Category Archives: Mental Health Conditions – Resources for the Public

Self-harm: ‘When I hurt, I cut…’

self-harmSelf-harm accounts for over 24,000 hospital admissions every year¹ and it is estimated that 1 in 12 children self-harm². Rates in the UK are some of the highest in Europe³ but – because self-harm is, by its very nature, a private activity and is often kept secret and thus remains unreported – these statistics may be just the tip of the iceberg.

Self-harm is generally thought of to include violent acts to the self – specifically deliberately cutting, hitting, burning, injecting or imbibing potentially dangerous objects or substances, hair pulling, eating disorders etc. Smoking and drinking, over or under-exercising, engaging in risky sporting/driving/sexual behaviour, cosmetic surgery, tattooing and piercing may also be added to the list – although some may not consider many of behaviours in the second list to be harmful. Is eating a doughnut after a difficult meeting at work an act of self-harm or of self-care?

Self-harm is on the increase, and many wonder at the “contagious” aspect of the behavior – is it a way of crying out for help or attention; an act to externally express inner rage; a form of self-punishment; or just a way of “belonging” to a particular group?

Whilst working with a self-harming client can be very distressing, Lynn Martin references many examples of clients who, she feels, were kept alive by their self-harm(4). She refers to “anti-suicide” element of the behaviour, and explains that, for some, self-harm actually allows them to feel that they are in control of their lives. The endorphins, which are released into the blood stream after a puncture to the skin, can serve to somehow “re-boot” the depressed, withdrawn client who has lost touch with her world. Similarly, the pain of the wound can highlight that it hurts “here” rather than just “inside”.

As therapists, it is important that we do not allow any personal shock to spill out when working with a self-harming client. Showing concern for the wounds, and making sure that they are kept clean; ensuring, too, that the client is secure in the fact that you see them behind their pain; communicating that it is alright to talk about the self-harm; respecting the fact that the client is, more often than not, trying to survive and not to die; and reassuring the client that you will not try to steal from them their coping mechanism until they themselves feel safe enough to live without it – all these sort of responses are seen as being the most helpful to the truly distressed and pained client.

Whatever the reasons or the resolutions for the self-harming individual, as therapists we need to be aware of the width and prevalence of this behavior. We need, too, to look after ourselves whilst working with self-harming clients by exploring, in supervision, the myriad of reactions that this particularly violent representation of pain can produce in us.

By: Annabel Murray, Counsellor, June 2015

1 Samaritans & Centre for Suicide, 2002
2 Talking Taboos, 2012
3 NICE 2002
(4) Lynn Martin, Therapy Today, July 2013


Self-help Information about self-harm

What leads a person to self-harm?

Self-harming behaviours, such as cutting, scratching and hitting oneself, are often a physical way to deal with very painful psychological experiences and feelings of distress and isolation. Self harm can arise for all sorts of reasons such as grief, abuse, trauma, fear, loss and other feelings that are overwhelming. These may be from early childhood or in the present, or they may follow an incident that makes a person angry, frustrated or disappointed.

There is usually mounting tension followed by a compulsion or an impulsive need to self-harm. Some people dissociate (separate themselves so that they are not fully aware of their behaviour) from their mental and physical pain during the act of self-harm. Because others may see acts of self-harm as “deliberate”, unsympathetic responses can be a consequence. However, quite often a person is not very conscious of their reasons for self-harming and does not feel in control when they do it.

There are various forms of self harm, including cutting with a razor or knife, burning, hitting or banging your head, or over-dosing when it’s not life-threatening. It is often done in secret.

Self-harm has hidden short-term benefits for the person harming. These can include:

  • Release of emotions – getting them “out” can bring relief and decrease in tension
  • Making the mental pain feel real (akin to crying without tears, when the person can’t externalise their feelings)
  • Giving a distraction from, or a sense of pause, from the mental pain
  • Providing a way of telling others how bad you feel
  • Punishing the self for self-hatred and guilt

How does therapy help?

  • learning to manage feelings and difficulties in healthier ways, such as talking
  • exploring and understanding the circumstances in which the self-harm arises
  • understanding the unconscious conflicts and buried emotions underneath the acts of self harm
  •  developing a capacity to contain, tolerate and think about distress

By: Wendy Bramham, July 2013

Remember:
Seek immediate help for any serious injury or overdose – with your GP, ambulance or A&E.


Thoughts from the front-line
We asked a few teenagers to tell us in their own words how they would have liked their parents to support or help them.   The purpose of this exercise was to inform and assist parents/guardians who may be unsure of how to help their child.  Comments remain anonymous to protect identity.
 
Girls aged 14 and 15 told us:
“Further criticism is definitely something NOT to do, because most likely that is what caused the person to self-harm in the first place.”
“Parents shouldn’t pretend they understand, that is one of the most frustrating things for people in this situation. Perhaps saying they are trying to understand would be a better way.”
“Friends can play a large part in preventing further harm… I would get the parents to talk to their child’s friends to see if they have noticed anything.. make it subtle though!”

