Trauma and Self Harm – When Hurting Helps the Pain

As domestic violence and sexual assault advocates we often come into contact with situations that we don’t feel equipped to handle.  Even though we understand the dynamics of power and control and receive training and education on providing empowering services that allow for the victims/survivors to make their own choices, we are often taken aback and feel powerless when we meet someone who has scars from injuries that were self-inflicted.  Unless we understand the underlying motivations behind self-harm we are at risk of over-reacting by assuming the injury is a part of a suicidal gesture or we under react by ignoring the evidence of internal pain.

According to Solomon and Farrand (1996) “the assumption is that the alternative to self-injury is ‘acting normally,’ but on the contrary . . .  the alternative to self-injury is total loss of control and possible suicide.  It becomes a forced choice from among limited options.”  In other words, when a person engages in self-injury she/he may be doing so in order to relieve the pain and anxiety and reduce the feelings of wanting to commit suicide.  “A basic understanding is that a person who truly attempts suicide seeks to end all feelings whereas a person who self-mutilates seeks to feel better (Favazza, 1998).”

Another misconception regarding persons who self-injure is that they are “attention seeking.”  Most people who self-harm are trauma survivors and experiencing extreme internal pain and ongoing activation of the flight-fight-freeze response (see my BrainTalk).  Throughout their lives they may not have had this internal pain validated.  In fact, many survivors have been accused of lying and manipulating by those people and systems that were supposed to help them.  When this type of pain is not recognized, an external expression of pain may feel necessary in order to have others see some sort of manifestation of what is happening internally.

According to Bessel Van der Kolk, “neglect [was] the most powerful predictor of self-destructive behavior.  This implies that although childhood trauma contributes heavily to the initiation of self-destructive behavior, lack of secure attachments maintains it.  Those… who could not remember feeling special or loved by anyone as children were least able to control their self-destructive behavior.”  This neglect leads to a person feeling that there are not of value and not worthy of any care or support.

People who self-injure do so in order to feel something or to not feel so much.  If a person is dissociating (feeling disconnected from self or surroundings) she/he may self-injure in order to be able to feel something and be able to feel grounded within the body again.  Some people may be feeling so much, the emotions are so activated, that the self-injuring may be a way to calm down and possibly reach a state where the feelings are less intense,

The following are some guidelines for responding to someone’s self-injuring:

Show that you see and care about the person in pain beyond the injury. 

Show concern for the injury, address safety (is the cut deep, has the person cleaned or treated the injury, etc.) and then move to validating the pain the person must be in to have done the injury. 

Make it clear that it is okay to talk about self-injury and convey your respect for the person’s efforts to survive.  She was doing the best that she could.

Help the person make sense of the self-injury.  When did it start?  What was happening then?  Explore how self-injury has helped the person survive in the past. 

Encourage the person to find safe ways to deal with buried feelings and seek support in order to care for herself.

Acknowledge that is frightening to think about living without self-injury and that reducing how often it occurs can be the first step.  She may need to learn there are other things that work before she can make different choices.

It is important mostly to remember that by validating the pain beneath the injury we are letting the person know that they are of value and recognized as a survivor.

Empowerment and Success

The term “empowerment model” has long been the term used to describe how advocates work with domestic violence survivors.   It is the understanding that only the victim/survivor can be the expert on their life. Advocates provide information, support, resources and education so that victims can make the best choices possible to become safe and self-reliant.  We strongly believe that empowerment is not something we give to the survivor.  Instead, it is something that is intrinsic to the survivor and it is our task to help the person find and expand their personal power.

When a woman comes to a crisis center for assistance in changing her life, she is often unaware that she has any power at all in her life.  Through the use of power and control, the abuser has diminished her belief in herself and her capacity for growth.

If we truly believe that empowerment is something that exists within each person, what then is the role of the advocate?  In the same way that a sapling has the capacity within to become a full grown tree, a survivor contains the capacity to be a strong woman.  However, without proper nourishment and support, that sapling may struggle and be less protected from the elements.  The job of the advocate is to provide the support, resources and education to encourage the growth of the individual into a woman who has power and control over her life. 

Support takes different forms during the progression from being under the power and control of the abuser to being in control of one’s own life.  When we plant a seedling, we may provide ground stakes and support lines to help the tree stand tall until its root system has expanded deep into the soil and taken hold.  Later, we slowly loosen that support as the tree is ready to stand on its own.  Too often we worry about disempowering a woman and remove the support too early or we smother her for fear that she may make a decision that will harm her or her children. 

In many ways, our definition of success has changed over the years.  The definition of success has increasingly been defined by funders so that we are mandated to worry more about moving a person along quickly to find transitional or permanent housing, a job, etc., rather than focusing on Judith Herman’s (see Trauma and Recovery) first stage of recovery from trauma – safety and stabilization.  This is not to say that housing and employment are not valuable and necessary.  However, we tend to lose focus on the need to allow time for the person to feel safe and stable enough to be able to reduce her trauma responses and make informed rational decisions rather than emotional reactive decisions.

Because of the need to provide good outcomes to funders or other interested parties (or for other reasons), we may find ourselves looking at a person who is seeking shelter or other supports and asking “will this person be successful in our program?”  The question we should be asking is “do we have what this person needs to be successful and, if not, can we find the resources to provide it?”  Even if the resources the person may seem to need (i.e. mental health, substance abuse, housing, etc.) are not initially available, are we able to provide the support the person needs in order to feel safe and stable? Assumptions made at the start of a person’s contact with a program about her capacity for success can be self-fulfilling prophecies.  Which outcome would you rather assume?

It also becomes imperative that we take a look at our definition of success.  If success means a linear progression from abuse to safety to independence, we may be setting ourselves up for perceived failure.  Understanding that success may be more of a process of small successes and setbacks rather than a straight shot to a successful event can lessen the pressure we place on a trauma survivor and reduce our own burn out and compassion fatigue. 

When I was first working as a shelter director back in the mid 90’s there was a woman, Bonnie, in the program who had come to us seeking shelter and an opportunity to engage in substance abuse services.  She was 43 years old and had been drinking steadily since the age of 13 and had been victimized as a child and an adult.  She stayed in the shelter for three months and then left on her own.  At first I felt that not only had she failed at maintaining her sobriety and safety, but that we had failed her.  Fortunately, my mentor at that time reminded me that we had given Bonnie three months of safety, sobriety and community that she had never experienced before.  It was not the success I was hoping for, but it was a success none-the-less.  Many people would have looked at Bonnie’s history and judged her as being at risk of failing the program.  However, Bonnie left the program with more information than she had when she came in.  She also knew she could return at any time. 

Trauma survivors are also very tuned into our attitudes and expectations.  If a trauma survivors senses that we are unable to see them as individuals capable of success, they will meet those expectations or fight against them. It is important that we find ways to take care of ourselves and challenge our own assumptions about people so that we can reflect an attitude of support and an expectation of success that supports rather than questions a survivor’s abilities.