, Intermediate and Advanced).

• Risk Assessment Checklist• Emergency Advice Sheet for Families and Caregivers• Map of Strengths and Vulnerabilities • Self-harm pamphlet for Schools and Colleges • Development of a Short-term Dynamic Treatment

Model• A Post-doctoral Research Project (Quantitative)

Video Clip http://www.youtube.com/watch?v=TdkNn3Ei-Lg

(Jonah Mowry)