Girls aged 17 told us:

“For me, my parents couldn’t have really done anything to help me, my mum made me keep my door open at night and took away my razors, making me use hair removal cream instead.  But that didn’t stop me and it wouldn’t stop anyone from doing it.  There’s no way parents can stop it physically in all honesty.   For me it was my own personal feelings of guilt and these weren’t gonna stop no matter how much my mum and dad tried to help.  But the situation would’ve been a lot better if my mum had understood when I told her.  She didn’t say anything and I feel like she didn’t understand why I did it.  Maybe she thought it was some sort of cry for attention, but it wasn’t (I’d been hiding it for one and a half years). If she was more aware of the reasons why people do it, and maybe just gave me a hug, told me I would be okay, comforted me when I was upset about anything, then maybe it would have stopped me doing it sooner.  But instead she never mentioned it to me, only tried to physically prevent me from doing it, not mentally”.  FW

“What might have helped would be if I was not made to feel it was my fault or that I was a drama queen. Guilt is a key contributor to my issues and I was made to feel guilty for self-harming.  I wanted my parents to understand that I wasn’t doing it because I hated them.  I knew they would be heartbroken if I died, but when you’re mentally ‘effed up’ you don’t see it that way, and the selfishness that depression produces isn’t controllable.  Self-harm isn’t always slitting your wrists.  It can be pinching yourself under the table all lesson, or forcing your mind through horrible thoughts (emotional self-harm is a huge thing).  Yes, we know we shouldn’t do it, we know it is bad for us, we know it’s selfish.  Telling us this just makes us feel guilty, which makes us feel crapper which makes us more likely to lose control and do it again.  When you get a cold or even cancer you don’t blame yourself or anyone else; you just look for a way to fix it.  Sometimes we self-harm because it is the only way to feel alive.  Yet, blaming the child for feeling so low is not healthy and will not make them forthcoming with reasons why.”  MA
 
From the above stories, it is clear that it is helpful if parents/carers/relatives can try to understand the emotional distress underlying any self-harm behaviour in their child.    It may be important for the parent to seek their own support, such as counselling, to cope better with this alarming situation.  Wendy Bramham Therapy offers a range of therapists in Newbury & Marlborough who are qualified and experienced in helping with these issues, so please don’t hesitate to contact us.  
Wendy Bramham
July 2015
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Robin Williams

Robin Williams

Many of us were shocked and saddened by the news of Robin Williams’ suicide in August 2014. In 2013 as part of BBC Wiltshire’s series on mental health, Wendy Bramham spoke about this devastating issue.  The following information offers a resource for people experiencing suicidal feelings; or for those bereaved by suicide; and for people who are attempting to help those affected by this issue.

What causes a person to feel suicidal?

Suicide may seem to be the only way to end severe mental pain; the only thing that’s left within the person’s control.  It may also be a way to convey desperate feelings to others. Most people who feel suicidal are actually quite confused and conflicted about the desire for death.  Most wish there was an alternative.

What causes it is usually a complex mix of factors that builds up into despair that becomes overwhelming.  It may be caused by a sudden crisis, a major setback or loss, but more typically there is a slower build-up over time.

Many kinds of emotional pain can lead to thoughts of suicide.  Each person responds and copes differently and uniquely to the myriad problems and crises we all encounter through life.  Each person has their own psychological and social history and genetic make up, which means that what is bearable to one person can be unbearable to another, and vice versa.

Tragic Statistics

This devastating problem is much more common than many of us realise.  Shockingly, in the UK suicide remains the most common form of death in men under the age of 35 (Mental Health Foundation and Department of Health).  It is the second largest killer of people worldwide between the ages of  16-19.  In the  last 45 years suicide rates have increased by 60% worldwide (source: World Health Organisation).).  It’s estimated that approximately 5% of people attempt suicide at least once in their life.  Men are 3 to 4 times more likely to kill themselves than women. However, unsuccessful attempts are more common in women and young people.   More people die by suicide each year than by murder and war combined.

Accusation of selfishness?

Some people accuse those who have committed suicide as selfish, and that they took the “easy way out”.  This is extremely hurtful and shows a lack of understanding of mental illness and the suffering that some people try to endure.  The following quote is taken from theguardian.com on 12 august by Dean Burnett who I think argues the point well:

“One of the main problems with mental illness is that it prevents you from thinking “normally” (although what that means is a discussion for another time).  A depression sufferer is not thinking like a non-sufferer in the same way that someone who is drowning is not “breathing air” like a person on land is.  (…..) The selfish accusation  implies that there are other options that the sufferer has, but has chosen suicide or that it’s the easy way out.  There are many ways to describe the sort of suffering that overrides a survival instinct that has evolved over millions of years,  but ‘easy’ is not an obvious one to go for. Perhaps none of it makes sense from a logical perspective but insisting on logical thinking from someone in the grips of a mental illness is like insisting that someone with a broken leg walks normally.  Logically you shouldn’t do that.”

Who is at risk?

Most important factors that put people at risk include mental disorders, such as depression, bipolar, schizophrenia, post-traumatic stress and obsessive-compulsive disorder (OCD).  The second biggest influencing factor is substance abuse.  Eg alcoholism is a factor in 15-60% of all suicides.

Having  depression or bipolar increases the risk of suicide by 20%.  Depression accounts for approximately 50% of suicides.  Those suffering from severe depression and feelings of hopelessness, and who have little or no social support are probably the most at risk.  Often people who are just recovering from depression are in fact more at risk of suicide, because it is then that they actually have the energy to carry out the act of suicide.

