I had never come across self-harm before – strangely enough we didn’t cover it at school for O-level – and suicide was something that ‘nutters’ did by jumping off roofs or motorway suspension bridges. I never expected to be dealing with it in my wife.
But then I never expected my wife to have multiple personalities, or to have been subject to atrocities of ritual and sexual crimes as a child. I certainly didn’t expect to wake one night to find her standing by the side of the bed with a knife in her hand ready to cut herself, or for her to say that her name was ‘Switch’. Or for this to go on for several years.
I think the Government has done a lousy job of preparing us for these things.
Self-harm and suicidality are as much a part of life with a dissociative survivor as turkey is a part of Christmas: not everyone does it, but most people do it a lot of the time. One of the things that crops up repeatedly in my conversations and phone counselling through my work for PODS (Partners of Dissociative Survivors) is the thorny issue of self-harm and suicide. It’s a topic of great relevance and even greater stress to many, many people – not just literal partners, but to anyone ‘partnering with’ survivors, such as counsellors, therapists, support workers and helpline staff. After all, what can be more stressful than the potential loss of life of a loved one?
And it’s been a journey for me too. In the early days, especially when my wife’s dissociation first became apparent following a literal overnight breakdown, and before we had secured any help at all (professional or otherwise), self-harm and suicidality were frequent visitors and ones that I didn’t handle very well at all. Quite understandably, I panicked. Here was the person I loved more than anyone in my life, with whom I had planned to spend the rest of my life, talking about ending it all, or worse still actually taking overdoses and coming pretty damn close. It was not just the literal threat to her survival, but it felt like a threat to mine too and I reacted with fear, panic and anger and in the early days with feelings of rejection and worthlessness as well. If she really loved me, I reasoned, why would she want to kill herself? The fact of her suicidality led to my logical conclusion that I meant nothing to her and that she didn’t love me after all.
Not surprisingly, my reactions made the situation worse and for many months we spiralled through a ‘valley of the shadow of death’. So strong was the sense of threat to my survival – the survival of life as I knew it, and my wife as a ‘secure base’ within that existence – that paradoxically with her ‘threats’ of suicide, she became my enemy and opponent. For a time we didn’t draw closer together through the stress of the situation and the need for each other’s support – we grew further apart. I was angry, I suppose, at the power that she was wielding – to end it all, to ‘cop out’ (as I saw it then) and leave me to pick up the pieces. Things were bad enough as they were, I reasoned – why did she want to make it worse by self-harming or killing herself? And didn’t she realise that society in general and the NHS in particular doesn’t respond too kindly to people ‘attention seeking’ in this manner? How was that going to help? I was desperate for a solution to what was going on, and I felt that it lay in the polar opposite direction that my wife was taking. ‘Frustration’ is far too mild a word to describe how I was feeling.
We needed a breakthrough. It came in the form of psychoeducation, an increased understanding of dissociation as a brilliant and creative survival strategy in the face of overwhelming and extreme childhood trauma. As I began to understand what she had endured in the past, her extreme reactions in the present began to make more sense. I hadn’t had her childhood experiences, I wasn’t dissociative, I didn’t have multiple personalities – and so I didn’t understand what self-harm and suicidality meant to her. Slowly though I began to listen. And slowly I began to understand how appalling for her was this maelstrom of out-of-control feelings – of flashbacks and dissociative episodes intruding into her everyday life. The woman I had married had been so in control of her life, so competent and capable and active. Now here she was barely able to function, some days barely able to drag herself out of bed or dress herself or make a simple decision over what to eat. She was barely sleeping and when she did she woke crying out with nightmares. And her days were a fuddle of lost time and different ‘alter personalities’ coming and going. It was scary, it was overwhelming, and it was totally out of her control.
