Safe mutilation

February 5, 2006 10:04 PM

Some British nurses want patients who are intent on harming themselves to be provided with clean blades so that they can cut themselves more safely.
posted by daksya (51 comments total)

"They say people determined to harm themselves should be helped to minimise the risk of infection from dirty blades, in the same way as drug addicts are issued with clean needles.

This could include giving the “self-harm” patients sterile blades and clean packets of bandages or ensuring that they keep their own blades clean. Nurses would also give patients advice about which parts of the body it is safer to cut. "

...what?
posted by tozturk at 10:15 PM on February 5, 2006

maybe we should just give them heroin?

Also, is this really a problem? It's not like they're sharing the blades, what's the worst that could happen? A bacterial infection?
posted by delmoi at 10:18 PM on February 5, 2006

tozturk, we're talking about people who have mental issues that compel them to cut themselves. They can cut and infect themselves or they can cut themselves with less damage.

If going cold-turkey doesn't work with regards to this behavior, at least some steps can be taken to minimize the damage it causes while going through other steps to address the issues that cause it.

Hence the drug addict comparison is apt.
posted by Firas at 10:18 PM on February 5, 2006

I can see where they're coming from, but one would think that the first step would be removing the sharp objects as part of the treatment, wouldn't it? And while, logically, I can see the similarity to needle exchange programs, somehow it just doesn't gel with me and I can't figure out why. If someone has a compulsion to drive cars into lampposts, do we treat them by installing airbags?

However, I assume we're dealing with the typical situation we find all over the world these days - instead of providing people with mental illnesses with appropriate treatment in a proper facility, we give them a stack of drugs and dump them back out on the street. Under these unideal conditions, where there's no way to control what sharp objects they get their hands on, I guess harm minimisation is the way to go. I'd still prefer that they get proper, intensive treatment in conditions where there's no possibility of harm,though.
posted by Jimbob at 10:27 PM on February 5, 2006

Bunch o whiners
posted by HTuttle at 10:35 PM on February 5, 2006

Presumably if some of these patients feel the need to self harm badly enough, they may resort to desperate measures. Tin cans, as the article says, bed frames, broken glass--I suppose you'd have to go one way or the other: lock these people up in padded safe rooms until treatment progresses, or do as these nurses are suggesting.
posted by stray at 10:40 PM on February 5, 2006

I can see where they're coming from, but one would think that the first step would be removing the sharp objects as part of the treatment, wouldn't it?

Not necessarily - we're talking about behavior that in cases such as this, I'd presume, can be classed as compulsive. People are clever, can, and will find a way to satisfy these compulsions. If somebody is compelled to self-harm, and you want to remove all possible means for the person to do so, you'd pretty much have to lock them up in a room with nothing more than a bed and some sheets. It's better to educate people, to get them to recognize their own triggers and issues and help them deal with the root cause rather than just try to take away the tools.

Taking away all sharp things isn't that easy. You'd be surprised what a torn fingernail, for example, can do with a little determination.
posted by truex at 10:46 PM on February 5, 2006

I can see where they're coming from, but one would think that the first step would be removing the sharp objects as part of the treatment, wouldn't it?

Unfortunately, if you do that, they'll use dull objects, which cause more serious damage.
posted by Happy Monkey at 10:46 PM on February 5, 2006

This seems crazy to me. Here's the passage that clinches the craziness factor, in my opinion.

At present nurses are expected to stop anyone doing physical harm to themselves and to confiscate any sharp objects ranging from razor blades to broken glass and tin cans.

However, Ian Hulatt, mental health adviser for the RCN, said: “There is a clear comparison with giving clean needles to reduce HIV. We will be debating introducing a similar harm-reduction approach. This may well include the provision of clean dressing packs and it may mean providing clean ‘sharps’.

This passage makes it seem like the nurses are faced with these choices:

1. take away sharpt things (and probably fail to prevent most cutting.)
2. give them clean sharp things (and fail to prevent all cutting, but at least it's infection free.)

I mean, if we're talking about obsessive non-lethal cutting, then I guess infection is the more major problem, but isn't this just straight up enabling? What method of psychological treatment involves fostering the harmful behavior in this way?