War veterans are a high risk category due to the mental trauma and physical ill-health from war.  Genetics and social-economic factors play a part too, eg poverty, discrimination, financial worries, unemployment, bereavement, social isolation.

Some medical conditions can trigger suicidal feelings, such as traumatic head injuries. A diagnosis of cancer can double the risk of suicide.  Such medical conditions can lead to depression and suicidal feelings, and carers should be aware of this.

Media and internet can cause a copycat syndrome of suicide whereby it is romanticised or glorified.

Warning signs

Suicidal feelings are more likely to build up when a person feels they can’t talk about their feelings.  They may be experiencing or have experienced some of the following, which can also be signs and symptoms of depression:

  • withdrawal from friends, family and regular activities
  • isolation and hopelessness
  • sense of futility and meaningless
  • self-loathing (“everyone would be better off without me”)
  • loss of energy
  • major and sudden changes in personality or mood
  • big changes in sleeping and eating habits
  • difficulty in functioning, such as going to work, or cooking dinner
  • unusual neglect of personal appearance
  • feeling cut off from their body, feeling numb
  • impulsivity, lethargy or aggressiveness (especially in adolescents)

Obvious major warning signs include

  • talking about killing or harming oneself (it is a myth that people who talk about suicide don’t do it)
  • talking or writing a lot about death or dying
  • seeking out things that could be used in a suicide attempt, such as weapons and drugs.

The above signals are even more dangerous if the person has a mood disorder such as depression or bipolar disorder, suffers from alcohol dependence, has previously attempted suicide, or has a family history of suicide.

How to help someone who is suicidal

Talking about it can save a life.  Try not to feel embarrassed or afraid.  Talking about suicide won’t give the sufferer morbid thoughts – quite the opposite, it is the most helpful thing you can do.

However, it is not usually helpful to say things like “you should feel lucky because you’ve got a lovely house, job, family”, etc., or “that’s not enough of a reason to feel suicidal”.   The best way to help is by offering an empathetic, listening ear.   See notes below on “How to talk with  someone about suicide”.  Don’t take responsibility, however, for making the other person well. You can offer support, but you can’t get better for a suicidal person. He or she has to make a personal commitment to recovery. If you are helping a suicidal person, make sure you get support for yourself.

Practical steps:

  • Get professional help. Call a crisis line such as The Samaritans for advice and referrals.  Encourage the person to see a counsellor, or take them to a doctor’s appointment.
  • Follow-up on treatment. If the doctor prescribes medication, encourage them to take it.  Help to communicate about any side effects and be aware that it can be a trial and error process to find the right medication.
  • Be proactive. Don’t wait for the person to call you, or to return your calls. People who are severely depressed find it difficult to ask for help.  Drop by, call again, invite the person out.
  • Encourage positive lifestyle changes, such as a healthy diet, plenty of sleep, and getting out in the sun or into nature for at least 30 minutes each day. Exercise is also extremely important as it releases endorphins, relieves stress, and promotes emotional well-being.
  • Make a safety plan, help the person develop a set of steps if they feel suicidal, such as who they will call.  Include friends, family and crisis line numbers.
  • Remove potential means of suicide, such as pills, knives, razors, or firearms. If the person is likely to take an overdose, keep medications locked away or give out only as the person needs them.
  • Continue your support over the long haul. Even after the immediate suicidal crisis has passed, stay in touch with the person, periodically checking in or dropping by.

How to help yourself if you feel suicidal

Asking for help is not a sign of weakness but a sign of strength, wisdom and self-responsibility.  If we try to do everything on our own we will become mentally, physically and emotionally exhausted.

However, if you have suicidal thoughts it can feel impossible to tell your family and friends how bad you feel.  You may feel rage, fear, guilt and shame.  If you have been hurt by someone, it is natural to feel anger, and sometimes suicide can seem a way to get back at that person.  However, suicide is anger turned against ourselves.

The intense emotional pain that you’re experiencing right now can distort your thinking so it becomes harder to see possible solutions to problems, or to connect with those who can offer support.

It is important to work out with a professional counsellor why you feel the way you do.  Give this process time and commitment even after you begin to feel better.

Coping strategies:

  • Promise not to do anything right now.  Make a promise to yourself: “I will wait 24 hours and won’t do anything drastic during that time.” Or, wait a week. Wait and put some distance between your suicidal thoughts and suicidal action.
  • Avoid drugs and alcohol
  • Make your home safe. Remove things you could use to hurt yourself, such as pills, knives, razors, or firearms.
  • Take hope – people do get through this.   Give yourself the time needed and don’t try to go it alone.
  • Speak to someone you trust, whether it be a friend, GP, clergyman, teacher, family member or therapistOr call a helpline such as The Samaritans.

How to talk with someone who is (or might be) suicidal

Following text is taken from http://beta.helpguide.org/mental/suicide.  Adapted from: Metanoia.org

Ways to start a conversation about suicide:

·         I have been feeling concerned about you lately.

·         Recently, I have noticed some differences in you and wondered how you are doing.

·         I wanted to check in with you because you haven’t seemed yourself lately.

Questions you can ask:

·         When did you begin feeling like this?

·         Did something happen that made you start feeling this way?

·         How can I best support you right now?

·         Have you thought about getting help?

