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National SI Awareness Day -- March 1, 2002

You can have the basic fact sheet emailed to you. An accompanying brochure, press release, and list of suggestions for distribution are being prepared. A general information sheet for participants will have suggestions about who to target in your area; who to contact about getting permission to speak in schools; where to send press releases; ways to get the information out and stay anonymous; etc.

If you'd like to participate, please send email with your name, city, nearest large city, and activities you're interested in.

Old news

It was a cool meeting. There were about 30 people the first day and 20 the second. We had a couple of lawyers, a woman who's been involved with the Boston women's health book collective for decades [and for whom I am currently critiquing a chapter of her new book on self-harm], a philosopher, a prison sociologist, a few psychiatrists and psychologists, some mental health program people, a few consumers, the woman who publishes "The Cutting Edge," and me.

The goal was to produce a "vision statement" and specific recommendations for the Center for Mental Health about how to implement it. Dusty Miller was there, Esther Giller from Sidran was there, and as I said, Ruta Mazelis of The Cutting Edge was there. Favazza was there but left partway into the first day.

One of the things that was interesting was the people who had not been directly involved with this before talking about how they felt weird even reading a book about self-injury on the plane or telling people who asked what conference it was they were going to, and how people just shut down when they mentioned it. The stigma is incredible.

Some important things that I think were established:

• Practitioners have to deal with their own feelings of revulsion/fear/disgust/uneasiness about this behavior; patients shouldn't be coerced into stopping or signing "no self-harm" contracts because the doctor can't deal with the issue him/herself.
• Self-injury should be recognized as a coping mechanism that serves/served a legitimate purpose in the lives of people who do it, and treatment should not focus solely on the injury but also on the underlying causes. I do believe strongly that dealing with the self-injury in some way (mixing in new coping mechanisms and/or taking control of it) is essential so that work can be done on the underlying causes. But it's not enough to force someone to quit then say, "Okay, you're fixed!"
• Self-injury by itself should not be considered grounds for involuntary commitment.
• Emergency-room doctors need to be educated about the fact that people who self-injure and seek treatment for their wounds are not just doing it to make the doctor's life difficult and they deserve complete, caring, and humane treatment -- no more stitches without anesthesia, no more being told you don't deserve a blood transfusion, no more automatically being treated as an attempted suicide.
• A public awareness campaign using simple, direct language needs to be instituted to educate the general public about the nature of self-injury; it must be made clear that self-injury is not a suicide attempt and not necessarily a manifestation of borderline personality disorder or psychosis.
• Treatment needs to focus on a choice-based model, not a deficit model. The choices, culture (of self-injurers as a group and as individuals) and experiences of self-injurers need to be respected and validated when treatment is considered.
• Education for practitioners and the public should include booklets, a media campaign, and a national clearinghouse for self-injury information.
• "Forced treatment" is an oxymoron.
• Patients and practitioners need to be partners in healing, not superior/subordinate. People who self-injure need to be asked what works for them and what doesn't.
• Self-injury is often a means of communicating things that can't be spoken; one focus should be on helping people find more effective ways to speak what they need to say and on giving people a place to be heard.
• People need to realize that "safety" has very different connotations for us, that it is possible to cut/burn/hit yourself safely, that threats to the spirit and the soul freak most of us more than threats to the body.
• Maybe one reason this is more prevalent among women than men (besides women not being socialized to violence) is that men are socialized away from expressing their feelings. So a state in which feeling cannot be expressed, in which emotion has been invalidated, might be less stressful in those men who have been successfully socialized to not speak what they feel.
• The goal of treatment should focus on expanding the ways in which people who SI can express emotion and not necessarily on stopping the behavior as soon as possible by whatever means necessary.

There was more, and I don't know how much of this will make it into the monograph they're preparing, but I'm still really glad I went.

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