Jayel Kirby Sue Briggs English 2010 @ 10 April 10, 2014

CALLING CUT ON THE SELF-HARM SCENE

Its Time To Rewrite the Script
My red-haired, 16-year old daughter, Staci Kirby, stood before her high school health class to give a presentation. She began by doing something shed thought shed never do: she removed her jacket, revealing a black tank top beneath. Across her upper arms were dozens of self-inflicted cutting scars. I imagine thats when health teacher Sandra H. Catten realized that this was going to be a memorable student presentation: a self-harm addiction was being publicly outed.
Staci Kirby, 11th Grade

As a somewhat introverted teen at the time, Staci was acting completely out of character. But this was her second attempt to pass the class; she had to talk about something. The assignment was to pick a topic that affected herself or someone she knew. And since two of her best friends had recently ratted her out, she figured that if people were going to know what she was doing, she would prefer that they also knew why.

Slides from Stacis presentation

Staci reported that after class, it seemed that everyone was talking about her. Many students spoke to her personally. Feedback included sincere gratitude by students who were currently struggling with self-harm themselves. Unfortunately, there were some negative reactions, too: some kids would say that I had just done it [self-harm] for attention. This made me really mad (Kirby, interview, printed page 1). The most surprising response was a couple of weeks following the presentation, when Ms. Catten unexpectedly pulled Staci from another class and into a meeting with the school board, where she was asked to share her presentation. Afterwards, they told her that after a little tweaking theyd like her to present it to other schools in the district. Regardless of her tendencies to withdraw socially, Staci told them that she would. Yet, a couple of days later, she was informed that the project had been dropped. No explanation was given. Staci remembers how disappointed she was: I wanted to get the word out and educate people about self-harm (Kirby, interview, pp. 5). How I wish they had allowed her to share her story! Not because Im a protective mother who dislikes having her firstborns ideas rejected, but because I agree that more members of the community need to learn the facts about self-harm. We live in a contemporary society where

topics that were once unacceptable, like sex and gay marriage, are now openly discussed without apology. Why is the subject of self-harm still taboo? There are too many people who just dont understand the complexities of the issue. Misconceptions and harmful stigma dominate the selfharm scene. Education is tucked away back stage, refusing help to those who need it most. This is unacceptable. And it needs to change now. It is imperative that correct information about self-harm be made available to those who suffer from it, and to the people they associate with, so we can counteract injurious stigma. In Klinebergs survey, a 15 year old who had never experimented with self-harm, complained that she didnt like people who purposely hurt themselves. She believed that they were merely seeking attention and felt that those who were admitted to hospitals seeking medical care for their injuries were wasting doctors time. She reasoned that if they were going to hurt themselves, they ought to do it properly; that if they wanted to die or whatever, then [they should] just do it (7). This attitude is shocking; yet it can be expected so long as the complexities of self-harm remain
Slide from Stacis presentation

misunderstood. Self-injury is a very real and prevalent issue. Stacis presentation reported that 1% of Americans participate in self-harm (Kirby, presentation, pp. 1). But that doesnt reflect the true impact on our teen population. Emily Klineberg et al. report that as many as 7% of 15-16 year olds self-harm within one years time (2). That works out to be close to two students per typical classroom of 28. Since cutting and other forms of self-harm are ways of coping with difficult emotions that many teens dont know how to talk about, it is common for them to refrain from

disclosing their participation in it, or to seek out help. So, with a ratio of one self-harmer per 14 students, there are hundreds of anxious, isolated children in our communities in need of help. Admittedly, if it were true that those who self-harm were merely seeking attention, school-wide presentations would clearly increase the prevalence and thus be an unwise decision. But this is simply not the case. Staci was emphatic that most people who cut dont do it for attention, since most dont want other people to know. She complained that attacking them by saying, Oh, shes just doing it for attention, really isnt helpful (Kirby, interview, pp. 1). Actually, it is worse than not being helpful. Recent studies by M. Long et al. explain that such stigma, myths, and lack of understanding can perpetuate the cycle of shame and guilt among people who self-harm, which subsequently increases their dependence on the behavior (106). Another reason why the school board may have decided against having her share the presentation could have been due to the fear of an increase in suicides. This may have been a plausible concern if most students who self-

Isnt Isnt It It Just Just Another Another Way Way To To Describe A Failed Suicide Describe A Failed Suicide Attempt? Attempt?
No. No. Self-injury Self-injuryis is a acoping copingmechanism, mechanism,aaway wayto to stay stayalive. alive.People Peoplewho whoinflict inflictphysical physicalharm harmon on themselves themselvesare areoften oftendoing doingit itin inan anattempt attemptto tokeep keep from fromkilling killingthemselves. themselves.They Theyrelease releaseunbearable unbearable feelings feelingsand andpressures pressuresthrough throughself-harm, self-harm,and andthat that eases their urge toward suicide. And, although eases their urge toward suicide. And, although some some people peoplewho whoself-injure self-injuredo dolater laterattempt attempt suicide, suicide,they theyalmost almostalways always use usea a method methoddifferent different from fromtheir theirpreferred preferredmethod methodof of self-harm. self-harm.

harmed ended up killing themselves. Again, Staci explained that this fear is unfounded. Somebody who is suicidal doesnt see that they have a future. People who self harm are looking for stress relief; so that they can continue their lives (Kirby, interview, pp. 1).