Am I just misunderstanding the situation here? For instance, here's a gem:

There is a clear comparison with giving clean needles to reduce HIV

This would be true if hospitals gave heroin to heroin addicts. But they don't. Giving clean cutting instruments to those who self-harm compulsively draws a clear comparison to giving clean needles loaded with dope to junkies to reduce HIV. It's fighting the side effect by ignoring the problem.
posted by shmegegge at 10:47 PM on February 5, 2006

It's an odd condition, I ran into an acquaintance last year (male in his thirties) who seemed normal but I saw him reach up for something and his arm was a hatch of dozens and dozens of fresh cuts. Then I came across this website about self injury, site psyke.org, lots of pictures of slashed arms and stomachs. Quite disturbing.
posted by bobo123 at 10:48 PM on February 5, 2006

I move we allow them to exchange their razor blades for chainsaws.
posted by keswick at 10:51 PM on February 5, 2006

I enjoy huffing lighter fluid until I am in a stumbling black-out. Therefore, I request the presence of a medical professional to keep me from falling and hitting my head on the edge of the coffee table, as that may result in traumatic injury and/or death.

Why is facilitating pathological behavior helpful, to either the individual suffering from the compulsion or to society as a whole?

The comparison to needle-exchange programs seems bogus to me, since self-harm is generally an individual act and doesn't risk the spread of transmissible diseases such as HIV or hepatitis.

I see how using kitchen implements may be unsanitary and unsafe, but shouldn't people who feel compelled to cut themselves then have to bear the burden of their impulsive actions?

_{(For the record, I have never "huffed" anything.)}
posted by BitterOldPunk at 10:53 PM on February 5, 2006

shmegegge : "This would be true if hospitals gave heroin to heroin addicts. But they don't."

Technically, you're right, but not in substance: I get my heroin on the NHS.
posted by Gyan at 10:56 PM on February 5, 2006

What method of psychological treatment involves fostering the harmful behavior in this way?

IANAD, but it seems this is a situation where you have to separate the condition from symptoms. You treat the condition that causes the cutting as a means of rehabilitation and prevention. The blades themselves, therefore, are almost irrelevant from a strategic treatment perspective.
posted by VulcanMike at 10:57 PM on February 5, 2006

This comes down to relativism. I presume these self-cutters do so, because it relieves tension. Society considers it harmful because we don't relate to it as it brings upon pain for most of us, i.e. a difference in brain functioning. So the "objective harm" that remains is the physical aspect. That is what this initiative wishes to contain.
posted by Gyan at 11:02 PM on February 5, 2006

Another step further away from dealing with the causes of such behaviour.

More enabling the victim which is more harmful to the individual in the long-run. Once you're a victim of whatever, there's this whole parasite care industry that seems to wrap itself around you and make sure you're never free from your victimhood just so they can keep their jobs safe.
posted by FieldingGoodney at 11:10 PM on February 5, 2006

...and before somebody tells me the NHS is public sector, I know already - but hospitals these days in the UK are run like private businesses.
posted by FieldingGoodney at 11:11 PM on February 5, 2006

This comes down to relativism. I presume these self-cutters do so, because it relieves tension.

This is a bit of a blanket statement. There are as many reasons as there are cutters, potentially. Some do it for attention and make (disturbing, in my opinion) online communities about it because they feel they need to go to extremes. Some fit into the "omg i can't feel i have to feel something even if it's pain" stereotype. SOme hav epent up tension or anger or sorrow, but for some the reason isn't even fully understood by the person in question. I've known somebody who described the actual act as a sort of disconnect between the intellect and action, watching himself cut while calmly thinking to himself that it probably isn't a good idea to do so, but oh well, I just need to get this done, then maybe I'll go out for some dinner or watch some TV or something.

With that said, however, I think that actually handing out blades is a step too far. Bandages and antibiotics and whatnot, I'm down with that. Handing out information and educating cutters about the risks and dangers, that's a good idea. Free knives for all, though? Not so much, I think.
posted by truex at 11:32 PM on February 5, 2006

IANAD, but it seems this is a situation where you have to separate the condition from symptoms. You treat the condition that causes the cutting as a means of rehabilitation and prevention. The blades themselves, therefore, are almost irrelevant from a strategic treatment perspective.

Also, this is pretty spot-on. The blades aren't a part of the treatment, but are part of the temporary management of the behavior. This is what I think these nurses have in mind. It'd be insane to suggest that they want to let these people continue their behavior unabated. They just want to make sure that until the root cause is addressed, the symptoms are managed so as to render the consequences less harmful.
posted by truex at 11:36 PM on February 5, 2006

truex, giving them antibiotics would do more harm to society than giving them clean blades would. Not just because antibiotics are more expensive, but because the problem of antibiotic resistance through overuse, improper use, and inadequate use in cases of repetitive exposure is a looming global health crisis in the making.
posted by George_Spiggott at 11:39 PM on February 5, 2006

Looks to me like the lunatiks have taken over Bedlam.
posted by squeak at 11:49 PM on February 5, 2006

This would be true if hospitals gave heroin to heroin addicts. But they don't.

