Hidden lives: self-harm and the LGBT community

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It is interesting what sort of psychological problems our society chooses to accept as tangible and important.

Our “Prozac Nation” understands and sympathises with depression in its various forms. We understand stress and anxiety, and few weeks pass without the mention of eating disorders.

Even suicide is discussed intelligently and empathetically and recognised as something that desperately needs to be dealt with.

However, if you mention ‘self-harm’, many people will shake their heads or shrug it off, believing it to be the domain of attention-seeking teen girls or misunderstood Goth kids.

It is seen by many not as a problem that needs care and attention but as a form of self-indulgent manipulation or self-pity, that the person in question will at some point grow out of.

The reality is that any one, of any age or any gender, may find themselves using self-harm as a coping method, for any number of reasons.

An estimated 170,000 people a year are admitted to hospital through self-harm injuries, and that’s before you factor in the many thousands more who may never seek medical help (based on a Healthcare Commission report for 2006 which found that 150,000 people attended Accident and Emergency departments with self-harm injuries).

What is even more worrying is that people who are lesbian, gay or bisexual (LGB) seem to be far more likely to self-harm.

The statistics vary, but one piece of research published by the Lesbian and Gay Foundation found that young LGB people are three to six times more likely to self-harm than heterosexual young people.

It also estimated that 40% of all young LGB people self-harm or attempt suicide at least once.

While these stats are shocking, they don’t reveal the true extent of the problem: newer research and anecdotal evidence from self-harm organisations suggests it is not just younger LGB people who self-harm.

The reasons for this high incidence of self-harm in the gay community are still being researched, but it is easy enough to work out the link with the homophobic bullying, hate crime and isolation experienced by large numbers of LGB people.

In 2005 the Lesbian Gay Foundation reported that 73% of lesbian, gay and bisexual people have experienced prejudice, discrimination and harassment because of their sexual orientation.

Stonewall research found that of current secondary school pupils, 143,000 children have suffered from anti-gay name-calling; 64,000 have been physically attacked; and 26,000 have had death threats.

It is also important to distinguish between self-harm and suicide – although the two are linked (about 3 in 100 people who self-harm over 15 years will actually kill themselves), the majority of people who self-harm do not what to end their lives, they are harming themselves to deal with emotional pain.

There are in fact many misconceptions surrounding self-harm, a result of a general lack of information or awareness and also skewed media representation of the problem.

One self-harm organisation, LifeSIGNS, defines self-harm as:

“any deliberate, non suicidal behaviour that inflicts physical harm on your body and is aimed at relieving emotional distress.

“Physical pain is often easier to deal with than emotional pain, because it causes ‘real’ feelings. Injuries can prove to an individual that their emotional pain is real and valid.

“Self-injurious behaviour may calm or awaken a person.

“Yet self-injury only provides temporary relief, it does not deal with the underlying issues.

“Self-injury can become a natural response to the stresses of day to day life and can escalate in frequency and severity.” (www.lifesigns.org.uk)

Saturday 1st March was National Self-Injury Awareness Day.

Despite events being organised by the small number of dedicated self-harm organisations across the country, it received very little in the way of media coverage.

One such organisation that works to raise awareness of self-harm is Nottingham based Harmless, a user-led organisation that provides support, information, consultancy and training on self harm to people who self harm, their friends and families.

It was founded in October 2007 and has users from all over the world.

While gathering information about the users of its website, the co-founders of Harmless noticed that a third of site members were gay, lesbian or bisexual.

Caroline, one of the two co-founders of Harmless (who are both gay), says she and her colleagues particularly noticed the lack of research into LGB self-harm, noting that research studies tend to lump suicide and self-harm together rather than consider them as separate issues.

“We set up Harmless in response to the need for a service,” Caroline told PinkNews.co.uk.

“We’ve worked within this area for a number of years and we just felt strongly that there were certain target groups that were being overlooked in this area.

“We set up Harmless to provide support and information for people that self-harm, but also to improve education and resources, so we really want to focus on outreach projects for places that come into contact with people who self-harm, giving training, workshops and speeches.

“We’ve worked in the field for a number of years and over the years we’ve noticed more and more people contacting us and the large number of people who informally state variations in sexuality leaves us to believe a high proportion of our members, who do self-harm, are lesbian, gay, bisexual and trans.

