Primary Care of the Psychiatric Mental Health Client I

Self Harm: What is it About? Video Transcript

I love self-mutilation. Self-mutilation intrigues me. It really fascinates me. My heart is after the cutters. I hope that your hearts will guide you through this journey with me. How it can help individuals who self-mutilate.

Self-mutilate is not a new thing. The first case report was 1846, was published, about a woman who mutilate her eyes out of grief. And self-mutilation is not a female thing, both men and women engage in self-mutilation.

Women has a little higher report, men is more aggressive in their behavior. One in five women, one in seven men, a total of 2 million individuals engage in self-mutilation every year.

Self-mutilation, we all heard about Vince Van Gogh, right? Mm-hmm (affirmative), mm-hmm (affirmative), high school, yeah? He cut the lobe of his ears because he was upset with his roommate. Watch the connection between Vince Van Gogh and students from the upstate pharmacies from Greenville area. These students, college age students, cut the feature [inaudible 00:01:54] with a razor, geometric tops on the top of the foot, to release stress from final exams and relationship problems.

Football player from high school cut the thighs to release symptoms of depression. A [pharmacies 00:02:18] from the upstate got a promotion. Great, right, a promotion, everybody? Woo. Anxiety. Too much anxiety to handle. This individual do not attempt suicidal. Attempt to drill the head to release anxiety, not suicidal. I'm not talking about psychotic patients, or suicidal patients. I'm talking individuals like you and I, that use the cope mechanism of cutting, self-harming, to improve their life. Make sense?

Okay, I have the pictures by the way. I'm not showing, show these pictures here, because I do not want to exploit self-mutilation. It doesn't matter what I say, what research shows, evidence based research, there is several theories that explain self-mutilation. I'd like to go with you guys just [inaudible 00:03:26] three theories, okay, just three, to explain self-mutilation.

Let's see if it go right. Yeah. Constructivist theory, do we have some teachers here, teachers? Any teachers in here? Okay. So, teachers, we learned at your school, right? Mm-hmm (affirmative), mm-hmm (affirmative). Constructivism theory describe how the individual learn, and is through observation, and scientifically study how the individual learning.

This theory's going to explain like that. If the individual that went through punitive verbal, physical blows, instead of constructively caring words, they might not develop the capacity of self-worth, internalize love for others, and maintain sense of connection with others.

Now, let's think together. We are academic here. If I don't have self-worth, I don't love myself. If I cannot internalize love for others, I don't love myself, I cannot internalize of [inaudible 00:04:48] others, I'm going down here. I'm numb. I don't make connection with others. So, I cut myself I feel like I'm not numb anymore, even though it's just for a second, I feel alive. Makes sense, people? Are you connecting?

There is another theory that we call psychodynamic theory. This psychodynamic theory express that individuals shape their personality in the way that they learn. Okay, everybody follow me? This comes from psychoanalysis, uncover desires and thoughts. So, if I have a negative childhood experience, what's going to happen? I'm not able to communicate my feelings, I don't feel understood, and what happen? Fear of abandonment. I can't communicate my feelings, I'm not good enough, and I have fear that you're going to abandon me because I'm not good enough, because I cannot communicate with you, right? So, what you gonna do? I physically gonna cut myself for you. That's what's gonna happen, I have traumatic and chaotic relationship with others. Are you following me?

There is the last theory that I want to show you guys, biological reinforcement. Research show that most of the individuals who self-mutilate that they are dysphoric, they are depressed, they're sad. When you are sad, you have low serotonin, is a chemical in your brain. When you have low serotonin, you have increasing depression, increasing anger, and increase in self-harm behaviors. I am severely depressed, my life is numb, life sucks. I cut myself, what's happening? I increase my endorphins. Anybody runs in here, any runners here? Woo-hoo, runner? Yeah, yeah. Do you remember the high, the runner high? Mm-hmm (affirmative). When you cut yourself, they feel this high, the natural endorphins in our body that make us the good feelings, the high. So they cut themselves, reinforce the better. I feel better. Everybody follow?

Okay. So, now gonna be a blank slide, because I gonna talk a lot. I'm kidding. There is a correlation between self-injury and suicide attempt. However, pay attention carefully, there is total difference in the motivation. When you attempt suicide, I'm trying to end it all. When I practice self-mutilation, I'm trying to improve the moment. That is the major difference.

Self-mutilation. Individuals self-mutilation for different reasons. To reinforce a behavior, positive way. For instance, a coping mechanism. I'm too anxious, I cut myself, I release stress. I'm feeling numb, I cut myself, I feel better. Everybody follow me? And also, there is negative reinforcement. For instance, this week in the ER I have a patient, and I ask this patient you check suicidal, homicidal, depressed, we do all the lists. Then finally I ask the patient, two patients in the ER. I think that was funny because of today. So, I ask the individual why do you cut yourself. This individual gave me three beautiful answers. To release stress, I said hmm, good. When I feel numb, I said hmm. And the individual also said because I deserve it. I'm like, yeah he nailed it.

So, I told this individual now that you know why you cut, tell your doctor so they can help you. The other individual was just 11 years old. Major scratch in his arms, major. And I asked the kid why do you hurt yourself? Not know the answer, he just know that works. I told the little kid next time, if you do that, try to see how you feel before and after, and let your doctor know so they can help you. Makes sense now, are you making the connection?

Okay. How we can help them. First of all, be non-judgmental. No judgment, they don't need more guilt. It's not necessary. Example, my last example. I have a patient the ER last week, and I went through the checklist, and I finally ask why do you hurt yourself, why do you practice self-harming, self-mutilation? And the patient [inaudible 00:10:26] stated, I wanted them to understand my point. If I'm judgmental, I would say my gosh, real is so borderline, you know, like oh my gosh, drama queen, right? Like [inaudible 00:10:41], just confrontation behavior, she wants confrontation, he wants confrontation. No. Communication skills, because now we understand the theory, right?

Second, support. Give support, encouragement. You are not the doctor, you are not the therapist. Just give support. You are not the healer. Connect them with a support group and doctors, therapists, medical advisors.

And finally, educate them. Educate yourself like you're doing today how to help others. When I talk to my kids, I call everybody kids, because I'm old, I ask them to redefine self-mutilation with me. And that's one of my kids, we did together, how we redefine self-harm. That's our last talk. Hope, acceptance, restoration, mindfulness. That's how I see self-harm.

Thanks so much, kids, thank you.