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- Herausgeber: Hammersmith Health Books
- Kategorie: Ratgeber
- Sprache: Englisch
- Veröffentlichungsjahr: 2015
Crisis Counsellor Liz Quish presents this practical guide for parents and others caring for young people who engage in self-harming and suicidal thinking based on her many years of working with vulnerable teenagers. Filled with insight and advice, her book offers a uniquely integrated, whole-person approach, focusing on all aspects of wellbeing: social, emotional and physical; outlines the purpose and function of self-harming behaviours and dispels the myths about self-harm while also offering strategies to support a teenager who self-harms; and offers key insights into suicide risk factors and preventative measures while also providing guidance for those who have lost a loved one through suicide or who are supporting a person through a suicide bereavement.
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Overcoming Self-harm and Suicidal Thoughts
A Practical Guide for the Adolescent Years
Liz Quish
Copyright
First published in 2015 by Hammersmith Health Books – an imprint of Hammersmith Books Limited 14 Greville Street, London EC1N 8SB, UKwww.hammersmithbooks.co.uk
© 2015, Liz Quish
All rights reserved. No part of this publication may be reproduced, stored in any retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publishers and copyright holder, with the exception of licences granted by the Copyright Licensing Agency, the Irish Copyright Licensing Agency and their affiliates.
The information contained in this book is for educational purposes only. It is the result of the study and the experience of the author. Whilst the information and advice offered are believed to be true and accurate at the time of going to press, neither the author nor the publisher can accept any legal responsibility or liability for any errors or omissions that may have been made or for any adverse effects which may occur as a result of following the recommendations given herein. Always consult a qualified medical practitioner if you have any concerns regarding your physical and mental health.
British Library Cataloguing in Publication Data: A CIP record of this book is available from the British Library.
Print ISBN 978–1–78161–056–5 Ebook ISBN 978–1–78161–057–2
Commissioning editor: Georgina Bentliff Designed and typeset by: Julie Bennett, Bespoke Publishing Ltd Cover design by: Julie Bennett, Bespoke Publishing Ltd Index: Dr Laurence Errington Production: Helen Whitehorn, Path Projects Ltd Printed and bound by: TJ International Ltd, UK
In memory of all those who could no longer see the light of hope.
Contents
Acknowledgements
I would like to extend my gratitude to Mary Mulcahy and Catherine Anne O’Connell, two exceptional and passionate facilitators on the Adlerian Psychology Programme at LIT Tipperary. Thank you both for your encouragement and validation and sparking what has now become my passion.
I would also like to thank the teaching staff of PCI College for their support and feedback as I worked tirelessly to achieve my Counselling and Psychotherapy Degree. A special note of thanks to one of my core lecturers, Willie Egan; your sense of humour and compassion are admirable. Thank you for displaying such empathy, congruence and unconditional positive regard!
Dr Fergus Heffernan, you are a true inspiration and a very special person; thank you for sharing your life story and insights. I learned so much from you and will be eternally grateful that our paths crossed.
My practice supervisors, Marie O’Connor and Frances Burke, thank you for listening, encouraging, validating and gently challenging me.
To my parents and siblings Sean, Mary and Steven, thank you for all that you taught me long before I learned the theory!
To Paul, my husband, thank you for believing in me, for all the cups of tea, and for feeding me as I endeavoured to complete this book. Thank you for making me realise that dreams can and do come true.
Sincere gratitude to Georgina of Hammersmith Books for realising the importance of the subject matter of this book.
Introduction
During my training in Counselling and Psychotherapy I became very interested in self-harming and suicide due to its prevalence worldwide and as such conducted a great deal of research into the topic and engaged in further training in the area. Immediately after I qualified as a Counsellor and Psychotherapist I secured a position as a counsellor with a Self-Harm and Suicide Intervention Crisis Centre based in Ireland.
Through supporting stressed and distressed teenagers from 12 years upwards, I noticed common themes, presentations, thought processes and struggles which I have come to term ‘self-defeatist syndrome’. Many came to see me feeling anxious, scared, tired, overwhelmed, angry and isolated, with a very negative view of themselves and their abilities and a great sense of hopelessness and inadequacy. They could not see the beauty within them; it was clouded and forgotten, shadowed by thoughts of uselessness and feelings of inadequacy. There was no brightness or twinkle in their young eyes. Self-defeatist syndrome had taken hold and what I call ‘the Gremlin’ had moved in and taken over their young minds and souls, causing havoc in their lives. These young teenagers did not know how to evict the Gremlin; many didn’t even know it had moved in. You see, the Gremlin is stress that progresses to distress – not a mental illness, but psychological distress that manifests in what I term self-defeatist syndrome.