“We’ve heard several statistics quoted about LGBT self-harm.

“Channel 4 did a recent programme which said 1 in 4 young gay teenagers self-harms, although other ones estimate that it’s higher, especially as a lot of it goes unreported.

“A lot of the statistics also only focus on young LGBT people, which doesn’t give the full picture.

“There does seem to be a lot of young LGBT people who self-harm but it might just be that they are the ones coming into contact with services more than older LGBT people.

“Understanding self-harm is very complex, people do it for a variety of reasons, usually because they are isolated and unhappy in one way or another; people express varying degrees of distress from anger through to self-hate.

“Many people express confusions over identity. People might self-harm because they have family difficulties or money difficulties or it might be a more personal thing about themselves.

“People self-harm to cope but they also self-harm to punish themselves.

“So with that in mind, we could concur that LGBT groups are going to be vulnerable if they’ve faced any kind of discrimination, internal distress over their sexuality or difficulties in their families.

“I think the group as a whole might be more vulnerable to some of the life difficulties that people go through that might lead to high levels of distress and the onset of self-harm.

“We’ve had some people who have contacted us state explicitly that issues surrounding their sexuality was their motivation for beginning self-harm.”

Caroline believes that Harmless is unique in what it does.

“The difficulty is that in the past few years we’ve had so many misconceptions and shame surrounding self-harm, it’s only in the past few years that people have really started to talk about it.

“Now we’ve got the National Institute of Clinical Excellence who provided some guidelines for NHS staff on how to best respond to self-harm, and that was a real shift in the perspective of health providers, really acknowledging the vast quantity of people who come into contact with services because they are harming themselves.

“That’s a huge shift in the way people are thinking about self-harm.

“There are a couple of organisations: Bristol Crisis Service for Women and 42nd Street which is a service for young people, but on the whole there’s not a generic service doing what we do.”

Another issue of concern is the response of healthcare professionals to people who self-harm.

“People seem to have had mixed experiences with healthcare professionals, you get people at both ends of the spectrum.

“Some people have had very positive experiences of coming into contact with services, but a lot of people say the treatment they received is abysmal.

“That’s an all too common experience.

“Many people are being told they are attention seeking, or manipulative or they can’t be helped, and that’s one thing we really need to target, not just as an organisation, but all of us can make a difference by raising the profile of self-harm and educating those nearest to us,” says Caroline.

PinkNews.co.uk spoke to two LGBT people about their varying experiences of self-harming and the links between self-harm and their sexuality.

Beth, 29, Manchester.

Beth is a male to female trans person who officially changed her name in January this year and is now about to begin hormone treatment and is on a NHS waiting list for surgery. She is a mental health nurse.

“Self-harm and ‘alternative lifestyles’ are both relatively taboo subjects in our society.

“The LGBT gay community are sometimes made to feel bad about who we are even in 2008 and so at times it’s all too easy to end up feeling a bit self-loathing.

“If you already feel marginalised and obscured from sight (even within the self-harming ‘community’) then it makes sense that you are likely to be more at risk of self-harm than the majority of the population.

“I first harmed myself in 2001 at the age of 22 as a response to having been deferred from going on to my second year of nurse training for 12 months due to a relapse of depression.

“At the time it helped unleash emotions that I had never been able to express as the male me since being brought up with the ‘boys don’t cry’ mentality.

“Initially it happened quite a lot in 2001 and then I’d say I have had one or two brief episodes of self harm each year since then up until stopping in early 2007.

“I’ve now come to realise that people may say ‘boys don’t cry’ but I’m a girl and I do cry so now I can express my emotions in less destructive ways.

“I didn’t tell anyone about my self-harming but my girlfriend saw the scars and was naturally concerned.

“My mum also saw the scars in 2001 when I answered the door to her wearing a towel and completely forgetting to cover my arms.

“My mum still asks me if I’m self harming. But thankfully I’m not any more although in times of stress the idea does pop in to my head just as other people reach for a pint or a cigarette when the going gets tough.

“I’ve sought medical help on a few occasions but that was more for help and treatment for depression rather than specifically for self harm.