Slide from Stacis presentation

Granted, Long reported that 40% to 60% of those who

commit suicide have a history of self-harm (111). Yet, Long followed-up with a quote by J.R. Curtliffe et al., emphasizing that [t]here is a wealth of empirical evidence that shows that 95% and over of people who self-harm do not go on to take their own lives (111).

Perhaps school board members were afraid that discussions on the topic would plant ideas into otherwise innocent minds and increase its prevalence. But, insightful discussions arent the danger; its the availability of unscrupulous blogs. Being tech-savvy as many youth are today, teens often turn to the internet to satiate their curiosity. While there are a number of helpful self-harm sites, there is also a plethora of addictive blogs which, as Alexandra Topping noted, present a surreal world of fantasy and pain (pp. 2). In Toppings article, Helen, who is now 18 and has stopped self-harming, explained, It starts out as trying to help, but you get sucked into this world of who can cut the deepest/be the skinniest and avoid notice by the outside world (pp. 2). Such blogs - not educated discussions - are virtual landmines. Teens need to be surrounded by competent, caring peers and adults that they can go to for factual information and support. Schools are an excellent place to reach children who are at the age of highest risk. A study by Rhiannon Phillips et al., stated that adolescents have emphasized the importance of the school setting in preventing self-harm (7). Parents and other family members should also be a dependable source of assistance. Yet, how can educators and parents be expected to comprehend the complexities of self harm when there is a drought of sufficient information even among professionals? In a 2009-2011 study, Nienke Kool et al. surveyed 178 mental health care staff members. They reported that only 4% had previously received training for self-harm. This is a disturbing observation, declared Kool. Without focused training on self-harm, there is a risk of inadequate care which may lead to greater dissatisfaction and avoidance in care (pp. 12). If Only

4%
Of Mental Health Care Providers Were Trained In Self-Harm

so few people in our society have the answers, where are desperate adolescents going to turn? Back to those poisonous blogs! It is evident that a program needs to be implemented that can help educate mental health professionals, educators, parents and students alike. I propose that such a program be initiated that educates health professionals across the board and is also presented in public schools to students, faculty and willing parents. As part of this proposal, I suggest that self-harm education begin with students as young as 12 years old. Why so young? A study performed by Paul Stallard et al. revealed that girls in 9th grade were more actively involved with thoughts and acts of self-harm than those who were in 8th grade (pp.7). How old are 8th graders? 12 and 13. It stands to reason that the earlier intelligent self-harm discussions are taking place in childrens lives, the more self-harm addictions can be prevented, for as Benjamin Franklin put it, an ounce of prevention is worth a pound of cure. Kools study amongst mental health professionals included an excellent example of an effective educational presentation. Their program involved an art exhibition in a central location that ran for several weeks prior to the training, where pieces of art had been created by artists who had a history of selfharming. A survey was then performed, followed two weeks later by a full day of training. After participants were given the
Art exhibit entry, Self Harm by Mimi Newbon, et al. Self learned for three weeks, the initial training was followed-up by additional training. All training

opportunity to practice what they had

was presented by what Kool referred to as a lay expert (someone with personal self-harm experience) and a trainer with a nursing background. The content of the training is outlined below (pp. 5):

Table 1 Content of the training

Day 1 (full day) - Introduction and acquaintance Emotions and reactions, individually and within the team Dilemmas - Communication about self-harm Discussion of the art objects Lay experts experiences - Theoretical knowledge about self-harm - Communication and building a relationship Cooperation Exploring needs and alternatives for selfharm - Communication and recognition of early signs Triggers of self-harm Early signs (thoughts, feelings, behaviours) - Communication and cooperation Early intervention plan - Evaluation and homework assignment Drawing up an early intervention plan with a patient Discussion of self-harm within the treatment team Day 2 (half day) - Looking back on day 1 and the period between day 1 and today Did anything change in the participants feelings about selfharm patients? How did this influence the participants attitudes and behaviour? - Discussion of homework assignment: Early intervention plan: difficulties and dilemmas Team discussion: reactions of the team. Did it lead to a collaborative approach of self-harm? - Discussion of practice situations - Role-playing to practise communication skills