This syndrome – or collection of symptoms and features that tend to occur together – causes our teenagers to become anxious, angry, hopeless, depressed, and to engage in self-harming; many consider and, unfortunately for some, complete suicide. In my experience, by employing an integrative approach which addresses the teenager’s lifestyle, with a focus on nutrition, complementary therapies, talk therapy, exercise and community engagement, self-defeatist syndrome can be defeated and the Gremlin evicted!
I aim to guide readers through the steps and tasks of assisting a teenager in managing and overcoming the many challenges presented by this syndrome, with the ultimate goal of restoring mental wellbeing and family cohesion.
Sadly, self-defeatist syndrome has proven fatal and resulted in many young people worldwide completing suicide, with devastating consequences for their families and friends. In the final chapter of this book I address the impact of such a loss and guide readers through how to support those bereaved by the death of a loved one through suicide.
Chapter 1
Understanding ‘Self-Defeatist Syndrome’
A person whose head is bowed and whose eyes are heavy cannot look at the light.
Christine de Pizan
What I will term ‘self-defeatist syndrome’ throughout this book is the uninvited Gremlin that moves into young minds, metaphorically speaking. The Gremlin is STRESS that leads to DISTRESS, an unruly tenant that is powerful, deceitful and controlling. Its ultimate goal is to take control of a teenager’s life in a destructive manner causing him/her to feel alone, depressed, angry, afraid, hopeless and anxious. The Gremlin is not a friend; the sooner it is evicted the better. The longer it stays the more powerful it becomes, taking the teenager hostage. The Gremlin’s goal is to isolate the teenager from family and friends, thus making itself even more powerful. It wants to make the teenager feel lonely and powerless, surrendering to the darkness, diminishing his/her light and self-esteem, distorting his/her belief system and sense of self.
The sense of self
The ‘self’ relates to our uniqueness and individuality, our thoughts, feelings, perceptions and sense of worth, and how we view ourselves. The self also relates to our sense of identity, our belief system and values.
A teenager with a healthy sense of self will:
feel confident and competent
feel a sense of belonging and acceptance
feel secure, safe and valued
have self-discipline and self-control
learn from and move on from mistakes with new awareness
value his/her strengths and accept his/her weaknesses
have a healthy set of core values.
These are all the traits that the Gremlin of self-defeatist syndrome despises and wants to eliminate. The Gremlin does not want the teenager to have a healthy sense of self; a healthy sense of self is its enemy. Its wish and desire is for the teenager to have a defeatist view of him/herself. In achieving this, the Gremlin has accomplished its objective and is actively compromising the wellbeing of teenagers, who are not strong enough to evict the Gremlin on their own.
The defeatist attitude
The ‘defeatist attitude’ refers to an attitude or view of oneself which is negative, pessimistic and unforgiving. A teenager with a defeatist view of him/herself will present with low self-esteem and a noticeable and ongoing lack of motivation, generally deriving little pleasure from life, with a distinct lack of belief in his/her abilities. This is a clear sign that the Gremlin has moved in and taken the teenager hostage. Teenagers in this situation will often use phrases like:
What’s the point?
It won’t work for me.
They would all be better off without me.
It’s just one thing after another.
I couldn’t be bothered.
I can’t manage this anymore.
I am no good.
No one cares about me.
I can’t do it.
Syndrome
A ‘syndrome’ refers to a combination of signs and symptoms that are indicative of a particular condition. A teenager in the midst of self-defeatist syndrome will generally present with:
Low energy
Low self-esteem
Depression
Anxiety
Anger
Self-harming
Suicidal ideation (thinking).
