At a recent training day we were given a fictional case study to consider for risk assessment. Consider this:
A young woman of nineteen cuts her arms. She cuts them with razorblades, on the inside of her arms. She uses clean blades. She usually uses bandages. She has had steri-strips, but never a stitch. What should our risk assessment say? What is it that we are trying to prevent?
“Suicide,” one person said.
“No,” said the trainer.
“More self-harm,” said another.
“No,” said the trainer, “actually, the fact that she self-harms is none of our business.”
There was a long, awkward pause while everyone got their heads round this and considered what the right answer might be.
“Accidental death,” another person said.
“Yes,” said the trainer.
Kudos to that person. I hadn’t guessed it.
There followed a plethora of further questions. How could a self-inflicted death be accidental? If she didn’t want to die, why was she cutting the insides of her arms? In fact, why cut anywhere at all? What is the difference between the risk categories of self-harm and suicide/ suicidal ideation? Was it all for attention? Why wasn’t it our aim to stop her from self-harming at all?
Throughout, on the inside, I was screaming: why don’t you get it? What exactly is so hard to comprehend? How can you even be in this job if you don’t know? I felt colour in my cheeks. I felt both exposed and annoyed. Compelled to speak but determined to stay silent. I stayed silent.
Later, calmer, I realised that I had been unfair in my thoughts. After all, they were asking questions to try to better understand. At least they were asking the questions rather than passing quiet judgements. And besides, it can be really difficult to understand something that you yourself have not experienced. I have always been an advocate of the “Just Ask” argument when it comes to myself and my mental health (ask me how I am. Ask me what bipolar means. The worst I can do is refuse to answer!) Yet there I was, getting prickly with people for asking simple questions about a topic they did not understand.
I wrote a while ago about how, until quite recently, I had found it very difficult to understand anxiety (in terms of the disorder, the day-to-day level of anxiety that some people experience). I had never been anxious in that way, certainly never been brought to panic, and though I sympathised and tried hard to understand my friends with anxiety, I had no real idea of what anxiety even meant. Until I experienced it myself. Similarly, I once had labyrinthitis. That was the only way I could understand what my friend, with Menieres disease, was really going through. A short-term experience of its symptoms lent me a better understanding when I learned about her illness. I had to be unwell: physically unwell (in the case of labyrinthitis), or mentally unwell (in the case of anxiety), to understand what another person experiences every day. And it was scary.
It doesn’t always take experience to develop an understanding. There are a lot of things for which I have empathy, even if I have never been in the other person’s shoes. Probably some of the people at training, the quiet ones, could understand self-harm. Maybe the fact that the woman’s self-harm was none of our business made sense to them. Maybe some of them even understood from experience. I couldn’t tell you; I don’t know; I cannot judge.
It was so easy for me to go against what I said before, to get angry with people for asking about the experience of self-harm (and it wasn’t even me answering the questions). So easy for me to be judgemental in judging others for being judgemental. I think it was partly because the subject had upset or embarrassed me. I think it was also because it brought up things that I myself had not understood until now: that sometimes, my self-harm had crossed over into suicide attempts/ ideation, and I had written it off as “just” self-harm because that was what it looked like on the surface of it. And the converse, that had my non-attempts ever killed me, it would have been “accidental death” and not suicide. These are things I had never really considered, things that I had not completely understood about my own life with self-harm. In getting angry with people for not understanding, I was masking the fact that there were things I did not understand. I was probably annoyed with myself, too.
So I reiterate: do ask. Always ask. A lack of understanding is dangerous and when you don’t ask, is when things can get dangerous. What you don’t know can hurt you. What you do know, you can work with. Don’t worry about people like me with occasionally thin skin. Be brave; understand what you can and be honest when you can’t. Whatever it is that you don’t understand: a word, a concept, a belief system: ask. I will, too.