What you can say that helps:

·         You are not alone in this. I’m here for you.

·         You may not believe it now, but the way you’re feeling will change.

·         I may not be able to understand exactly how you feel, but I care about you and want to help.

·         When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage.

When talking to a suicidal person

Do:

·         Be yourself. Let the person know you care, that he/she is not alone. The right words are often unimportant. If you are concerned, your voice and manner will show it.

·         Listen. Let the suicidal person unload despair, ventilate anger. No matter how negative the conversation seems, the fact that it exists is a positive sign.

·         Be sympathetic, non-judgmental, patient, calm, accepting. Your friend or family member is doing the right thing by talking about his/her feelings.

·         Offer hope. Reassure the person that help is available and that the suicidal feelings are temporary. Let the person know that his or her life is important to you.

·         If the person says things like, “I’m so depressed, I can’t go on,” ask the question: “Are you having thoughts of suicide?” You are not putting ideas in their head, you are showing that you are concerned, that you take them seriously, and that it’s OK for them to share their pain with you.

But don’t:

·         Argue with the suicidal person. Avoid saying things like: “You have so much to live for,” “Your suicide will hurt your family,” or “Look on the bright side.”

·         Act shocked, lecture on the value of life, or say that suicide is wrong.

·         Promise confidentiality. Refuse to be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional in order to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word.

·         Offer ways to fix their problems, or give advice, or make them feel like they have to justify their suicidal feelings. It is not about how bad the problem is, but how badly it’s hurting your friend or loved one.

·         Blame yourself. You can’t “fix” someone’s depression. Your loved one’s happiness, or lack thereof, is not your responsibility.

How to help someone who is bereaved by suicide

Bereavement by suicide can be more complicated because it is common for people to feel confused or guilty that they didn’t know the extent to which the person was suffering, and that they were not able to help.  They may also feel angry and disappointed with the person who committed suicide.  Because of stigma, they may feel they can’t talk about either the mental illness (if this was a factor) or suicide, adding to feelings of isolation.  Bereavement by suicide often carries feelings of deep shame. Following information is taken from sane.org

Common responses:

I don’t know what to say.

·         If not sure what to say, ask ‘ How are you feeling today? ‘

·         Tell the person you’re not sure what to say. Being honest will help to build trust

·         Try to listen 80% of the time and talk 20% of the time

·         Avoid making unhelpful statements such as, ‘It’s God’s will’ or ‘Time heals all wounds’.

I don’t want to make it worse for them. By allowing the person to express their grief you will be helping. Nothing you do can take away the sadness, but it is important to be there for them.

·         Allow tears or accept no tears

·         Understand that the way the person expresses grief may be different from the way you would express it

·         Don’t take anger personally.

They have lots of family and friends around. They don’t need me. People with lots of friends and family still need support from others. It’s important to have grief acknowledged by friends and colleagues so the person doesn’t begin to feel isolated.

They need help from a professional. There is nothing I can do. While professional help can be very important, don’t underestimate the importance of friendship when someone is grieving. You can do things a professional person can’t such as going for walks, cooking a meal or being there in the evenings and on weekends, remembering the birthday and anniversaries of the person who died.

I’m not sure what to say about the mental illness. Ask the bereaved person how they feel about this and reassure them you are happy to talk about mental illness if they want. Seek out some information so you know something of what the person may have been experiencing. Be compassionate and understanding about difficulties it may have caused in their relationship, and encourage them to talk to a bereavement counsellor if they are not coping or do not feel they can talk to anyone else.

 Useful Contact Numbers

Survivors of Bereavement by Suicide – 0844 561 6855

Samaritans –  08457 90 90 90

by: Wendy Bramham
Written as a resource for listeners of BBC Wiltshire mental health series, October 2013
Updated August 2014

Bipolar Disorder, BBC Wilts, by Wendy Bramham

BIPOLAR DISORDER

Bipolar is also known as manic-depression or manic-depressive illness.  This may be diagnosed by a psychiatrist if a person experiences extreme mood swings over a period of time, which in turn affects their ability to function in their everyday life.  The illness, if untreated, can often be destructive to the person’s job, marriage and family life. These changes of mood are much more extreme than the normal ups and downs we all experience and which are part of normal  life.  The change in mood can happen within seconds, or over months, or a person can experience both simultaneously.

A person with bipolar will usually experience several of the following symptoms during a manic phase:

  • a confidence, exhilaration and energy in the early phases but which can lead to a desperate restlessness, irritability and turbulence in the later phases
  • a tendency to spend money they haven’t got, leading to serious debts
  • sleep disturbance, and early waking which offers the person the opportunity to become excessively productive
  • a feeling of “grandiosity” – feeling at the centre of the world, and as if nothing is impossible
  • loss of any regularity in normal everyday activities
  • disinhibition to the extreme
  • rapid thinking and talking; a flight of ideas (one thought leading to another at a pace that is hard to keep up with); the need to communicate your ideas; dominating the conversation
  • speech feels incredibly easy; sense of absolute vitality turbo charges speech
  • imposing oneself on others, visiting and phoning to the point of exhausting the other
  • a tendency to begin grand projects or ventures, often taking big risks
  • a powerful feeling of connectedness between things
  • the future holds much promise, with certainties of success, wealth and achievement
  • senses are heightened, colours more vivid and contours better defined
  • an unwavering belief in the goodness of the world
  • behaving impulsively with activities such as drink, drugs or sex
  • in the final stages of mania, a person may become suspicious of others, paranoid, and unwilling to be helped or treated as they are fixated on their own delusions of greatness

A depressive phase can be experienced as:

  • an emptiness that is totally devastating
  • unbearable loneliness, mental pain, terror or rage
  • a sense of paralysis that makes simple everyday decisions, (such as what clothes to wear once you get out of bed, what direction to walk in, how to respond when someone greets them) seem impossible
  • feelings of worthlessness and self-reproach, but also thoughts of how others have wronged them
  • a feeling that human endeavour and achievement are meaningless
  • suicidal thoughts

For further information about depression on its own, please see our other blogs.