Low energy
A teenager can experience low energy for a number of reasons. Adolescence is a period marked by a rapid increase in physical and emotional development. Puberty, hormonal changes and the soaring growth of bones and muscles can have a temporary effect on energy levels, causing many teenagers to feel fatigued from time to time; this is totally normal and to be expected. However, if low energy persists and negatively affects the quality of life of a teenager, a detailed and comprehensive medical investigation is warranted and strongly advised. A full medical investigation should uncover any organic reasons for fatigue and low energy; then, the right treatment can get a teenager’s energy levels back on track and prevent the onset of self-defeatist syndrome.
Common organic reasons for low energy uncovered through a medical investigation in teenagers include:
Infection
Virus
Iron-deficiency anaemia
Low thyroid function
Vitamin B and C deficiencies
Allergies.
Harder to diagnose, and more unusual in younger people, are underactive thyroid (hypothyroidism) and pernicious anaemia/vitamin B12 deficiency.
If after a full medical investigation no organic causes for low energy and fatigue can be detected, then lifestyle needs to be further scrutinised and addressed as the Gremlin may be actively trying to move in.
Exploring a teenager’s lifestyle
Diet
Nutrition is especially important during the adolescent years due to the rapid growth and progression that occurs during this developmental period. Many teenagers have developed poor eating habits and have little understanding of healthy eating and the effect food has on their physical and mental health.
Food production and manufacturing techniques have changed considerably in the last few decades. This, combined with fast-paced lifestyles and an ever increasing reliance on processed foods, has resulted in the decline of fresh and nutritious foods in our diet, particularly in teenagers. Teenagers who have poor eating habits, or who are eating irregularly and consuming lots of processed, high-sugar foods and drinks, are compromising their wellbeing. These foods have a remarkably negative effect on energy levels. Sugary foods and drinks cause energy rushes, but we need to remember that what goes up must come down! These processed and high-sugar foods and drinks give a short bust of energy, but then comes the low. In cases where diet is inadequate and affecting the overall wellbeing of a teenager, parents are advised to consult a nutritionist in order to assess and address their child’s negative eating habits. Diet will be addressed in more detail in Chapter 6 (see page 91).
Sleep
When sleep requirements are not being met on an ongoing basis, teenagers will present with fatigue, low energy, exhaustion and a lack of motivation. It is generally recommended that teenagers get eight to 10 hours quality sleep a night. This is vital for the body to relax, repair and refuel. Lack of sleep has a domino effect and impedes mental and physical wellbeing, inviting the onset of self-defeatist syndrome. As I have said already, parents are advised to take their child to a GP to rule out any organic causes of fatigue. In instances where no organic cause is established it is highly likely that the Gremlin has moved in. The Gremlin loves and thrives on the darkness. It becomes alert and active, coming out to play its evil games at night when we are programmed to relax, unwind and fall into a peaceful slumber. The Gremlin is very powerful and demanding, wanting to keep us awake, bolstering and encouraging negative thinking, which leads to rumination, tossing and turning and feeling like our head is going to explode! Thoughts are negative, racing and exhausting. It is vital that teenagers who have been taken hostage by the Gremlin receive appropriate support and professional intervention so they may be facilitated in developing the tools and techniques needed to evict the Gremlin. This will be outlined in Chapter 4 on Talk therapies (see page 49).
Low self-esteem
Self-esteem relates to how we think and feel about ourselves. Teenagers with low self-esteem will not like any part of themselves. This is not the same as not liking an aspect of ourselves, which we can all relate to and generally accept. They will be very critical of themselves and will not be able to identify any positive traits; in this instance, the Gremlin is winning and achieving its objective.
The main characteristics of low self-esteem are:
Withdrawal
Insecurity
Poor body image
Isolation
Lack of motivation
Anger
Inability to accept a compliment
Self-neglect
No value put on own opinion
Negative thinking
Extremely critical of self
Self-blame.
I have witnessed on a daily basis the pain and anguish caused by low self-esteem and how it cripples the emotional and social wellbeing of teenagers.
Reasons for low self-esteem include:
Struggling with sexual identity
Pressure from parents to achieve, and being likened unfavourably to a sibling
Pressure from teachers to achieve high grades
Isolation by peer group
Sexual abuse
Physical abuse
Emotional abuse
Being overweight
Being underweight
Break-up of a relationship
Bullying
Rejection.
