As I have come out and been open with my own self-injury and mental illness history I’ve become more and more of a go-to person for friends and family in a situation where someone they know is going through some of the same kinds of things. If you’re still at all skeptical of the stigma surrounding mental illness (though, I assume if you’re here reading this you most likely are not), picture yourself in a situation where someone you know has gotten really sick physiologically. Now, put yourself in the same situation, but the person is struggling psychologically. Granted, in either situation you may not know exactly what to say to the person — particularly if you’ve never personally experienced whatever it is they’re going through — but often people are somewhat more comfortable, and feel like they are more prepared to handle, the physiological over the psychological.
Much like the physiological, there is no one solution that will work for every psychiatric issue. For instance, you can joke around and be very sarcastic with someone struggling with depression, but that is unlikely to be an effective approach for someone who is actively psychotic. And then, of course, everyone is different. When I’m at my worst the last thing I want is for anyone to touch me. Do not touch me, and definitely do not try to hug me. I can’t stand it. For others that’s exactly what they do want. For the sake of this post, I’m just going to focus on self-injury, and give some general pieces of advice I’ve learned from being on both sides of the situation (the self-injurer and the friend).
So, what do you do when you discover someone you know is self-injuring?
I’ve been mulling this over a bunch, and there are a few ways I could go about this post. I don’t want it to be entirely lecture-y (I’ve found that’s not necessarily the most effective method teaching university classes, so it’s probably not going to be the best here), so I think I’m going to use two vignettes based on personal stories, and then go over what worked and what didn’t work in each situation.
STORY #1: Confronter point of view
I was a teaching assistant for an introductory-level class that included both lectures with the professor, and breakout discussion sessions (we call them recitations), which myself and the other TAs ran. As is common in these large university lecture classes, the TAs did all the grading for the students in our recitation sections, and in general had more contact and interactions with students. One day a student of mine showed up to office hours wanting to go over a recent test. While going over the test with her, at one point one shirt sleeve drifted up her arm and I caught a glimpse of a couple scabbed over, fine red lines on her arm. I continued speaking with her about her short answer questions while taking a few more nonchalant glimpses. Based on these I assessed the situation: she doesn’t have scars that I can see in that location (this could be a newer thing for her); based on their location, appearance, and pattern, this is definitely self-injury; the cuts are superficial (no immediate concern of a suicide attempt). She had come to office hours in the past, so I had had some prior one-on-one interactions with her, and knew that this wasn’t something I could just ignore. So after going over her test, I asked her if she wouldn’t mind hanging out while I spoke with one or two other students who had come about their tests. Once I was done with them, I took the student out into the hallway (with shared basement offices, it’s actually often more private than the office) and confronted her about what I had noticed. The conversation went something like this:
Me: I just wanted to talk to you because I noticed the cuts on your arm.
Student: (A look of shock and fear: deer in headlights wide-eyed. Face pales by a few shades.)
Me: I am not judging you or anything like that. I’ve dealt with self-injury myself in the past, so this is not coming from a place of judgment. I just want to make sure you’re alright.
Student: (cannot get the words out fast enough) “Yeah. I’m fine.”
Me: Internal monologue, “No, clearly you’re not ‘fine’. You can’t try to tell me that. I INVENTED ‘fine’” Okay. Like I said, I’m familiar with cutting. I get it. Based on what I saw I’m not worried about your safety, so I’m not about to walk you over to psych services or anything like that, but I do want to make sure that you do have someone you can talk to, or know where you can go if you want that. But you are okay?
Student: Yes. Yes, I do. I have someone I talk to.
Me: Alright. If you do need any resources, let me know.
Student: Okay. (Does an about-face turn and very quickly walks away.)
Granted, I had a leg up in this interaction. Based on my personal experience, I seem to have a very sensitive self-injury radar, and I was able to approach the conversation as someone who has done the same thing. However, I think this is a good example of confronting the issue without attacking the person. I think it’s worth being straightforward and bringing up the issue when there are recent injuries (Scars are a whole other thing. Unless the information is volunteered, don’t ask about scars), while also not focusing on the injuries themselves, and emphasizing concern over judgment.
What I did do very wrong in the situation came later. I became a confidante to the student and got in way over my head. When I first confronted her, unbeknownst to me this was the beginning of a spiral that resulted in more severe self-injuring and suicide attempts. I did refer her to psych services and brought her over there myself, but also allowed her to stay at my house a couple of nights because she felt safe there, and on two occasions accompanied her to the emergency room when the school sent her there. She told me she didn’t have anyone else, so I stepped in. If I were in a role other than her teacher, these may have been appropriate actions, but in my role I should not have been doing these things. I should also mention that this was a spring semester, so I was already going through my own spring slump.