Causes of Bipolar

Exact causes are not fully known although there is a strong family link.   This is not just genetic inheritance, but perhaps more importantly it can also be caused by the experience of interacting with a parent who is bipolar.  For example, a child can be frightened and confused by a parent’s unexpected and inconsistent mood changes.  The child may learn that attachments are unstable and precarious.  A parent who is bipolar may seek relationships which require dependency as a way of guaranteeing closeness; as a way of coping with an internal fragile sense of connection with others, and the fear of  abandonment.  This would then become problematic for the child as s/he becomes independent and the parent’s love collapses.  Bipolar sufferers can often be children who have been earmarked to raise the family’s social status; the child may be burdened by these ideals, but conforms.

Mania can be triggered after a stressful or traumatic experience, such as a loss, a physical illness, or when something is too bad to think about.  Such a trauma or loss may have happened many years previously.  It is thought by psychotherapists that apparently arbitrary cycles of mania and depression are not accidental, but often the connection is not made in the conscious mind.

Getting Help

If you are worried, visit your GP in the first instance.  He or she may then refer you to a psychiatrist.  Getting help early is very important.  Subsequently, if you do receive a diagnosis of bipolar you will be prescribed medication and also possibly offered some form of talking therapy.  For those people who suffer debilitating depressive episodes, a manic phase can be a welcome relief!  This is why it is very tempting for sufferers to either resist getting help in the first place, or to deny the need for medication.

It is helpful to:

  • accept that you have a problem and receive help
  • educate yourself about the condition, and where appropriate involve family or friends
  • recognise the early warning signs around your symptoms, such as restlessness, changes in sleep patterns, etc.  Gather support from family to help recognise these.
  • share your experiences with others suffering from the same condition
  • once your moods are more stable, seek a psychological therapy to talk through your feelings, the details of your highs and lows, to manage stress, and to explore your past in relation to your current difficulties.
  • try to lead a healthy lifestyle and improve well-being, by incorporating exercise, sleep and good nutrition etc.

Wendy Bramham September 2013, for BBC Wiltshire series on mental health

References:

Depression (blog 3) – Getting help, by Lindie White

lindie white

Lindie White

In the last of our blog series on depression, psychotherapist, Lindie White, writes:

Most people need help when they are depressed or have prevailing sadness and low mood. If we can’t acknowledge this when we’re suffering, then that’s part of the problem! The essential first step is to name your depression to yourself and someone else. When it is acknowledged, then what?

If you go to a GP you will be offered medication and/or some kind of talking therapy.
Medication can help some people, sometimes, although some find that anti-depressants don’t help at all or are not enough on their own.

Therapy really does help tackle depression and there are many different kinds of talking therapies on offer. Most commonly available through the GP is Cognitive Behavioural Therapy (CBT), often delivered by an in-house counsellor. This aims to address negative, self-destructive and ‘untrue’/unrealistic thinking patterns. Other therapies include psychodynamic or psychoanalytic – stemming from Freud and Jung’s thinking about the unconscious – and humanistic or person-centred – focusing on helping the client find their own answers. All therapies have different emphases and have been developed as people discovered that no one method serves all people or meets all needs.

Research has consistently found that what makes the real difference is the therapist rather than the therapy. So, do some research, see what appeals to you, and trust your instinct as to how you ‘fit’ with a particular therapist and how the first one or two sessions feel. A good therapist will facilitate this sort of discussion.

The following are important factors in successful counselling and psychotherapy:
• a good working alliance between therapist and client
• a therapist who listens well and is responsive and flexible within reason
• a therapist who displays qualities of empathy, warmth and care
• an agreement between the client and the therapist on the goals of the work
• a client who is highly motivated for change and relief of suffering
• a therapist who can enable the client to experience calm if the client is highly aroused with anxiety or other emotion

A key point in dealing with depression and its recurrence is that it is our emotional reaction to our emotions that keeps them going and complicates them. We can exercise choice about our reactions when we have greater awareness and can fully engage our will to heal ourselves.

As practitioners and clients, we need to keep exploring better ways to find this healing and bring a natural, organic quality of enjoyment and engagement to our lives. A recent development has been to integrate insights and practices of Buddhist-based mindfulness, yoga and meditation with more traditional talking therapies. (See The Mindful Way through Depression, Freeing Yourself from Chronic Unhappiness by Mark Williams, John Teasdale, Zindel Segao and Jon Kabat-Zinn, Guilford Press, 2007.)