Hence came the need to control something, and much as she later recalled doing as a child, she tried to take control by self-harm and suicidal ideation. She was at least in control of how and when to kill herself. That was one aspect. Another was a simple and understandable flight away from the awfulness of the feelings that were flooding her – feelings of shame and disgust, humiliation, guilt, powerlessness, isolation, betrayal. As I began to see how overwhelming these feelings were, I began to understand that in that situation perhaps I too would seek a way-out, and in the absence of alternatives, suicide was a sensible one. Carolyn was being driven by a day-in, day-out explosion of horrendous emotions, chronic and at times unbearable physical pain, and pitifully infrequent snatches of broken sleep, to a despair and a belief that things would not, could not get better. If this was what life was like – so awful to her and so destabilising and ‘inconvenient’ to others such as myself – then would it not be better to end it? I began to understand the rationale behind her feelings.
Then there was the self-hatred. This poured out like sewage coming up through the drains into our house. It had always been there, we later realised, but it had been safely subterranean and on the right side of the U-bend. She had her mechanisms for flushing it away, and so we had lived mostly ignorant of its existence. But something had blocked its egress and here it was backing up into her emotional plumbing and suddenly, violently, exploding up in a torrent of self-loathing. Many times her self-harm and suicidality was driven by the urge, even the need, to destroy that which she most loathed and hated: herself. It would take many years for her to locate the foul, stagnant source: not just the unspeakable violation of her at the hands of multiple abusers, but also their coercion of her, to perpetrate against other children. This realisation was awful in itself, ebbing and flowing in and out of consciousness accompanied by numerous further episodes of self-harm, but as it took narrative form in therapy it unblocked the pipes – slowly the excrement began to flush away, but until that point there were intermittent but regular outbursts of self-loathing manifesting in a desire to destroy the self so potent that it is a wonder that she survived at all.
At other times, self-harm especially in the form of cutting was enactment pure and simple. Where words failed or the narrative was unclear, some unconscious process led her to act out what had happened to her as a child by re-enacting it upon her own body. At times this took the form of death threats directed against the self by another part of her personality, the bullying ‘Big Ones’ of her internal system of alters who would bring her near to the point of death and then rescue her again, just as had happened as a child. Similarly, other ‘Big Ones’ meted out punishments in the form of self-inflicted pain in a desperate and rather hopeless attempt to keep her from ‘telling’. Mirroring the original threats not to disclose that she as a child had received, these ‘Big Ones’ did their best to ensure her protection and survival by somewhat paradoxical self-harming punishments: they were convinced that ‘telling’ would lead to awful retribution, and they were employing the disciplinary methods of her early caregivers to ensure obedient silence. Many times, therefore, either in therapy or with myself, we would have a breakthrough in the muddled narrative as another piece of the jigsaw would slot into place, but this would be instantly succeeded by self-harm or matte-black episodes of suicidal rumination.
Other parts in the system, however, used self-harm differently. This was what might pejoratively be called ‘attention-seeking’: communicating with actions what could not be asked for or told directly. It was a ‘help me’ cry, the ‘come close’ cry of infanticidal attachment, which assumes that pain must be present to attain proximity to the caregiver. Alexithymic, many of Carolyn’s alters didn’t know how to say or what to say to express their feelings, and self-harm was the only way. It was attention-seeking, yes, but with a genuine purpose, communicating a genuine need – feeling this bad, having experienced such atrocities, she really did need my attention or her therapist’s to help her get through.
Gradually therefore, over time, both Carolyn and I began to learn what self-harm and suicidality meant, where it was coming from, and most importantly what to do about it. My empathy was crucial. While I failed to understand and responded in anger or frustration, in effect I pushed Carolyn away and punished her for her feelings, a subtle and unconscious re-enactment of her childhood experiences. What she needed most from me during these fraught and fearful times was attachment: closeness or proximity, attunement, responsiveness, containment. I began to see that her self-harming or suicidal behaviours were driven byfeelings, and that feelings can either be acted upon (behaviours) or ‘contained’: that is to say, they can be sat with, expressed, felt, and held until they naturally and eventually move on. The very meaning of the word ‘emotion’ comes from the Latin emovere meaning to move, and this is exactly what emotions do – they either move us to act (too often in a way that we later regret) or we can sit with them and express them safely, until they are the ones that move along. I stopped being intimidated by Carolyn’s feelings and I learned to contain them. For me that meant learning to sit with my own feelings myself, rather than acting on them – when faced with the terror of losing my closest friend, lover and wife, my emotions would move me to lash out, control, or run away, none of which were helpful responses. So I learned to say to myself, “It’s okay, it’s only a feeling – I don’t have to act on it, I just have to feel it.” And over time, it worked.
