|
|
Self Harm
Bill of Rights for People Who Self-Harm
Preamble
An estimated one percent of Americans use physical self-harm as a way of
coping with stress; the rate of self-injury in other industrial nations
is probably similar. Still, self-injury remains a taboo subject, a
behavior that is considered freakish or outlandish and is highly
stigmatized by medical professionals and the lay public alike.
Self-harm, also called self-injury, self-inflicted violence, or
self-mutilation, can be defined as self-inflicted physical harm severe
enough to cause tissue damage or leave visible marks that do not fade
within a few hours. Acts done for purposes of suicide or for ritual,
sexual, or ornamentation purposes are not considered self-injury. This
document refers to what is commonly known as moderate or superficial
self-injury, particularly repetitive SI; these guidelines do not hold
for cases of major self-mutilation (i.e., castration, eye enucleation,
or amputation).
Because of the stigma and lack of readily available information about
self-harm, people who resort to this method of coping often receive
treatment from physicians (particularly in emergency rooms) and
mental-health professionals that can actually make their lives worse
instead of better. Based on hundreds of negative experiences reported by
people who self-harm, the following Bill of Rights is an attempt to
provide information to medical and mental-health personnel. The goal of
this project is to enable them to more clearly understand the emotions
that underlie self-injury and to respond to self-injurious behavior in a
way that protects the patient as well as the practitioner.
The Bill of Rights for Those who
Self-Harm
The right to caring, humane medical
treatment.
Self-injurers should receive the same level and quality of care that a
person presenting with an identical but accidental injury would receive.
Procedures should be done as gently as they would be for others. If
stitches are required, local anesthesia should be used. Treatment of
accidental injury and self-inflicted injury should be identical.
The right to participate fully in decisions about emergency
psychiatric treatment (so long as no one's life is in immediate danger).
When a person presents at the emergency room with a self-inflicted
injury, his or her opinion about the need for a psychological assessment
should be considered. If the person is not in obvious distress and is
not suicidal, he or she should not be subjected to an arduous psych
evaluation. Doctors should be trained to assess suicidality/homicidality
and should realize that although referral for outpatient follow-up may
be advisable, hospitalization for self-injurious behavior alone is
rarely warranted.
The right to body privacy.
Visual examinations to determine the extent and frequency of
self-inflicted injury should be performed only when absolutely necessary
and done in a way that maintains the patient's dignity. Many who SI have
been abused; the humiliation of a strip-search is likely to increase the
amount and intensity of future self-injury while making the person
subject to the searches look for better ways to hide the marks.
The right to have the feelings behind the SI validated.
Self-injury doesn't occur in a vacuum. The person who self-injures
usually does so in response to distressing feelings, and those feelings
should be recognized and validated. Although the care provider might not
understand why a particular situation is extremely upsetting, she or he
can at least understand that it *is* distressing and respect the
self-injurer's right to be upset about it.
The right to disclose to whom they choose only what they choose.
No care provider should disclose to others that injuries are
self-inflicted without obtaining the permission of the person involved.
Exceptions can be made in the case of team-based hospital treatment or
other medical care providers when the information that the injuries were
self-inflicted is essential knowledge for proper medical care. Patients
should be notified when others are told about their SI and as always,
gossiping about any patient is unprofessional.
The right to choose what coping mechanisms they will use.
No person should be forced to choose between self-injury and treatment.
Outpatient therapists should never demand that clients sign a no-harm
contract; instead, client and provider should develop a plan for dealing
with self-injurious impulses and acts during the treatment. No client
should feel they must lie about SI or be kicked out of outpatient
therapy. Exceptions to this may be made in hospital or ER treatment,
when a contract may be required by hospital legal policies.
The right to have care providers who do not allow their feelings
about SI to distort the therapy.
Those who work with clients who self-injure should keep their own fear,
revulsion, anger, and anxiety out of the therapeutic setting. This is
crucial for basic medical care of self-inflicted wounds but holds for
therapists as well. A person who is struggling with self-injury has
enough baggage without taking on the prejudices and biases of their care
providers.
The right to have the role SI has played as a coping mechanism
validated.
No one should be shamed, admonished, or chastised for having
self-injured. Self-injury works as a coping mechanism, sometimes for
people who have no other way to cope. They may use SI as a last-ditch
effort to avoid suicide. The self-injurer should be taught to honor the
positive things that self-injury has done for him/her as well as to
recognize that the negatives of SI far outweigh those positives and that
it is possible to learn methods of coping that aren't as destructive and
life-interfering.
The right not to be automatically considered a dangerous person
simply because of self-inflicted injury.
No one should be put in restraints or locked in a treatment room in an
emergency room solely because his or her injuries are self-inflicted. No
one should ever be involuntarily committed simply because of SI;
physicians should make the decision to commit based on the presence of
psychosis, suicidality, or homicidality.
The right to have self-injury regarded as an attempt to
communicate, not manipulate.
Most people who hurt themselves are trying to express things they can
say in no other way. Although sometimes these attempts to communicate
seem manipulative, treating them as manipulation only makes the
situation worse. Providers should respect the communicative function of
SI and assume it is not manipulative behavior until there is clear
evidence to the contrary.
© 1998-2001 Deb Martinson. Reprint permission granted with proper credit
to author.
Disclaimer:
This site contains information to be used only for the purpose of
support and general education. It should not be used for diagnosis
and/or treatment of any physical or mental conditions. It is owned,
designed
and maintained by a healing survivor in recovery. The author of the
general text is the owner and that general text remains the property of
said owner. Other materials used on the site come from various authors
and will have the author credited and those materials remain the
property of said authors with copyright information included when and
where it is available.
We assume no liability for the contents or effects of this site. Some of
the content may be disturbing. Read at your own risk. If you believe you
are suffering from a physical or mental condition seek help from a qualified professional physician, psychiatrist,
psychologist or therapist; a crisis center; or call 911.
Recommended Online Support Group
for
those who have been diagnosed with DID
and are in treatment for healing with a professional,
and for those professionals who treat those with DID:
Thank you for
stopping by.
You are visitor
number:
|