- Evaluation and closure

I was intrigued by the fact that Kool addressed the significance of involving lay individuals who have struggled with self-harm themselves. This was reiterated several times throughout their research article and was summarized in their conclusion: [t]he deployment of lay experts is essential here (pp. 2). In Kools evaluation table

below, the importance of combining lay experts with trainers is again reinforced, as trainees listed this aspect as the highest scoring statement (pp. 10):

Table 4 Evaluation of the training

M N I found the combination of lay expert trainer and professional trainer instructive 4.74 268 I found the trainers qualified 4.60 268 The trainers complemented each other 4.57 268 The trainers answered the questions sufficiently 4.54 268 The attitude of the trainers stimulated me to reflect 4.49 268 Training was practical 4.11 267 I found the feedback day instructive 4.10 267 There was sufficient variety in the training methods 3.99 267 The training lived up to my expectations 3.97 267 The intervention programme is practical and useful 3.94 264 I behave differently with self-harm patients as a result of this course 3.81 264 I learned a lot by practicing communication skills 3.67 206 The length of the training was good 3.62 268 I found the homework useful 3.46 235 I need a follow-up training 3.36 262 Note: meaning of the scores: 5 = totally agree, 4 = agree, 3 = neutral, 2 = disagree, 1 = totally disagree.

Although this seminar was offered only to mental health professionals, it could be adapted to include a slightly briefer public/private school implementation. I like the idea of offering a pre-training art exhibition. Imagine! Students from all walks of life witnessing a selfharm art exhibit created by their peers, as Kool suggests, expressing feelings of intense emotional pain and loneliness, which are the emotions that occur most frequently in patients who harm themselves (pp. 4). I find it difficult to believe that such an experience would leave anyone unaffected. A few days later, while the emotional reaction to the exhibit is still fresh, the program could begin with someone who has had self-harm experience sharing their story as the keynote address. Then students and faculty (and parents whove elected to attend) could learn facts about self-harm by attending break-out sessions led by both medical and lay experts, covering various topics. It is important that these workshops be as interactive as possible, as

encouraging participation can help maintain teens attention spans. It will also help attendees to internalize what they are learning. The influence that a program such as this could have in building a greater understanding of what students who self-harm experience would be phenomenal. When the school board met that autumn day in 2005, the troupe decided not to allow Staci the opportunity to aid her peers, and most-likely help herself in the process. As stated before, we dont know what line of thought they were following. What we do know, however, is that the current manuscript is failing the principal players. It is evident that implementing a self-harm education
Staci, recovered self-harm addict. Dec. 2013. By Farris Gerard

program that involves the participation of those, like Staci, who have experience with self-harm in schools and within the medical community - could have a profound effect. It shouldnt be taboo to educate and provide compassionate assistance. When I consider the universality and the immediacy of the current self-harm scene, and the multitude of characters who needlessly feel tormented and isolated, I join with Long, and ask, [i]s it time now to rewrite the script? (112, emphasis added).

Works Cited
Kirby, Staci. Personal interview. 6 Jan. 2014. Kirby, Staci. Self-Injury. Sandra H. Cattens Health Class. Cottonwood High School, Salt Lake City. Fall 2005. PowerPoint presentation. Klineberg, Emily, et al. How Do Adolescents Talk About Self-Harm: A Quantitative Study Of Disclosure In An Ethically Diverse Urban Population In England. BMC Public Health 13.1 (2013): 1-10. Academic Search Premier. Web. 26 Mar. 2014. Kool, Nienke, et al. Improving Communication And Practical Skills In Working With Inpatients Who Self-Harm: A Pre-Test/Post-Test Study Of The Effects Of A Training Programme. BMC Psychiatry 14.1 (2014): 1-17. Academic Search Premier. Web. 26 Mar. 2014. Long, M., R. Manktelow, and A. Tracey. We Are All In This Together: Working Towards A Holistic Understanding Of Self-Harm. Journal of Psychiatric & Mental Health Nursing 20.2 (2013): 105-113. Academic Search Premier. Web. 26 Mar. 2014. Phillips, Rhiannon, et al. Could A Brief Assessment Of Negative Emotions And Self-Esteem Identify Adolescents At Current And Future Risk Of Self-Harm In The Community? A Prospective Cohort Analysis. BMC Public Health 13.1 (2013): 1-11. Academic Search Premier. Web. 26 Mar. 2014. Stallard, Paul, et al. Self-Harm In Young Adolescents (12-16 Years): Onset And Short-Term Continuation In A Community Sample. BMC Psychiatry 13.1 (2013): 1-25. Academic Search Premier. Web. 26 Mar. 2014. Topping, Alexandra. Self Harm Sites and Cyberbullying: The Threat to Children From Webs Dark Side. Guardian. 10 Mar. 2014: n. page. Web. 2 Apr. 2014.