Why do we self-harm?

Self-harm, like so many physical manifestations of the growing psychological distress in our world, is on the increase, according to a new survey among young people conducted by four self-harm support groups, and referred to yesterday on Radio 4's The World at One. Figures from the NHS in England show that 11% more young people were admitted to hospital having harmed themselves during 2012 than during 2011, the piece revealed.

The report covered an interview with a girl called Chloe, who was 14 when she began cutting herself, and is now in successful counselling treatment.

Chloe described her former routine dispassionately - she would go to school, come home, go to her room and then cut herself, and remain in isolation from her family for the rest of the evening. She put down the cause of her behaviour to bullying and unhappiness at school and was able to make a clear association between needing to express the pain she felt on the inside by hurting herself on the outside. 'If you can hurt me on the inside, why can't I hurt myself on the outside?' she said to herself at these times.

This distorted notion of 'you're hurting me, so I'll punish you by hurting me too' will not be unfamiliar to therapists who will likely spot the projection involved in this maladaptive way of thinking and behaving. While the victimisation from class mates is obviously real, the attempt is actually to punish the parents - who, after all, will be most punished by living with self-harm in their midst?

Notwithstanding this well-known but little understood psychodynamic principle, according to the survey, bullying is the number one reason given by young people for starting to self-harm, along with a sense of feeling alone in the world. This latter point is significant - why would a child feel alone in the world if the family is operating in the way it's supposed to?

Rachel Welch from selfharm.co.uk, one of the groups responsible for the survey also points to the role of smart phones and tablets in providing 'inescapable' victimisation - with 24/7 connectivity, you're only ever a beep away from the next spiteful remark, she says.

Surely, that's true, but what ever happened to formation of fortitude. something I seem to recall having to cultivate in response to my own long distant and catty adolescence. Learning to understand that a spiteful comment says more about the persecutor than the victim was part of my formation - unless we come to understand this, we will forever remain victims of a naturally dysfunctional world.

Let's hope Chloe's counsellor is delving deep and helping her identify exactly what was driving her need to punish her parents in this tragic and misguided way - rather than simply vilifying the bullies, who are themselves victims of irresponsible parental nurture.

Written by Jacqui Hogan

A Cambridge research first in teenage male depression

It probably comes as no surprise, just from looking within our own circles of acquaintance, that depression and anxiety among our young is on the increase.

According to the Centers for Disease Control in the States, 81% of deaths from suicide between the ages of 10 and 24 occur in males - that might be America, but like any good, virulent strain of flu we, in the UK, seem to catch whatever they do. Research from The Nuffield Foundation confirms this trend and cites changes in employment patterns and family life over the last several decades as possible contributing causes.

Recent findings by Professor Ian Goodyer and his team in the Department of Psychiatry at the University of Cambridge suggest that predicting the likelihood of clinical depression among teenage boys, at least, may become a reality in the near future.

The protocol entailed collecting saliva from hundreds of teenage boys and girls who were concurrently asked to self-report any symptoms of depression. The saliva samples were then measured for cortisol, a hormone released by the adrenals in response to stress. The cohort was then divided into four groups based on cortisol levels and depressive symptoms, and followed up for between 12 and 36 months.

Girls who started out with high cortisol levels and depressive symptoms were found to be four times more likely to develop clinical depression than those starting out with no symptoms and low cortisol levels (an interesting enough finding). Boys with elevated cortisol and depressive symptoms, however, were found to be fourteen times more likely to progress on to developing clinical depression than those with low cortisol titres and no symptoms.

Two obvious implications arise:
1. It would appear that gender difference does have a role to play in the evolution of clinical depression
2. Cortisol may be a reliable biomarker, which could be used to identify those at risk of developing clinical depression, especially among teenage boys

The work also raises the question of how cortisol might be contributing to the development and maintenance of depression and whether it may even be considered as a target for treatment.

This is useful research and let's hope it leads to early identification and prevention of depression in vulnerable young men. But let's not forget, for one minute, the need to address the social, environmental and many other complex factors in the aetiology of depression.

Written by Jacqui Hogan

One sure-fire cure for depression

The current debate in The Netherlands around doctor-assisted suicide for depression sends a shiver down my spine. It's all been triggered by a controversial new clinic, the pragmatically named Life-Ending Clinic, which is now proudly ending the lives of people with chronic depression. Clinic Director, Steven Pleiter, has said:

"We consider it self-evident that someone who is terminal can turn to euthanasia. Now we are entering a phase in which there will be more debate about about patients who are not terminally ill, among them psychiatric patients…" 

A jaunty press release from the clinic stated 'The figures over 2013 show a strong growth of euthanasia in these groups' (referring to those with dementia and psychiatric problems). If that kind of marketing sound-bite doesn't raise a red flag for you, I suggest you look into your heart and see whether some small part of it hasn't turned to stone. For when the day comes that business models and growth projections are applied to the practice of killing our fellow humans, we have truly turned out all the lights on truth and dignity.

