Viewpoint 1.AJN

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Call (800)544-7255 or visit us at medicalexpress.com for details 357 SOUTH MCCASLIN BLVD., SUITE 100, LOUISVILLE, COLORADO 80027 Circle No. 85 on Reader Inquiry Card A Proud Sponsor of ▼ Viewpoint By Megan Johnston, BMedia Patients Who Self-Injure They’re not as dangerous to themselves as you might think. ou’re relaxing on the bled, young woman into a sob- and factitious disorders such as couch while watching bing mess. These actions are in Münchausen syndrome, in which an episode of ER enti- direct contravention to ideas the sufferer feigns an illness. tled “If I Should Fall outlined in the Bill of Rights for People who intentionally harm From Grace.” One Those Who Self-Harm by Debra themselves are generally very Yof your favorite characters, Dr. Martinson, BS, an advocate for clear on whether or not they are John Carter, and his colleague, people who self-injure and trying to die, as an article in the Dr. Susan Lewis, find a patient founder of the Web site Secret April 1996 issue of the Journal of named Grace collapsed on the Adolescence noted. Furthermore, floor. As Dr. Lewis helps Grace being treated as suicidal when up, she asks about the scars on Self-injury one isn’t may lead to a down- Grace’s arm. She admits that she alone doesn’t ward spiral of repeated self-harm used to be a “cutter,” but insists (and increased caregiver frustra- that she has stopped. Dr. Lewis indicate tion). This is particularly true if flips up Grace’s skirt and finds suicidal patients face the contempt of clin- fresh cuts. The clinicians want icians who believe that they were her to see a psychiatrist, but intent. making a “half-hearted” suicide Grace refuses. Dr. Carter tells her attempt or that they could stop if that they’re going to put her on Shame (www.palace.net/~llama/ sufficiently motivated. “psych hold” on the grounds of psych/injury.html). The rights set People who harm themselves “danger to self.” Dr. Lewis sends forth by Martinson include but aren’t suicidal have the right another staff member for droperi- • caring, humane medical to refuse psychiatric treatment, dol. Grace resists injection but is treatment. even if it seems obvious that it overpowered, and sinks to the • bodily privacy. would help. After all, many floor in tears. • full participation in decisions “normal” people feel uncom- This episode would probably about emergency psychiatric fortable seeing a physician about make any viewer uncomfortable, treatment (as long as no lives sensitive topics. For people who but imagine how frightening it are endangered). self-injure, many of whom also must have been for the estimated Some of the images of self- have maladaptive social and cop- 1% of the U.S. population who injury—blood, wounds, sharp ing skills, seeking professional regularly harm themselves. And blades—are associated with care can be terrifying. that estimate, reported by CNN danger and confrontation. It’s During their careers most in 2000, may be low. obvious that the act of injuring clinicians will eventually treat The threat of being “locked oneself is taboo, alluding to sui- patients who have intentionally up,” medicated, or virtually cidal tendencies. But for many harmed themselves. Because ostracized can discourage people sufferers, the secrecy surround- evidence of self-injury alone who self-injure from seeking ing self-injury is at least as doesn’t necessarily indicate sui- professional help, especially harmful as the behavior, and cidal intent, when patients pre- someone like the Grace charac- deepens their sense of isolation. sent with self-inflicted wounds, ter, an aspiring law and medical How caregivers react to these it’s vital that caregivers assess student with much to lose. By patients is crucial. their patients’ feelings and forcibly exposing her wounds Let me be clear: self-injury is thoughts about living. It’s often and hospitalizing her against her not a healthy behavior, but nei- neither appropriate nor possi- will, the TV clinicians trans- ther is it inherently suicidal. For ble for nurses to counsel such formed an intelligent, if trou- many, it is primarily a coping patients at length. But a thor- method used to deal with dis- ough initial assessment of and Megan Johnston is a journalist based in turbing thoughts or emotions. response to self-injury reduces Sydney, New South Wales, Australia, and one of six message board monitors on the U.S.- Indeed, the most current clinical the risk of recurrence and based Bodies Under Siege Web site (www.buslist.org) that promotes education definitions explicitly distinguish makes a patient’s long-term and understanding of self-injurious behavior. self-injury from suicidal behavior recovery more likely. ▼ [email protected] AJN ▼ December 2002 ▼ Vol. 102, No. 12 11.

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