Hello -
As has been said I am Graham Morgan and I am the Advocacy Project Manager for Highland Community Care Forum.
Highland Community Care Forum exists to give voice to carers and users of community care services. In my project we work with members of HUG, the Highland Users Group. This is an advocacy group with 250 members, which represent the views of people with a mental illness.
We also work with People First, a network of 6 groups in the Highlands representing people with learning disabilities. We are just starting some work with the deaf community and also have a role in the development of the different forms of advocacy across the Highlands. Perhaps, more importantly from your perspective, I am also a user of mental health services.
In my early twenties I was diagnosed as having a personality disorder and spent some time in a world where I self harmed and eventually made a suicide attempt. In my late twenties I became psychotic and was eventually diagnosed as having schizophrenia. At this time I also self-harmed.
In the next half-hour I intend to talk about self harm. What it was like and why I did it; my suicide attempt and why it was different to self harm; and also the different experience that I had of self harm when I was psychotic.
I hope also to draw in some elements of the HUG report on "Suicide" that we produced some years ago, and my experience of coping with the self-harm and suicide of those around me in my role as a worker.
In HUG, a huge part of our work is in raising awareness. We take the attitude that when we talk about our own personal experiences we are talking about just that - our experience. Some of the things that work for us may work for others, some of the feelings that we have may be common to others but we do not pretend to have the definitive experience or answer to the, sometimes, horrific things we go through.
Anyway, to start off with self harm:
I will start off with a time around when I had just completed my first year at university. I was a very shy, very awkward, confused and arrogant young person.
I had no idea who I was, what I believed in, how to react to other people but at the same time I didn't really realise this. I tended to see other people as the source of my problems.
In the year before University I had spent part of my time in Israel on their northern border when they had invaded Lebanon. Because I had had fleeting glimpses of guns and rockets I liked to think that I had been moulded into a man of wisdom before my time.
- and yet I found it hard to walk across a café without thinking that everyone was looking at me,
- I had no idea how to speak to people without being full of intensity
- I found women frightening and confusing
- I wondered around university in straggly untidy clothes
- I sat on the edge of radical groups and had arguments with them
- I sought out born again Christians to try to convert them to atheism!
- I railed against my family, my public school education, my university course and tried to make sense of a world that I found confusing
For me there was no sense and no meaning to anything, I was deeply unhappy. Unhappiness was a pit in my stomach; it was an ache of unshed tears. In trying to make sense of it all, to my alienation, my loneliness, my anxiety, I put all my sadness down to my lack of a belief in a god. I cultivated the philosophies of nihilism and existentialism without ever really understanding them.
Life became increasingly grey. The days became treacle to wade through and its sweetness tasted of ashes. The learning I was meant to be doing at university became an irrelevant burden that loomed over me. My smile was only ever a half smile. I became sadder and sadder and more and more lonely and miserable. Days stretched and merged into each other until they became an uneventful blur and slowly but insistently the idea of suicide grew and grew in my mind. It seemed the only logical, sensible option to a pointless stay on our earth. It also seemed a romantic and bitter blow to the world and people around me that I could not get on with. I could see no way of gaining any purpose to my life.
There seemed to be no future ahead that beckoned with any warmth. I was lost in myself and in my vision of myself. Friends, family, work and pleasure did not even scrape the surface of my conscience, they became irrelevant in the world that I was finding I lived in.
I began to carry knives around with me. I began to plan how to die. I told the people who I knew that there was no point to anything that we did, and one day I summoned up all my courage and misery and failed abysmally to try to kill myself. I spent a weekend with a packet of razor blades and a lot of alcohol. I intended to cut my wrists but I couldn't. It was so frightening, so sickening, so final and so desperate.
As I held my razor blade my skin felt like it was covered with ice, my heart raced, my stomach felt empty and my hands trembled.
Over the weekend I made a series of scratches across myself that became more and more easy once I started. It felt like I was giving room to all my unhappiness. Blood welled up and slid down and yet I felt both deeply angry and ashamed that I couldn't kill myself and deeply shocked at what I had done.