Many people are also helped by complementary therapies, an approach we promote at Wendy Bramham Associates. Acupuncture, homeopathy, massage, nutrition and chiropractic are all useful for different issues, so explore what appeals to you.

Whatever path of therapy you pursue, do your research and follow your own instincts, hints and leads. Each of us makes our own path by walking it, connecting and disconnecting with others as we do so. And if you feel so low that you don’t know where to go, ask yourself what might appeal if you weren’t feeling so depressed and follow that, maybe with the support of someone you trust. Therapy is a powerful tool for combating depression, so have courage to take the first step and seek help.

See previous posts on this blog for more information about types of therapy, the effect of life choices, how therapy helps and book recommendations.

We particularly recommend the following books on depression and how to live with and through it:
Depression – the way out of your prison, by Dorothy Rowe, Routledge 2003
Living with a Black Dog, by Matthew and Ainsley Johnstone, Pan Macmillan Australia, 2008
First Steps out of Depression, by Sue Atkinson, Lion Hudson, 2010
The Endorphin Effect, by William Bloom, Piatkus, 2011

Plus, on spirituality:
The Power of Now, by Eckhartt Tolle, New World Library, 2004
The Power of The New Spirituality, by William Bloom, Piatkus, 2012

And an audio CD for guided meditation:
A Meditation to help you relieve Depression, by Belleruth Naperstek, Health Journeys, 1993

Self-harm – BBC Wilts, by Wendy Bramham

SELF HARM

What a leads a person to self-harm?

Self-harming behaviours, such as cutting, scratching and hitting oneself, are often a physical way to deal with very painful psychological experiences and feelings of distress and isolation. Self harm can arise for all sorts of reasons such as grief, abuse, trauma, fear, loss and other feelings that are overwhelming. These may be from early childhood or in the present, or they may follow an incident that makes a person angry, frustrated or disappointed.

There is usually mounting tension followed by a compulsion or an impulsive need to self-harm. Some people dissociate (separate themselves so that they are not fully aware of their behaviour) from their mental and physical pain during the act of self-harm. Because others may see acts of self-harm as “deliberate”, unsympathetic responses can be a consequence. However, quite often a person is not very conscious of their reasons for self-harming and does not feel in control when they do it.

There are various forms of self harm, including cutting with a razor or knife, burning, hitting or banging your head, or over-dosing when it’s not life-threatening. It is often done in secret.

Self-harm has hidden short-term benefits for the person harming. These can include:

  • Release of emotions – getting them “out” can bring relief and decrease in tension
  • Making the mental pain feel real (akin to crying without tears, when the person can’t externalise their feelings)
  • Giving a distraction from, or a sense of pause, from the mental pain
  • Providing a way of telling others how bad you feel
  • Punishing the self for self-hatred and guilt

How does therapy help?

  • learning to manage feelings and difficulties in healthier ways, such as talking
  • exploring and understanding the circumstances in which the self-harm arises
  • understanding the unconscious conflicts and buried emotions underneath the acts of self harm
  • developing a capacity to contain, tolerate and think about distress

By: Wendy Bramham, July 2013
for BBC Radio Wiltshire

Remember:
Seek immediate help for any serious injury or overdose – with your GP, ambulance or A&E.

Helplines:

Domestic violence 0808 2000247
Bullying 020 8554 9004
Chidline 0800 1111
Homeless: Shelter 0808 800 4444
Samaritans 08457 909090
Drugs: Frank 0800 776600
B-eat (eating) 0845 6341414
Consumer Credit counselling services 0800 1381111
Mind 0300 123 3393

BBC Wilts – Eating disorders, by Wendy Bramham

EATING DISORDERS

An eating disorder is when an eating pattern starts to have a serious impact on your emotional or physical health, and on your day-to-day feelings. Typical categories include anorexia, bulimia and binge eating; many people will swing between all three, or not fit into any of these. Eating disorders are a form of addiction, and can be extremely difficult to relinquish. You can suffer from an eating disorder at any weight, i.e. you don’t have to be thin (only 10% of sufferers are anorexic; 40% suffer from bulimia; the remainder fall into binge-eating or non-specified categories).

Why does a person develop an eating disorder?
It is difficult to answer this question simply, and it is dangerous to generalise. Mental health issues involve a mixture of mind, body and emotions, and so are complex. Many psychological difficulties occur due to a mixture of genetics, early childhood experiences, personal and family history, and current life circumstances. Each individual will have their own different reasons and different avenues that lead to recovery.

  • Often an eating disorder begins in adolescent or teenage years, but not always
  • We are vulnerable if we are preoccupied with studies at school; are desperately trying to hold things together; are afraid of letting people down; feel that we must keep going; want to be high achievers; or feel deep down we must be perfect to be lovable
  • Onset may follow a stressful life event, such as trauma, neglect, a difficult relationship or a bereavement
  • Eating disorders are sometimes linked to anxiety about bodily changes during and after puberty and the onset of sexual maturity
  • Conflicting fears and wishes for independence and autonomy can be a factor. For example teenagers and  young adults naturally  need their parents’ support and affection and yet equally need to be separate and have their own relationships
  • Underlying issues may include low self-esteem, depression and anxiety, and these have a great impact on someone who is, for example, vulnerable to societal and media pressure to be thin. Such a person may not be able to find enough of an identity for themselves beyond such false/unrealistic comparisons
  • People who do not develop eating problems may be concerned about their weight but there are other domains in life that influence their self-esteem; these act as a protective buffer