And it worked for Carolyn too. Through therapy and together we began to recognise that she was feeling suicidal but that she didn’t have to act on it. We stopped putting all the focus on the behaviour, and I encouraged her to talk about the why. Why was she feeling like this? What exactly was she feeling? Sometimes it was just the flood of feelings from the past, and we talked about that. Sometimes it was the pressures in the present, so we talked about that. I did my best to sit with her and attune to her empathically, straining with all of my being to be right-brain present, to hear her, to respond to her, and ultimately to contain her. I was surprised at first to realise how effective this was at soothing her. When I could just respond empathically rather than trying to make her change her mind, to agree not to kill herself, her feelings began to subside. Being with her, both physically and emotionally, was incredibly powerful – to let her talk about or seek out within herself what it was that she was feeling (and many times she didn’t know to start with) and then to sit with it rather than acting on it. It did and it does work.
But life doesn’t always have a pause button when these episodes hit and sometimes you just can’t. You have to go to work, you have to stay at work, you’re asleep, you’ve got flu, you’re in the middle of Tesco’s. Sometimes we just had to be more practical about it. I hid knives, I removed tablets, I locked doors, I had someone else ‘babysit’ her. We had plans to keep her safe, we came up with a ‘survival kit’ of a safe place to be, safe comforting objects to hold, safe people to contact, safe things to do. At times of extreme stress, we used medication. One of the hardest times to cope was when there were external pressures which couldn’t be averted on top of night after night of insomnia. Exhaustion is not a great place to fight from. So at times like these we would use medication. We have been blessed with a GP who understands nothing about dissociation and DID, but who trusts us to ask for what we need when we need it. So at times we have used sleeping tablets such as Zopiclone, or tranquillisers such as Diazepam, on a short-term basis – always and only to get through a crisis. And then we always, always, always, look at all the factors that led to the crisis and see if we can avert it from happening again – we consider what constellation of factors led to Carolyn going so dangerously outside her ‘window of tolerance’ and how we can restabilise things now in the short-term, and avoid it happening again in the long-term. One of the biggest mistakes we made early on was not learning from our crises, but just repeating them unthinkingly. When we reframed crises and looked at them as information-rich opportunities for learning, we started to make progress. There is nothing worse than cycling through endless destabilising crises without anything ever changing.
We also learned to create a future. At the very low times, the wordless fog of despair and depression, it is very difficult to think, or plan, or formulate. So we learned to do it when Carolyn was functioning reasonably well – when she could think. We learned that in order to get through the dark times of despair, there needed to be hope for the future, and that hope needed to be in bite-size chunks, something tangible and real. So we began to plan into our diary little ‘hope events’. These might be holidays, or weekends away, a trip to Old Trafford or the Space Centre, some special people for dinner, a speaking event, something being published. In the plughole of depression, all life constricts down into ‘now’ and the ‘now’ is so bleak, so empty, so painful, so dark, that it is not a reason to live. But we began to stretch out the ‘now’ into the future with these positive events that were coming, that were inevitable, that were going to happen. And somehow that touched some of Carolyn’s alters with a sense of ‘future’ and gave them a little more, just a little more, reason to live.
In every suicidal phase, we began to see that there were parts of Carolyn’s team who wanted to die, and almost invariably many other parts who didn’t. After all, this is the nature of dissociation. Resourcing in this way – by giving certain alters something to look forward to, to hope for and anticipate – seemed to provide them with resilience when other alters were intent on self-destruction. Carolyn worked hard at understanding the different aspects or elements of her team, the alter personalities which comprised ‘her’ as a person, acknowledging each of them and the specific role that they had played in her survival. And rather than shaming or alienating the parts of her that seemed so stubbornly bent on suicide, she began trying to understand and value their perspective and outlook. What arose spontaneously was a realisation that, as Janina Fisher says, she is ‘pre-wired for survival’. Even the parts who wanted to die were doing it in order to survive – with faulty logic to be sure, but it was their attempt to flush away the awfulness of the trauma that was surfacing so painfully like that sewage into the present.