That weekend signalled a turn in my life. It signalled entrance into a world of people and services that are defined by such acts, where such events are the bread and butter of every day life. It also meant that I began to take on the mantle of a new place in society, gaining a new vision of myself which slowly began to reveal itself as someone on the edges, someone with problems and labels.
The people in my house were the first people that I told about this. They were very helpful, very concerned, very upset and very clear that I needed to see a doctor. I also knew that I should see a doctor but the threshold of the surgery was so hard to cross. It was so frightening I didn't know how to say what I was feeling, I didn't even know how to ask for an appointment.
I sat on the wall outside. I walked up and down, and I stood still. I told myself I had to go in. I bullied myself to go in and eventually I crossed over and the reception staff who had seen me hesitating for so long sent me straight in to see the doctor without having to wait in the waiting room. That was so good. I couldn't have faced the wait in the waiting area and over the coming months found that place to be one of the hardest to endure.
I couldn't speak to the doctor. I had lost my words, my expression. I just pulled up my sleeves and showed him my wrists and he took control and reassured me and arranged for me to go to, what turned out to be, a student hospital for a while.
The time out and the access to understanding people, whether they were nurses or patients, was great. It also gave significance to what was happening to me. I found it difficult to believe that I was ill or deserved help, but this showed that other people saw what I was going through and thought that something needed done. I stayed there for a time and then left to return to my house.
Nowadays we make a great distinction between self-harm and suicide but in those days I didn't see any difference. At home I continued to want to die. I would wake up and wonder if I could kill myself that day, go in to hear my lectures and then come home and cut myself and always I wouldn't cut myself enough.
I would visit the doctor weekly but I could hardly talk. To express myself was always so hard. I tried writing down my thoughts but I didn't know what I thought or believed. I tried to rationalise the way I was feeling now with my past life. I dearly wanted to know why I was doing such things - in fact many of my writings and pictures that I gave the doctor were one long "why", but I didn't know why I was asking the question. I was bewildered and lost in my own confusion.
At each visit to the doctors I would sit in a jumble of whirring thoughts, so frightened of those around me in the waiting room that I would often mishear my name being called and barge into the previous patients session.
I was always hoping that there would be some breakthrough in what I was experiencing. I think the mythology of psychiatric couches and of the detectives of the catharsis of hidden trauma has caused people like me a lot of damage. It was inevitable that with the anxiety and high expectations that I held for these visits, that there would always be a let down as I walked home because of course there never was or could be an easy solution.
Sometimes I think the doctor who saw me was as confused and as frustrated and bewildered by me as I was myself. He gave such mixed messages. Sometimes he would promise me (whilst banging on the table) that life would one day get better, that one day I would end up living in a rose covered house with a loving family. At other times he would say the opposite. That what I was going through was a fundamental part of my character and that I had to adapt to a life that would always be hard and would always be unhappy.
Sometimes he would say that he would not see me any longer if I carried on cutting myself and then when I did carry on and arrived waiting to be thrown out of the surgery, he would reverse his decisions and tell me that he knew all along that I would have carried on in this way.
Despite this, despite the fact that he was much older, that he didn't really seem to understand how I could feel or how I felt, and despite my belief that someone somewhere would one day step in and cure me of the anguish that my life held, the fact that the doctor was there was a great help. To know that there was someone who would listen even when I couldn't speak, who was there to hear and try to understand what I was going through and who did not look on me as a bad person. This constancy in my life was something that I held onto like a leaky life-raft
Over time I did begin to realise that I was not going to kill myself and self-harm began to become almost a ritual. I would prepare for a session when I knew I was going to cut myself and also knew that I was not going to try to kill myself. It was almost something that I had to do and had to get through.
In later years the conversations with other people who had done similar things helped me get a better understanding of what I was doing. It was the most graphic way of expressing how I felt.
Words were an entirely incompetent mechanism to talk and give expression to the slack empty sadness of a life that seemed to stretch onwards in pale shades and with little relief. Whilst, in contrast, the shocking presence of blood and later on pain allowed for expression, release and some way of maintaining a tolerable existence. It was a way of coping with a life and a pain that I found hard to endure.