Picture the scene: a board meeting at the Life-Ending Clinic, with share-holders seeking higher return on investment and demanding a greater recruitment drive from administrators, setting targets for increasing 'customer buy-in'; the advertising agencies weighing in, the PR machine cranking up, twisting and distorting the minds of those whose minds are most vulnerable.

The Dutch legalised euthanasia in 2001 The law, as implemented back then, allowed doctors to end the lives of patients, but only in close consultation family physicians who had known the patient over many years. Termination of life was intended to be limited to those with 'unbearable and hopeless suffering' who were in full command of their mental faculties and had no hope of relief.

Compare this model to one highly publicised case last year in which the Life-Ending Clinic terminated the life of a 63 year-old man described as having severe psychiatric problems. The customer in question, after an active career in government, could not face the prospect of his up-coming retirement. Gerty Casteelen, the clinic's psychiatrist, told Dutch newspaper NRC Handelsblad that the man:

"...managed to convince me that it was impossible for him to go on. He was all alone in the world. He'd never had a partner. He did have a family but was not in touch with them. It was almost like he'd never developed as a person. He felt like he didn't have the right to live. His self-hatred was all consuming."  

Hey Gerty, well that sounds like a good reason to bump him off then, doesn't it? Maybe your October quota was a little shy of where it needed to be and, well, it must be awful to be in such a terrible position in life, mustn't it? This sounds conspicuously like a man who needed help dealing with some very painful realities and feelings, but not a man who needed to be enabled to die.

We were warned, weren't we, that legalising euthanasia was the thin end of the wedge. And with moves afoot to allow the depressed to choose to die, it would appear that we that we are now boldly scaling that wedge, with barely a 'by your leave'. Anyone who knows anything about depression knows that it is often a wake-up call for a need to change, a precursor, when handled effectively, to a richer and more profound experience of life. Not only that, but those who have been depressed are graced with an empathy, an ability to help others which is a benefit and a gift.

It would appear that the Culture of Death is playing some serious trump cards. But the game isn't over yet.

Written by Jacqui Hogan

Talk is cheap - or is it?

I guess you all know that yesterday marked the first ever outing of Time to Talk Day, described on the official website as '24 hours in which to start conversations about mental health, raise awareness and share the message that mental illness is nothing to be ashamed of, and neither is talking about it.'

The idea was that for a whole day, people of all stripes would gather over a cuppa (in my opinion, the most reliable of all antidepressants) and strike up conversations which would include saying nice things about mental health issues - in environments as diverse as offices, libraries, schools and shopping centres. And goodness me, even people like AXA PPP, private medical insurers, were adding in their caring two-bob's worth!

Now call me a cynic, but I wonder how many of those with mental illness were chirpily flicking on the kettle for Elevenses and tweeting a shot of their cuppa at the appointed hour, while animatedly drilling down into the subject of say, their suicidal depression or bipolar affective disorder? And by contrast, how many of those who cannot come close to understanding the actual experience of living with mental illness were taking advantage of the latest pitch at self-promotion, the latest opportunity to associate themselves with a worthy cause?

In this context, talk is decidedly not cheap, but rather has a distinctive value, oiling the voracious wheels of the public relations industry. Gotta have something to talk about don't we, something to create a new logo for, something to make us look the part while we cash in on the referred glory that will come our way by association. How much of the money paid towards staging this day could have been used to help people with actual mental illness, like my friend, let's call her Veronica, who has been on the brink of suicide all week?

When I spoke to Veronica on the telephone last Sunday, she could barely talk, occasionally supplying faint, monosyllabic answers to my basic, by now anxious, questions about the state she was in. You see, Veronica has attempted suicide three times before, so she has form.

In this latest episode, her mother wound up taking her to hospital, where she was told, more or less, to 'get a grip' and that there are people who are much worse than her whom they had to prioritise. Veronica has been in the system for fifteen years and she will tell you that the system is broken at every level, from clinicians' basic understanding of mental illness to the barrage of drugs she's endured over the years. (On this note, she has told me that she survived this latest bout without the aid of antidepressants and that she can now see that antidepressants made, at best, no difference to her thinking and, at worst, made things worse.)

Oh yes, it's time to talk alright, but perhaps not in the frivolous, self-serving way that the 'powers that be' dream up to try to convince everyone that there's progress being made. Just how gullible are we? Do we not understand the vested interests in promoting mental illness? This is where the talk needs to be - in exposing those who have plenty to gain from the existence of the mentally ill.

Written by Jacqui Hogan