The National Centre for Eating Disorder lists the following typical personality traits in eating disorder sufferers (http://eating-disorders.org.uk):
• Feelings of powerlessness, or worthlessness
• Sensitivity to imagined rejection or abandonment
• Poor assertion skills and difficulty managing relationships healthfully
• Perfectionist attitudes, and applying high standards to themselves whcih they would not necessarily apply to other people
• Poor emotional problem-solvers, tending to avoid life’s difficult situations
• Difficulty saying “no” or asking for what they want in life; tendancy to be “people pleasers” or go out of their way to be nice, but may have moments of aggression when things get on top of them
• Lack of confidence in managing relationships in a way that serves their needs rather than those of other people

An eating disorder can seem like a logical way of coping with some of the issues listed above. It is an attempt to regain a sense of control and safety when life or our feelings are overwhelming and chaotic, and because weight can be controlled it becomes an important source of power for the sufferer. Controlling food intake is often an attempt to manage feelings of anxiety, fear, helplessness, hopelessness and sadness, and additionally the disorder can become a useful scapegoat for all that is wrong with a person or their life.

Hidden Benefits of an eating disorder
 offers something that the sufferer cannot achieve elsewhere (eg control)
 a way of communicating something that can’t be done in other ways
 a way out of commitments or pressure
 due to the pressure to be slim (endorsed by fashion media) we falsely believe that if we have the “perfect” body we will feel more confident and life will be good
 helps us to feel we can cope when life feels overwhelming
 a way to rebel against parents, and assert autonomy

Stages
 Most eating disorders start from dieting
 A person begins to set very strict rules about “good” and “bad” food, which must be followed
 Meals with family and friends will be avoided, leading to withdrawal/isolation
 Strange rituals with food may occur
 Weight loss happens, and this may also be due to over-exercising and/or making oneself sick and/or taking laxatives
 People make themselves sick (bulimia) because they can’t keep up the strict controls over eating, and then resort to binge eating on the so-called bad foods. This leads to guilt, self-hatred and shame. Due to these feelings the problem can remain hidden from others for years.

How can you tell if you have an eating disorder? (see http://www.b-eat.co.uk)
 Do you ever make yourself sick because you feel uncomfortably full?
 Do you worry you have lost control over how much you eat?
 Have you recently lost more than one stone in a three month period?
 Do you believe yourself to be fat when others say you are too thin?
 Would you say that food dominates your life?

Serious health side-effects
Due to loss of muscle and electrolytes (important chemicals in our bodily fluids), the vital organs can be seriously damaged, including the heart which can become weak. This can lead to cardio-vascular disease and heart attack. Other problems include loss of periods in females, lanugo hair on face and upper back, hypothermia, infertility and osteoporosis. Tragically, whether intentional or not, people can and do die from eating disorders.

First Steps to Recovery
Shame, guilt and fear can stop someone from getting the help that is so vital to recovery. Admitting things have gone wrong is not at all easy but is the crucial first step to getting better.
Don’t try to manage this on your own. It takes determination, motivation and insight – as well as time and patience – to begin to recover. Get support from family, friends and professionals. See your GP and join a local support group or contact a charity such as B-eat – 0845 6341414 or ABC – 01934 710679. Alongside daily practical support, try to find a therapist who will meet with you for as long as you think you need.

How to find a therapist
Ask your GP for what is available in your area on the NHS. Alternatively look for a private therapist. It’s always good to get a personal recommendation if you can. Otherwise I recommend searching for a local therapist by going onto the British Association for Counselling & Psychotherapy (BACP) website – Its Good To Talk – http://www.itsgoodtotalk.org.uk/‎ – look for “accredited” therapists. Or try the UK Council for Psychotherapy (UKCP) http://www.psychotherapy.org.uk/‎ Then look for someone with whom you feel comfortable and understood, where your strengths as well as difficulties can be validated. It is common practice for the first session to be utilised to work out whether it is right for you. Try to gauge if you feel safe enough with this particular therapist to be open, honest and vulnerable. Trust your instincts.

Self-Help
Don’t just measure eating and weight as a sign of getting better. It is crucial to try to address the emotional turmoil beneath the eating disorder.

 Take a realistic look at how your eating disorder affects you in a negative way. Also be honest about the hidden benefits (as mentioned above) you might be subconsciously gaining from your attitude to food and eating. What is your eating disorder giving you? What need is it meeting in you? Then learn more positive ways to meet that need. This endeavour should probably be undertaken in regular therapy sessions with a therapist who is supportive and who also can see you as a whole person beyond your eating disorder, i.e. so that you can discuss your passions, abilities and begin to address your future hopes and ambitions.
 Get support from friends and family
 Join a local support group see B-eat or ABC as mentioned above
 Consider family therapy
 Read up on it and learn – become an expert
 Be honest with yourself and others; don’t put on a false façade and pretend that all is OK

Words from a recoverer: “Developing a sense of self after years of being detached from life was very exciting!”.