In those days nothing touched me and no one could reach me. I was away, a hundred miles from the presence of those who might be affected by what I was doing. Eventually I stopped coping altogether, I gave up.
There were no other options. It seemed to me that everything was too painful. My life had become a prison from which I wanted to escape and so one night I finally took the decision to commit suicide. I took an overdose of paracetomal and aspirin washed down with whisky over the course of an evening.
It was so frightening once I had done it.
Going to bed having swallowed lots of pills and alcohol was very hard. I was thinking that this would be the last night that I would experience.
At one point I woke up and was sick. In the morning I woke up very much alive but not feeling very well at all.
I didn't know what to do so I made an appointment to see the doctor, which led to me being admitted to a general hospital and then later on to a psychiatric hospital. In those days treatment was a lot worse than nowadays. I was interviewed and asked about my overdose in front of other patients. I was never told how ill I was. I was shifted from ward to ward and as a final broken straw, was called by another name after they put the wrong name on my notes before transferring me to the mental hospital.
I was now at last in touch with psychiatric services, which was something that my doctor had been trying to arrange for some time. I also had wanted to see a psychiatrist but to admit this even to myself was very, very hard. It signified so much about myself, about maybe being ill when I found it hard to believe that I was, while at the same time half wishing that I was. About being dependent, about having control over my destiny - both having it removed by putting myself in someone else's care and also reluctantly gaining it by asking for help when I couldn't bring myself to.
It also meant that I had acknowledged within myself that I wanted to get better when I wasn't sure there was anything wrong, or that if there was, that I wanted to change it. This way, when help from mental health services stopped being an option, was for me a way of getting assistance without having to admit to myself that I needed it.
My time in hospital opened my eyes to life. It was an old hospital in the process of shutting down. It was shabby and neglected and nothing like I had expected.
My parents found out that I had been admitted to hospital after a benefit's form was sent to their house. I will never really understand what they went through when they found out why I was there. I blamed them for a lot of my unhappiness and refused to see them. In those days I had no concerns for their feelings. I had no interest in them at all. Nowadays I think that it must have been almost unbearable when I think how much I worry over the life of my son. I just see an echoing wound of reproach, a terrible, terrible pain that must be so awfully hard to bear and recover from.
Sometimes I meet parents whose sons or daughters have attempted suicide and I see the pain that this has caused. For me my only message is that when I got to such a state it stopped being possible to see clearly and those that were around me were only seen through a mist of incomprehension. The effect that I was having on everyone else was not something that even came into my world.
I think that that must have been part of what was going through my friends' minds when, after celebrating my release from hospital, they surrounded me, pushed me against a wall and threatened to beat me up if I didn't explain to them why I could do such a thing. I think that they felt deeply betrayed and offended and incapable of knowing how they could adapt to this situation or help me with it.
What got me through to the other side of this is hard to tell. The fact that I had access to a good doctor and a very strange and uncommunicative psychiatrist (who seemed to specialise in silent interviews), probably did help in that I knew they were there if needed. But for me there were some fundamental changes in my life that altered how I saw life around me.
First of all I do think that time heals. It is a balm even if only because you grow used to the pain. It can become a companion with which you are familiar and to which you can adapt and grow used to. I also found something to do. My experience in hospital had opened my eyes to the things that people were going through, both to their distress and the injustice that they were facing.
I became a volunteer with a mental health organisation whilst still a patient. This transformed my life. I had something to do. I kept occupied in such a way that I couldn't dwell too much on myself. I felt as though I was needed and wanted and useful and that I had something to give and some purpose.
I met people who had been through similar experiences to mine and found that I was not as alone as I thought I was. I also began to find a cause in which I believed and in which I could participate. I met a few people and made friends with them. Having company, having a meeting of minds, meeting people with whom I could stay up late at night and solve the problems of the world, having friends who were not shocked at all at what I was going through, was really, really great.
The thing that really took me through to a place of happiness was meeting and marrying my wife.
The healing power of love is probably sneered at nowadays, but to know that someone cares for you deeply, that they find you attractive and interesting just as you do them, to run into each others arms, to want to be with each other as much as possible, does not fit into a world of self loathing.
