When is Enough Enough?
Melody Nolan, M.S.
If you are aware of someone engaging in self-mutilation, what should you do? It is an addiction, and it can be lethal. Friends, family members, and members of the mental health community I ask you: When is enough enough? When should you call 9-1-1?
There are so many reasons not to:
*My client will never trust me again.
*My daughter will hate me.
*My boyfriend will break up with me.
Then come the rationalizations:
*It really isn’t any of my business.
*I didn’t know what would happen over the weekend, but he walked into my office Monday morning, so hospitalization wasn’t needed.
*The cuts are very careful and deliberate; she would never hit an artery.
In my book, the potential of saving a life is more important than how a person will respond to my intervention. I prefer that someone hate me and be hospitalized as opposed to liking me and bleeding or burning to death. If the police are called to do a welfare check and one is safe, the officers will waive good-bye. No harm has been done. If one is taken to the hospital, he or she will be assessed prior to admission: if this person is not at risk, he or she will be permitted to return home. If, however, someone is a danger to him or herself, this person will be hospitalized for 72-hours. I ask you, isn’t this what should happen? If first the psychiatric response team of the local police department and then the mental health crisis team at the hospital deem an individual to be at risk for significant self-harm or suicide, isn’t hospitalization appropriate? It isn’t ideal, but I don’t have a better solution, do you?
Let’s continue with some rationalizations to which I do have a response:
They will keep him three days and then he will be right back in the same situation.
At least he will have been in a supervised environment for three days. He may also be given resources to assist him when he returns home.
They will change her medications.
Perhaps this is warranted.
Interacting with the police and possibly forced into the hospital is traumatizing.
It sure is! If your loved one simply wants attention (which, by the way, is generally not the case,) he or she will think twice before taking this path again. If there is a legitimate problem, experiencing this may lead to voluntary hospitalizations in the future.
As for you: the chaos created by intervening in threats and acts of self-harm is miniscule compared to what you will experience if the act goes too far, and whether by miscalculation or by intention, you lose your friend, family member, or client forever.
She hasn’t killed herself yet.
Personally, I have a higher standard for people than having them walking around with long sleeves, long pants, and in turtlenecks to hide the scars; stashing blades in backpacks and lighters under lampshades. The fact that someone continues to breathe and have a pulse is an illogical reason not to intervene, because should that person die, you forever lost your opportunity. In the event of permanent injury or death, it is crucial for those of us who are left behind to feel that we did everything possible to help the one who became a victim of himself or herself. The only way to do this is to call upon the necessary resources professionally trained in assessing and keeping people at risk safe, and that includes dialing those three numbers: 9-1-1.
Clinical and Statistical information from HEALTHYPLACE: America’s Mental Health Channel
Self-injury crosses all age, socioeconomic, and ethic lines. There are numerous reasons why people engage in self-abuse. Such behavior often occurs as a response to trauma. It may also be a comorbid condition accompanying diagnoses such as depression, anxiety, bipolar disorder, borderline personality disorder, as well as a variety of psychotic disorders.
Statistics regarding self-mutilation are below:
Each year, 1 in 5 females and 1 in 7 males engage in self- injury
Approximately two million cases are reported annually in the U.S.
90 percent of people who engage in self-harm begin during their teen or pre-adolescent years
Nearly 50 percent of those who engage in self-injurious behaviors have been sexually abused
Females comprise 60 percent of those who engage in self- injurious behavior
According to Harrell Woodson, PhD, director of the Menninger Hope Program which treats adults with mental illness, “Stereotypically people think that self-injury happens only among teenagers and young women, but it also happens with older, middle-aged females and males.”
The following behaviors are common among people who engage in self-harm:
Interfering with wound healing (picking or reopening wounds)
Punching or hitting oneself or other objects
Inserting objects into the skin
Purposely bruising or breaking one’s bones
Certain forms of hair pulling
Self-mutilation is usually not done with suicidal intent. However, because the pain that leads to self-mutilation is often the same that leads to suicide, it is reasonable to conclude that a person engaging in self-mutilation may be at risk for suicide. In addition, life-threatening wounds may occur during acts of self-injury “Self-injurious behavior can cause irreparable physical damage and can even lead to death, from cutting too deeply, getting an infection or going into shock,” says Dr. Woodson. Therefore, it is essential that treatment be sought from a mental health professional specializing in self harm.
If you or someone you know struggles with self-harm, please visit
S.A.F.E. Alternatives at www.selfinjury.com
or call (800) DON’T CUT (1-800–366-8288)