Another major paradigm shift for both of us was the understanding that self-harm is often an attempt to reduce pain, not to increase it. Cutting for example releases endogenous opioids – the body’s self-made painkillers – and so paradoxically leads to a release of calming, soothing hormones into the body and bloodstream. Self-harm is an effective and potent self-soothing mechanism. What had at first seemed to me totally illogical began to make sense. I stopped shaming Carolyn for what she was doing – not that I had meant to shame her, but my frustration and lack of understanding was undoubtedly shaming. And that in itself helped improve matters. Because by shaming her, or ‘punishing’ her by distancing myself or withdrawing, I destabilised her and drove her further out of her window of tolerance, which of course meant that she needed to self-soothe in order to regain a sense of emotional equilibrium. And the most effective form of self-soothing to her was … self-harm. And so the cycle would continue.
But gradually we learned other ways for Carolyn to self-soothe that weren’t harmful or dangerous. We learned to notice the discreet signs that indicated that she was heading for a state of hyper- or hypo-arousal, and to do something about it at an early point, rather than when it was ‘too late’. Even just that act of being mindful, of noticing what was going on in her, helped – and I helped too by gently reminding her to notice what was happening, to stop the orbit of ever-increasing circles of heightened affect at an early point. One of the most helpful strategies for us was the development of a literal ‘safe place’ in our house. To start with this was just a particular position on a particular settee in a particular room that Carolyn could go to when she was beginning to feel stressed or dysregulated, and this would be a sign to her and also to me that she needed to feel ‘safe’, that she needed something. It was a tacit acknowledgement on both of our parts as well that it was okay for her to need something. I was more surprised than anyone to see how monumentally successful this strategy was – it helped Carolyn to communicate without words (which when stressed were in short supply), to say in actions that things were beginning to feel tough, and it helped me to recognise and leap into helpful action rather than missing the signs. I would bring her comfort objects, leave her alone if she needed space, or try to attune and connect if that was what she wanted. As far as possible I would keep other members of the household away (children in particular) and just remove those kinds of practical stressors. When we moved house, this ‘safe place’ became Carolyn’s study itself, a place where she could literally shut the door and not be disturbed and down-regulate herself in safe and helpful ways, perhaps by looking out at the birds in the garden, or listening to music, or playing games on her phone, or reading a book. As this strategy became increasingly successful, we realised how much of her early crisis-hopping was fuelled largely by the absence of any strategy at all for self-soothing or self-care. It wasn’t rocket science and it worked.
Self-harm and suicide haven’t gone away entirely. But firstly, Carolyn is still alive. That in itself is a massive achievement. And secondly her self-harm has become minimal and undangerous. I have learned a lot about remaining calm and being a safe, soothing presence to another person, and how the simple but incredibly difficult act of being empathic can regulate someone even from the extreme peaks and troughs of self-harm and suicidality. I have learned that feelings are just that – feelings. We’re supposed to feel them, not necessarily to act upon them. That’s something that I have had to learn myself as much as Carolyn has had to. Both of us are assaulted frequently by sudden, volatile eruptions of unexpected feelings – like icebergs suddenly surfacing and tipping over the boat that was bobbing gently on a placid surface. Emotions don’t go away, especially when you’re dealing with years and years of dissociated trauma and ritual crime. But we are learning not to be so terrified by those feelings, and not to obey their injunctions to act. A few years ago Carolyn could do nothing other than self-harm and follow the pathway to suicidal ideation. But she is learning kinder ways now and I have gained a confidence in talking to partners and survivors on the PODS helpline that crises can be survived and strategies put in place to reduce the potency and threat of such extreme but understandable reactions.
© PODS 2010