I entered a world where life was all about living. I will never forget how happy I was skiing through the forest with my wife, with the blue sky and the sparkling glitter of crystals of snow, or sailing in the Atlantic looking at the stars and the dolphins and the flying fish swaying to the motion of the boat or walking in the mountains, or camping in a sandstorm in a desert, or looking at the temples in India or just enjoying making a lovely meal together. I was tremendously lucky and privileged to do such things and meet such people.
Such things gave me a life happier and more fulfilling than I could ever have imagined. People had told me when I was at my lowest and saddest that life would be better one day and that the unhappiness didn't last forever and I had found this impossible to believe. I had found their optimism both laughable, unrealistic and patronising and yet not that many months later I had left despair a long, long way behind me.
However, life is no fairy tale and we don't live happily every after. In my late twenties five months after my son was born I became quite dramatically psychotic and our world turned over and shattered in its expectations. For a couple of years I was quite often ill and I ended up being diagnosed as having schizophrenia.
One of the main things that I went through when I was psychotic was an obsession that I was evil and that my blood was filled with bad spirits. I felt that people could read my thoughts and that the spirits that swarmed in the bright reflections of a summer's day were warping and altering my thoughts.
In the world that I was living in I thought that the only thing that I could do was to release my blood and the evil spirits in it in some place of "safe energy" where they would be neutralised. For me the woods and the trees with their peace represented a safe place. Just before I was admitted to hospital, late one evening when my son was fast asleep in bed, I told my wife about my spirits, the fact that they were evil and that I was going to go to the woods and cut my wrists.
The world that people like me sometimes live in when psychotic can be seen as a horrible place, a place of fear and confusion and distorted realities, but when I left her and set off for my woods I think my wife was in a far more frightening dimension.
To see someone you love living out a reality that bears no connection with your world is something that is so hard to adapt to. It is as if all the foundations on which you have based your life have been shaken and twisted. When certainty and familiarity have become alien you can lose all your ideas of what to do or how to act with your loved one. There is nothing to grasp hold of except that life, in the space of a few days, has lost the glow of happiness and been replaced with uncertainty and pain.
I didn't hurt myself very much that evening but I was admitted to the psychiatric hospital the next day after having a seen a GP. I was completely obsessed with the spirits that were around me and in me and thought that if anyone touched me that I would infect them with my badness and corruption. I thought I had to rid the world of the evil around me either by getting rid of the blood that was in me or by electrocuting myself. I spent my time on the ward telling the nurses that I needed to go to the woods to cut my wrists, but they would not let this happen which I found incredibly frustrating and hard to understand.
One morning in the hospital I decided that if I could make certain patterns on my hands then maybe the spell I wove would stop the progress of the spirits that was so painful to me. I started burning patterns onto my hands by stubbing cigarettes out on them. It didn't hurt me very much and no one noticed what I was doing at first except for one nurse who I told I had warts when she made a puzzled query at the sight of my hands.
Not long after lunch on that day I realised that I would not be let away from the hospital and decided to escape. I left the ward by hiding behind a lunch trolley and ran to the woods where I climbed a tree in the hospital grounds.
Sitting on the branch of the tree I made a deep cut in my wrist. It was so frightening and so ugly, and it was at that point where I realised what I was doing. Psychosis is very strange but it doesn't mean that you lose all reason. At that point I became very frightened and spent a long time trying to work out whether to continue to cut myself or to stop. I chose not to. I threw my razor blade away and walked back to the ward wondering what on earth I should be doing.
I met one of the nurses and was taken to the nurse's station where there was a big kerfuffle. I was still very unhappy about anyone touching me because I thought they would be damaged by contact with me and yet they had to stitch my cut and dress my burns. I remember the doctor in particular being very angry and frustrated at my behaviour.
From that point I was put on special observations. All the things that I could damage myself with were taken off of me and a nurse was put within arms reach of me 24 hours a day. At first I still managed to burn myself occasionally when I was given cigarettes, but gradually I stopped doing this. Being "specialled" by the nurses was very, very frustrating. I felt so trapped, so intruded upon, any pretence of privacy had gone.