The lesson here? As someone helping another person, you still need to take care of yourself. There is a chance that these situations can become very intense. They can also be exceedingly frustrating trying to offer help to someone when they don’t appear to want it. Set some boundaries so you don’t lose yourself in someone else’s problems, and know your own limits.
STORY #2: Confrontee point of view
Toward the end of my first year in university I found myself in my spring slump and turned to cutting. In my mind this was no big deal because it was always superficial, and I’d been in significantly worse headspaces in the past. Some of my friends, however, (rightfully) found this concerning when they had noticed the cuts. One day, there was a group of us in my dorm room talking about whatever it was that us first years in spring of 2005 talked about and the conversation shifted to something slightly more serious regarding personality types and how to talk to people when they’re angry or upset (it was that time of year when we were discussing dorm arrangements for the following year). From there one of my friends took the opportunity to shift the conversation to ask me about the cuts they had noticed. After years of experience, and practice, at this point, I followed the only thing my mind was screaming at me – DENY, DENY, DENY – though I’m pretty sure my facial expression wasn’t all that different than my student’s described above. Whether or not my friends bought my pretty lame denial tactics, they didn’t press the issue. What they did do is say that they had noticed that I had seemed more down recently; they were there for me if I wanted to talk; and they cared about me.
And I kid you not, after that I did not cut again that year.
What was good about this? Once again, the emphasis was not on the cuts themselves, but more about the fact that they cared. I didn’t have the easiest transition to college, and spent a lot of time that first year feeling like an outsider, so just that gesture that these people had noticed and did care meant a lot to me. Sometimes you just need that reassurance that someone gives a crap. My friends saw something that concerned them, and confronted me without making me feel judged or attacked. And even though I did not open up to them, or even admit what they already knew, it was still a good thing.
Obviously every situation will be different, and things like your relationship to the person, their history with self-injury and/or mental illness, and the seriousness of the self-injury will result in very different approaches to the person and situation. Taking all of this into account, my general rules of thumb when I’m asked as a consultant of sorts on the topic are as follows:
1) Try not to freak out (can be easier said than done). By “freak out” I mean things like immediately jumping to the conclusion that they are suicidal when you have no evidence, or judging the person in any way (pro tip: be extra conscientious of your facial expressions). If the person is coming to you, there’s a good chance that they’re embarrassed enough as it is, so freaking out will make them feel that much worse. Also, them coming to you is a good thing. You freaking out will discourage the person from coming to you (or someone else) in the future. On the other hand, if they are trying to hide it, part of the reason could be because of their fear that someone will freak out.
2) Don’t focus on the injury itself. Obviously, severe self-injury that requires medical attention doesn’t apply to this rule, but if you think the injury can be taken care of with some at-home first aid focus less on the self-injury and more on what may have lead to it. This also means that if someone should disclose that they have cut but don’t want to show you, don’t push them on it. Try talking first. If you think it is something serious, but they don’t want to show, look for hints (strange body positioning of the area, blood on clothes and/or under fingernails). Try to think of the self-injury as symptomatic – a side effect of something else – and look past it when possible.
3) Ask the right kind of questions. In my experience, talking with the person (if they are willing) is much better than talking at them. Getting someone to talk can be tricky, but the right questions will help. I always recommend that people start broad and give the person the opportunity to say as much, or as little, as they want to tell — “What’s been going on?” “When did you start feeling this way?” Once again, focus on the person, the circumstances, and their emotions, rather than the self-injury itself. That being said, if you have any reason to believe, or if you have no idea whether or not this person is actively suicidal, you need to ask that question. And you need to do it directly. There’s no problem in acknowledging that it’s not an easy question to ask, but that you really need to know. “I’m sorry, but I need to ask this question. Are you suicidal/thinking about suicide?”
4) Don’t make this about you. I think a lot of the time it’s tempting for people to ask why the person couldn’t talk or come to them about their problems, but I suggest avoiding that line of questioning. In my experience, it makes the individual feel guiltier about the situation and turns the focus away from the individual and more on the person asking the questions. I get the impression that this is particularly difficult for parents.
Like I said, every situation is different, but I think that these four tips are general enough to apply to most situations. People who have asked my advice on the matter have all told me the same thing, “I just don’t know what to say.” That’s fine, and actually may even be better, because you’ll be more willing to listen to the person. As long as you’re approaching the person with genuine concern, and offering some empathy, you’ll be alright.
About Tracy Deyell
Tracy Deyell is a Ph.D. student living with major depression and bulimia. Follow her story on HMC's Supportive Minds'd blog, or follow her on Twitter.