“In the past I’ve sought help and support from an online support forum relating to self-harm and the part that my gender issues have had in causing my self harm.

“I was told at the time that I couldn’t expect support for the gender issues as only I knew what it was like to transition from one gender to another.

“My argument to that is that I don’t know what it’s like to be a patient with dementia but I can still try to empathise with the person rather than not bothering to even try to understand on some human level.

“It seems that if you say you are LGBT then people assume that that is more of an issue to discuss than the self harm that you went looking for support with.

“I don’t know if you can say people ‘recover’ from being someone who self-harms.

“I guess it’s a bit like ex-smokers and recovering alcoholics. No matter how long it is since you have last self harmed, or had a drink, or a cigarette you know somewhere deep down that self harm/alcohol/nicotine is there as a coping strategy that has worked for you in the past.

“These days sometimes self harm still needs ME every now and then but I’m able to remember that I don’t need self harm. So I’m getting there.

“There is life during and after self harm. It is a bit of an uphill battle at times. But I’ve given up self-harming. When the time is right for you, you can too.”

Lindsay, 31, Yorkshire.

Lindsay is a computer programmer who lives with her partner in Yorkshire.

“I don’t really remember the first time I self-harmed, just that I was doing it regularly by the time I was 10.

“It slowly got worse through my teens until I was doing it daily during A-levels and Uni.

“In my twenties I did it less frequently but more severely, usually after drinking.

“I struggled with drugs and alcohol from about 17 onwards and it was my self-harming that lead me to realise that I also had to stop drinking completely, which I did about 2 years ago.

“The “why?” is something I’ve attempted to unravel many times. I was sexually abused as a child and developed a dissociative disorder – basically my body doesn’t always feel like it is part of ‘me’.

The abuse was certainly a factor but I also have a very strong instinct to attempt to manage emotional and physical pain internally – I’ve always felt that asking for help might get me in trouble.

“I grew up in a very homophobic, religious family. We attended an evangelical church where it was believed that gay people were possessed by an evil spirit.

“I knew deep down that I was attracted to other girls but also that it would cause huge problems if I didn’t pretend to be ‘normal’.

“I am absolutely happy to be who I am today and am out in every area of my life but I know that I still have a lot of internalised homophobia to contend with.

“My family loved me but weren’t emotionally equipped to help me, so there was pressure to hide my self-harm and simply pretend to be OK.

“In my teens there was a cycle of my parents finding out that I’d hurt myself because I needed to be taken for stitches or someone at school had reported it, and then me promising that it wouldn’t happen again and feeling very guilty for all the worry, and then hiding it for a while until I got caught out again.

“I find it hard to understand how so many doctors and nurses let me simply go home and didn’t push for there to be a deeper exploration of what was going on for me, but I’m told that I’m very good at appearing to be ok when inside I’m imploding.

“It’s a paradox which lots of people who self-harm have to contend with – generally self-harming requires some degree of dissociation, and when you’re dissociated it’s impossible for people to accurately assess your state of mind.

“I’ve even self-harmed in Accident and Emergency after being left alone with a sharps bin despite telling them that I wasn’t safe.

“Apparently I came across as calm and together – the opposite of what was going on internally.

“A couple of weeks ago it was a year since I last self-harmed. It had to get to a horrendous and dangerous situation before I got the help I needed, and I’m lucky to be alive.

“Just over a year ago I was turning up in Accident and Emergency needing treatment a couple of times a week.

“I had a crisis stay for four days in a wonderful place called The Maytree which offers respite to people at risk of suicide.

“As well as simply providing a safe haven they helped me to piece together a picture of the kind of help I needed to get better.

“I still think about self-harming a lot. Probably every day. But I don’t actually want to do it any more, I have finally found a connection with my body which allows me to feel that it’s part of me.

“I also have a very supportive partner who can help me to find words for what is going on, or just hold me until I’m ok if I’m really struggling.

“She’s a therapist herself so it doesn’t freak her out, and is also very understanding of my need to stay away from alcohol and drugs – something not all my friends have been able to accept.”

For more information on Harmless and their work with people who self-harm visit their website.

Harmless is filming a DVD project about self harm and would like to invite LGBT people to contribute their experiences.

Please email [email protected] and write DVD in the subject heading.