I think that it was very hard on all of us. I was beyond human companionship at the time and yet at the same time felt incredibly lonely and craved company and solace. I felt sad and bad and unhappy and although the nurses tried hard, they were variable in the company they provided. Some were brilliant. You could feel the warmth of their compassion. Others were nervous and frustrated which caused tension and others were clearly just doing a job they had been told to do which only served to increase the feeling of isolation and loneliness that I had built up around me.
The first time I was put off being specialled was amazing; too walk around, to smoke a cigarette without asking. It was just great. I was still not allowed off the ward though. I remember the door of the ward became a symbol of freedom to me. I would walk up and down the corridors passing and passing the door that I was not allowed out of. The first time I was allowed through that door without a nurse accompanying me is a particularly sweet memory.
I think that there are a number of things that strike me from that experience.
First of all that it was completely different to the other times that I had self harmed. What I was doing was neither an expression of pain, nor a means of coping, nor an escape.
For me it was a logical action to take in the reality that, at that time, had most bearing on my thoughts. Somewhere in the back of my mind I knew that I was in a position to do myself a large amount of damage but for most of the time I thought that by damaging myself I was protecting the people around me and those that I loved.
I think that the action that was taken to prevent me hurting myself was very reasonable, even though it didn't feel so at the time. I feel that hospital, though a dispiriting lonely place, was an appropriate place of refuge for the time and much as it pains me, I feel that the large amounts of medication that I was on both helped me cope with the times that were unmanageable and also eventually pulled me out of the frightening world I had come to live in.
What I do wonder sometimes, though, is whether I would really have harmed myself in the way I said I wanted to if I had been free to? There was that moment when I chose not to cut myself any more. Sometimes I wonder whether hospital with its cocoon of safety and protection allows us the safety to express ourselves and damage ourselves in ways that would be too risky in normal society.
To an extent this is illustrated by the two other times that I became acutely ill. On both occasions I stayed at home and on both occasions my reality was alien with the devils and the spirits surrounding me. On both occasions I would circle my cigarettes above my hands to burn myself and always I would talk of cutting myself, and always the sight of the pain that I was causing my wife stopped me doing what I wanted to do.
The tears and anger of the person I loved kept drawing me back into a reality that I would not have been able to sustain if I had agreed to go into hospital where such intensity didn't exist.
Those times at home were one of the hardest times and hospital a huge temptation. I think that emotionally we suffered greatly, my wife especially, but I didn't harm myself and my illness was intense for a matter of weeks rather than months.
What can I draw from what I have been saying? I suppose that self-harm and attempted suicide are very different, and that the self-harm caused when psychotic, is also very different. But also more generally that many of us cannot believe we are ill and need and deserve help. It can be very hard to agree to see people from mental health services, both because there is a shame in admitting to illness and not coping but also because services have an image that can discourage contact.
Also the degree and depth of our sadness can prevent us from seeking out services when we need then or even in believing that they will be able to help in the first place.
When we are young services may seem disconnected from our lives, and that once you have made contact with services that knowing you have access to professionals when you need them, is very important even when they do not seem to be helping.
The effect of these actions on those around us can be devastating.
Feeling useful, needed, loved and occupied can take you out of the world of self-harm.
Sometimes the appropriate response to self-harm is to see it as a coping mechanism, whilst at other times we clearly need interventions to stop the damage that we are doing from happening. Access to a safe place when distressed is very important. It is important to be able to make our own sense out of what seems to be such an illogical and destructive act.
We need to find our own solutions but this can be a very lonely journey to embark on and company can be appreciated. Above all, from my point of view is to be given the possibility to believe that life can get better - that it is right to dare to hope.
For me now, I have a superb life. I live in a beautiful place. As I write this I can look out past the cherry trees and the larch trees to the field with its rabbits and horse, to the river and forest beyond. I have a good income, I have a family that I love, and I do work that I love. I am around people that I respect and this is something many people do not have and when the struggle to find belief in yourself is made harder by poverty, poor housing, unemployment and discrimination, it is easy to see why people may struggle so much.
However for me nowadays, I find it hard to even contemplate the fact that I could ever become suicidal again. It seems such an alien thing. There is so much life to be lived and savoured and appreciated.