The Gremlin is very happy and content when it discovers a teenager has experienced, and is struggling with, any of these issues. It taps into this vulnerability with great energy and enthusiasm and feeds the negativity and sense of hopelessness that can emerge from such struggles, further exacerbating the issue. Low self-esteem is the foundation stone of self-defeatist syndrome and results in teenagers becoming depressed, anxious, and angry, engaging in self-harm and contemplating suicide.
Depression
Teenagers who feel depressed will have ongoing low mood, low energy and difficulty concentrating, and often have bouts of sleep disturbances along with tearful and angry outbursts. They will have a poor sense of self, presenting to health professionals with low self-esteem and actively engaging in negative thinking, stating and believing that they are no good, unloved and a burden, and are full of self-loathing. They may lose pride in their appearance and eating or, indeed, begin to overeat for comfort. A teenager experiencing a period of depression will find little pleasure in life and may have ongoing suicidal thoughts and actively engage in self-harming.
A diagnosis of depression is usually made if the symptoms outlined have been persistently present for two to four weeks, or longer. In this instance, self-defeatist syndrome has taken hold and professional intervention is vital. Teenagers who are feeling depressed need support, guidance and patience. They are not able to simply ‘snap out’ of this state of mind and evict the Gremlin; if they could, believe me they would! The anguish caused by depression is soul destroying. Cognitive behavioural therapy (discussed in Chapter 4 on Talk therapies (see page 49)) is often the talk therapy of choice in supporting a teenager through depression. This form of therapy has been scientifically proven to be extremely beneficial in supporting teenagers through the management of depression. Medication has its place, and parents are advised to seek guidance from their GP around this. It is, however, worth noting that anti-depression medications have many side-effects and can increase and heighten the symptoms for which the medication has been prescribed to treat. Lifestyle habits and choices also need to be addressed in order to manage rather than exacerbate the condition.
Anxiety
Teenagers who present with anxiety are in a constant state of high alert and fearfulness. They are physically and mentally drained as a result of being in this constant state of ‘fight or flight’. They experience and struggle with poor concentration, lack of recall, and restlessness, often reporting tension headaches and stomach cramps. Anxiety is a major characteristic of self-defeatist syndrome.
We all have experienced anxiety from time to time, be it before an exam or job interview, moving house, or moving to a new school or job. We feel butterflies in our stomach and may have one or two nights of restless sleep. This type of anxiety is short lived, common and expected in these situations. By contrast, the anxiety that is associated with self-defeatist syndrome is much more debilitating and often and goes hand in hand with depression. Anxiety and depression are best friends that fight us in order to stay together, as together they are more powerful in controlling us. This form of anxiety is constant, draining and debilitating. The body and mind are in a constant state of stress.
Characteristics of chronic anxiety are:
Tension headaches
Stomach cramps
Chest pain
Feelings of impending loss of control
Tearfulness
Physical and mental tiredness and restlessness
Nightmares
Low levels of concentration
Angry outbursts
Sweating and feeling clammy
Panic attacks.
The wellbeing of a teenager who displays this level of anxiety is highly compromised and entering a danger zone. Many in this situation are also engaging in self-harm and have strong suicidal ideation. They are in a very distressed state, afraid, tired and vulnerable, and in many cases misunderstood by family, friends and teachers.
Many teenagers try very hard to hide their anxiety. They display what I term ‘swan stance’, appearing to be controlled, confident and at peace on the outside, but underneath they are paddling like crazy, possibly engaging in self-harm in order to release their inner turmoil, if only momentarily. Self-harm will be explored in more detail in Chapter 2 (see page 13).
Anger
Anger is generally a result of an unmet need, perceived or real. The key to managing the anger strand of self-defeatist syndrome is to help teenagers to uncover and verbalise their unmet need in a proactive, healthy, respectful way rather than in an aggressive, reactive manner such as bullying, destructiveness, threats, unpredictability and vengeance.
Teenagers who display regular bouts of anger often, in my experience, have a limited emotional vocabulary; consequently they are unable to identity their feelings and as a result act out, flipping the lid or losing the head. When we are angry and act on this feeling we are in essence switching off the cognitive, logical part of our brain and exposing the more primitive, emotional part and setting it in motion. I am sure we can all recall a situation in which we got angry, acted out and regretted it later! We flipped the lid, exposed our primitive emotional brain and operated without logic – never a good idea!
