troubled minds & scarred bodies a presentation by dr terence nice maidstone 2013
TRANSCRIPT
Troubled Minds & Scarred Bodies
A Presentation by Dr Terence NiceMaidstone 2013
This Presentation
Informative InteractiveInspiring Interesting
Where are we going?
• Poem• What is Self-harm?• Wounded Narratives• Equilibrium • Video Clip
http://www.familyfriendpoems.com/poem/self-harm
It calls me closer, its calls me near "Just once and it'll be over" Death whispers in my ear Irresistible is its sweet entice Staring down, which one to slice, I observe my previous tries My unseen hurt and earlier cries No peace in my mind, no peace in my head The quiet intelligent me, long since fled Anger and rage consumes me My minds demons bursting to be free The walls of my cage finally cave "Just be still, just be brave" I slash down with an improvised knife "Forget this world, forget my life" Blood oozes and drips down the drain A slight tingle but no real pain A Calmness comes over me My last attempt please, it's got to be "Screw everyone, that's made me into this" The very same people who I'm going to miss Tears stream down my cheek, My head feels heavy, I get dizzy and legs go weak Darkness surrounds me, I get a glimpse of the abyss I embrace the darkness, then hear a shriek...
NICE 2011
• Self-harm: any act of self-poisoning or self-injury carried out by an individual irrespective of motivation. This commonly involves self-poisoning with medication or self-injury by cutting.
• Exclusions: harm to the self caused by excessive alcohol, recreational drugs, starvation arising from anorexia or accidental harm.
NICE 2011
• In a recent UK survey of 15-16 year-olds more than 10% of girls and more than 3% boys self-harmed in the previous year.
• Annual prevalence for all age groups is 0.5%.• Self-harm increases the likelihood of completed suicide
by 50-100 fold above the rest of the population in a 12 month period.
• Self-harm is highly correlated with depression, borderline personality disorder, psychosis, bi-polar disorder, drug and alcohol conditions.
Self-Harm and Suicide
• Why do adolescents self-harm and commit suicide?• What is going on in their minds?
Terminology
Self-harm
Deliberate Self-Harm
Self-Injury
Non-Fatal Self-Harm
USA
Self-Mutilation
Europe
Self-InjuriousBehaviour
Parasuicide
Self-Abuse
Attempted Suicide
Suicide
Table of Participants
12 Participants
Title
Age Date of Birth
Gender Ethnicity TabletsTaken
Intent 0-10
School Status
A1Andy
16 13/10/93 Male WhiteBritish
100 9-10/10 College
B2Bess
15 19/11/93 Female WhiteBritish
13 2-3/10 State School
C3Carol
16 12/11/92 Female WhiteBritish
20 4/10 StateSchool
D4Daisy
16 08/09/94 Female WhiteBritish
11 3/10 StateSchool
E5Emma
13 25/05/95 Female WhiteBritish
23 6/10 StateSchool
F6Freda
15 30/01/93 Female WhiteBritish
Cut Self
9/10 Out of School
G7Gill
16 16/07/92 Female WhiteBritish
56 7/10 Out of School
H8Harry
15 18/05/94 Male WhiteBritish
Hit Self 1-10/10 StateSchool
J9Josie
15 18/10/93 Female WhiteBritish
13 & Alcohol 2-3/10 StateSchool
K10Kay
13 11/01/96 Female WhiteBritish
28 8-9/10 StateSchool
L11Larry
16 22/12/93 Male WhiteBritish
21 5/10 StateSchool
M12Mary
15 27/10/94 Female English-Iranian
11 8-9/10 PrivateSchool
Deconstruction & Reconstruction
A1 Word by Word
Equilibrium – The Chief Construct
Master Story & Master Construct
Concept-CategoryMicro-Stories
Grounded Theory Nvivo 8 (A1-M12)
Narrative Method(A1-M12)
A1 Theme by Theme
Stories Constructs Synthesis of
findings
Primary Recurring ThemesA1 Text Themes Higher Order
ThemesPrimary
Recurring Themes
R: What did you expect would happen?A1: Err…Just that I would not wake up really … but I just
couldn’t get to sleep because it was that painful, so…R: There was something physically painful or psychologically painful?A1: Just being sick constantly and…R: You were being sick …A1: Yeah… every 10 minutes R: Did you think you would go off to sleep and never wake up again? A1: Yeah, I was expecting it to be quite easy T: Was it?A1: No…Not as easy as I thought T: Okay…At the time of taking the tablets what was in your mind? A1: Just to hurry up and finish taking them really, okay
Expectations Wish – not to wake upA1 in pain Sick every 10 minutesBeing sick Expecting it (OD) to be quite easyGoing off and not waking up Thought it would be easy but doing it hardHurry up and finish taking them.
Wish to escape Bodily pain Vomiting Harder doing than A1 thought Urgency of self-harm
Bodily pain of taking tablets and being sick.
Wounded Narratives
• R: If your cuts could have spoken what would they have said?
• Freda: Look at me, look …look at this person…shameful… • R: What would they have needed to see?• Freda: This person needs help… if my arm could have
spoken at the time it would have said ‘ow’ I’m in terrible pain, but I didn’t feel the pain because I was numb, but I could feel, my arm could feel the pain, but I couldn’t…if you know what I mean …if my arm could have spoken it would have said look everybody help this person, help her …
(R = Researcher Freda = Participant)
Four Cardinal Constructs
(1) The Upset – Affect Dysregulation
(2) Who Cares? The M/other-Adolescent Relationship
(3) The Telling- Self/Other Relations (4) Equilibrium-Disequilibrium.
Equilibrium
The Body Emotions Cognitions Life Events The Act Friends & Family
The Upset Who Cares? The Taking The Telling
Relational UpsetsSelf out of Balance
Equilibrium
Disequilibrium
Equilibrium-Disequilibrium
Diagram 11: Equilibrium and Disequilibrium I
Home Mates/Peers School
Stress Trigger
Toxic Affects
Distress
Everything’s Out of Control
Can’t Think …Too Many Thoughts
Entrapment – Get Away
Compulsion to Act -Self-Harm
Relief & Repair
Things are Okay
Tensions are building up – Too much Pressure
Can’t Cope – Mind Numbness
Attempted Suicide
Suicide
I’m Coping Much better
Moving Forward
Equilibrium – A Treatment Model
School Teacher/Class
Discharge
Home Mates etc
Adol./Parent Psychotherapy
Family Therapy
1-6 Sessions of Adolescent/Parent
Psychotherapy Then Review
Restoration of Equilibrium
No Change No Change
Applications
• A Tripartite Self-harm Training (Introduction, Intermediate and Advanced).
• Risk Assessment Checklist• Emergency Advice Sheet for Families and Caregivers• Map of Strengths and Vulnerabilities • Self-harm pamphlet for Schools and Colleges • Development of a Short-term Dynamic Treatment
Model• A Post-doctoral Research Project (Quantitative)
Video Clip http://www.youtube.com/watch?v=TdkNn3Ei-Lg
(Jonah Mowry)