I do occasionally have symptoms of illness. Sometimes I become very unhappy, sometimes I feel that people can read my thoughts, sometimes I feel that inside me I remain rotten and corrupt but these are feeling that I am used to and can manage.
I have no strong wish any longer to self harm but in the back of my mind razor blades remain in some perverse way a symbol of safety for the dreaded possibility of life becoming unmanageable again. I have talked about my experience of self harming and attempting suicide. However in my job and the work of many of you too, self harm and suicide is a routine part of our experience.
I have lost count of the number of people that I know who have felt suicidal or who have self harmed. It is strange that such a desperate thing can become a routine in our lives. We are, I hope, slowly coming out of the dark ages of the treatment of such people. However we all know that in the recent past at least, people have been routinely been made to feel worthless in Accident & Emergency departments and hospital wards.
People have vivid memories of being regarded as time wasters, attention seekers, manipulators - of being less important than people with more conventional illnesses or injuries, of being wicked or evil or immoral. People have talked of the contempt in which they have been held. People have talked of being ignored and sneered at, and been told that there are people in genuine need of hospital beds unlike them. People have had doctors refuse to come to see them after they have badly injured themselves, to the extent that the police have had to be called out to insist that they will come and help the person with their problem.
This is all very wrong. The one thing that people need when so desperate and so unhappy is understanding and human warmth and a lack of judgment that continues to last as long as the person remains in such a lonely world.
Many people who self harm are diagnosed as having personality disorders. A wonderful diagnosis with which to shunt all those problem people, all those awkward people, all those people you heave a sigh of frustration at. A diagnosis, that because it is neither an illness nor regarded as treatable, allows those that wish to wipe their hands and consciences clear by refusing assistance and leaving them to get on with the agony of sometimes unlivable lives.
We need desperately to find out what it is that causes people to end up in these states. We need to be confident that one day we will find ways of helping such people on to better lives. We need to know that such people have a right to treatment, to help and to hope.
We need through speaking out and through training to reduce the stigma of such actions. We need to know that in the near future, people will never be put off having treatment because of their shame or the way in which professionals act.
It is hard though and I have often had people phone me, some of whom are in the act of self harming or attempting suicide. Sometimes after the initial panic and the busy sorting out of access to routes for help, you can settle down in the tension of the aftermath and know that there is nothing that you can do, and that the solace you offer is only a temporary balm that will fade as quickly as it is applied. There are sometimes no solutions, no miracles and sometimes after you have heard time and time again from the same person your heart can harden into a professional veneer for your own safety and that can be hard to cope with too.
There are no easy procedures either. Sometimes the crisis is so clear and direct and urgent that you know that you need to get someone in to help. Sometimes the person knows what they want from you and if you can, you supply it, but often you can only listen, only hear the pain, only know that there is nothing to be done and no services able to respond and that can be so depressing and hard to cope with.
I will finish by talking about those around me who have not come through to the other end:
There is Graham who died in the Grand Canyon.
There is Michael who jumped off the Forth Road Bridge.
There is Ken who stood in front of the London train.
There is a friend who wouldn't want to be named who swallowed cleaning fluid.
There is Quentin who was found floating in the sea.
There is Pete who took an overdose.
I feel a huge sense of loss that such precious people that I have known are no longer with us and dedicate this talk to them. You will all have knowledge of other people who have died in this way. For me I have a crude way of dealing with this in my mind. When people are living, I choose to think that the main task is to keep them living and to prevent suicide, but for those that have died I choose to hope that they have found a form of peace, maybe sanctuary from unbearable lives. I hope that is what they have found anyway.
I suppose the only message that I would leave you with is that of respect. It is central to so much of what we are all doing. The people who enter worlds and harm themselves in such distressing ways are also entitled to respect. What is wrong with seeking attention when your world is in ribbons? What is wrong with trying to get the help you need when no one listens? We are all manipulative to an extent. We who do such things to ourselves suffer enough and to label our actions as a wicked or evil does not help at all.
Trying to understand each other, being there for each other, looking after ourselves, becoming comfortable with our emotions and seeking help when we suffer are such simple but such dramatically helpful things.
Thank you.