How does Therapy help?
 Provides a safe container for the dialogue that can begin to explore the underlying and sometimes hidden feelings, thoughts and circumstances behind the disorder
 Such an exploration is done in the context of a trusting, reliable, boundaried, non-judgemental working partnership over time
 Can increase a person’s ability to tolerate difficult feelings and also uncertainty
 Can increase a person’s capacity for self-awareness, self-acceptance and self-compassion
 Negative thinking is often rooted in disordered relationships. Therapy can offer a different experience of relating
 Can illuminate self-destructive thinking and core beliefs such as “I am not good enough”. Such thinking patterns can form a person’s identity and gives reasons for bodily attack

Parents/Carers
It is extremely hard to have to watch your child suffer and to be confronted with strong emotions such as anger and despair. Parents have a tough job because they are trying to be both supportive but are also expected to “supervise” mealtimes etc.

 Try to see the person beyond the eating disorder. Try to view the eating disorder as separate from your child.
 Because your child feels safest with you, it is likely they will vent their anger and other scary feelings onto you. Remember that intense feelings are triggered by the eating disorder and are often not personal. Try not to get into confrontations, get angry or use emotional blackmail
 Get support for yourself – this also teaches your child that it’s healthy to ask for help; it will also make you more able to cope with your child
 Draw limits for unacceptable behaviour – when things are calm make a plan with your child how you will both cope when times are fraught
 Encourage your child to get professional help and be part of the process
 Learn and understand about eating disorders
 Don’t ignore warning signs – encourage your child to talk, and listen to them
 Try to keep doing normal things together – without the eating disorder being the main focus
 Firmness needs to be combined with explanation and encouragement rather than threats or punishment

Statistics the from USA (Association for Anorexia Nervosa & Associated Disorders)

 More people die from eating disorders than any other mental health condition
 For women aged 15-24 the death rate from anorexia is 12 times higher than all other causes of death (American Journal of Psychiatry Vol. 152 (7), July 1995, p. 1073-1074, Sullivan, Patrick F.y)
 20% of those with chronic eating disorders will die prematurely from associated symptoms (www.b-eat.co.uk)
 On a more positive note – just under half of patients who get treatment will recover fully (www.b-eat.co.uk)

 

Wendy Bramham, July 2013, for BBC Wiltshire

Depression (blog 2) is a wake-up call – by Lindie White

In the second in our series on depression, pyschotherapist, Lindie White, writes about the causes of depression:

‘Every cloud has a silver lining’ and, as I wrote last month, with help we can make the cloud of depression our guide and our friend.

Proverbs carry much folk wisdom and the common sense we all share by virtue of being human. As humans we are hard wired for pleasure and pain and the whole gamut of emotions. We arrive in this world programmed to seek life, food, warmth, comfort and with the predisposition to attach and relate. How does the experience of depression sit with these facts? I wrote in last month’s blog about the experience of depression. This month I’m writing about the causes of what we call depression.

Depression is generally labelled a mental health problem and still carries a stigma although many well known people have spoken out about their own experiences: Stephen Fry, Richard Mabey, Monty Don and Will Young’s brother, who lives in the Newbury area.

The causes of depression are variously attributed according to how it is viewed. At one extreme, many psychiatrists name it as a chemical imbalance in the brain. It is seen as a physical illness and therefore comparable with other physical illnesses. From this angle depression is seen as bad, wrong and therefore something to be got rid of, treated and controlled. It is seen as a deviation from ‘the norm’. This begs the question, ‘What is the norm?’ We all know that ‘it takes all sorts to make a world’. Depression is widely seen as negative and, in the current Western mindset, negative is usually thought of as ‘bad’. In fact, negative and positive are like night and day, sun and moon, female and male. They are inevitable partners in creation.

Every sufferer knows that depression is not a purely physical affair. Why else would it carry a stigma? It is not seen in a similar way to a broken leg or cancer. The original meaning of suffering is ‘to undergo’. This comes closer to the mark. Most people who suffer from depression, and those who try to help, are aware that it is a part of being and staying alive. We are all happy and unhappy, we all go through the stresses of separation, illness, bereavement and change, more or less traumatic, in the course of our lives.

But not all psychiatrists approach mental health from a limited viewpoint. Joanne Moncrieff says: “If you want to understand mental disturbance, you have to try to understand how it is a response to an individual’s particular circumstances and history.”

Clearly there are extremes where the depressed person is severely disabled from participating in the flow of life. They are stuck. Dr. James Gordon, a Clinical Professor in the Departments of Psychiatry and Family Medicine at the Georgetown University School of Medicine, and Founder and Director of the Centre for Mind-Body Medicine in Washington, begins his book, Unstuck: Your guide to the Seven-Stage Journey out of Depression* like this:

“Depression is not a disease, the end point of a pathological process. It is a sign that our lives are out of balance, that we’re stuck. It’s a wake-up call and the start of a journey that can help us become whole and happy, a journey that can change and transform our lives.”

So, if depression is caused by being alive, being alive holds the answers to the questions it asks or masks!

Next month I will be writing about ways of being helped, and helping ourselves.

*Dr James Gordon, Unstuck: Your Guide to the Seven Stage Journey out of Depression, Hay House, 2008

See also the graphic novel-style books, I Had a Black Dog, and Living with a Black Dog, by Matthew Johnstone (Robinson Publishing, 2007), which use words and pictures to talk honestly about the experience of depression and of living with someone suffering from depression.

 

Lindie White, 2013