Yes they do.

IIRC, it's about 600 people at present in the UK getting heroin prescriptions for the treatment of drug dependence.

We've been doing it continuously since Sir Humphrey Rolleston legitimized it in the 1930's, the Dutch and the Swiss now do it as well, and other countries such as Canada and Australia have been contemplating it for some time.
posted by PeterMcDermott at 11:51 PM on February 5, 2006

I don't see why already overworked and overstressed nurses should be burdened with the 24/7 task of policing patients who will find some way of harming themselves in any case. Sometimes compassion takes superficially cruel forms. Nurses are more on the front line of health care than many doctors. If they say a thing is necessary, I'm inclined to at least listen to their argument.
posted by slatternus at 12:51 AM on February 6, 2006

I'd like to hear a more detailed argument from the nurses, but it sounds crazy to me. There is no analogy to harm reduction, like heroin addiction.

I've never heard of a cutter being actually addicted to the behaviour, although the endorphin rush may reinforce it subconsciously. And it's generally associated with suburban boredom, alienation, and a certain desire for attention. These are solvable problems, why must we resort to giving out razor blades?

I would prescribe some physical activity where they can get endorphins more easily, and hopefully that would help with their general stimulation.
posted by brevity at 1:34 AM on February 6, 2006

The real problem is that we don't teach safe cutting anymore. The first rule is to always, always wear a condom while using a razor blade. Prevents infection and pregnancy!
posted by nlindstrom at 1:38 AM on February 6, 2006

self-harm is generally an individual act and doesn't risk the spread of transmissible diseases such as HIV or hepatitis.

I see how using kitchen implements may be unsanitary and unsafe, but shouldn't people who feel compelled to cut themselves then have to bear the burden of their impulsive actions?

posted by BitterOldPunk at 10:53 PM PST on February 5 [!]

Any self-caused deliberate harm should not be treated?
Pretty soon those pesky AIDS-infested drug addicts and sexual deviants won't be bothering us anymore. Problem solved. I think we could extend this "not my problem"-policy to more things. Smokers, fat people, careless drivers and mentally ill people should bear the burden of their actions. They don't harm other people, just themselves and therefore should have to live with their choices.

Fucking hell. You think these people want to be slashing their arms to ribbons? It's not a simple question of choice. The treatment isn't just telling the people to "get over it and stop hurting yourself". It's a lot more complex than that.

Too many people think that self-harm is simply something done by 16-year old girls seeking attention. It's a

As for passing out clean blades? I don't think it's necessarily the best option, but I would rather they have clean blades and anti-septic treatment (and knowledge about infection) on hand than have people suffering from this condition cutting their arms with whatever they can get their hands on...
posted by slimepuppy at 2:21 AM on February 6, 2006

This would be true if hospitals gave heroin to heroin addicts.

What everyone else has said PLUS that they get given huge quantities of methadone which is worse for you in all sorts of ways than Heroin. e.g. It's more addictive, it lasts longer in your body, oral administration is apparently rather bad for your teeth/gums, it takes longer to quit, nausea, vomiting, hallucinations, weight gain, constipation, depression, fainting, insomnia, breathing problems, increased heart rate, and seizures.

Methadone is given to people trying to get off of heroin simply because it doesn't give you the happy warm feeling. From my experience with people getting off heroin they say that it's the structure and support offered by the rehab clinics that makes the difference, not the Methadone.

---

I've never heard of a cutter being actually addicted to the behaviour, although the endorphin rush may reinforce it subconsciously. And it's generally associated with suburban boredom, alienation, and a certain desire for attention. These are solvable problems, why must we resort to giving out razor blades?

You clearly have limited or no experience with people who self harm. Just as with giving out needles to people who inject, giving out clean blades is simply an exercise in damage limitation. It is not supposed to be solving all their problems, just keeping them from dying before they've had proper help.

This is not being touted as a cure, or a solution of any kind, it is merely an aid in the process of psychological rehabilitation that these people should be receiving and no doubt will be offered to them when they are given the blades. It's not like they will be given out in anonymous vending machines on street corners. You will have to go and talk to someone to get them. Which in it's self turns your self harm into a social activity rather than an isolated one in which you are the only party.
posted by public at 3:29 AM on February 6, 2006

Why is facilitating pathological behavior helpful, to either the individual suffering from the compulsion or to society as a whole?

Amen! I say that we give them blades covered in a thin layer of ricin. Maybe then they'll cut the shit.
posted by Mayor Curley at 4:46 AM on February 6, 2006

I enjoy huffing lighter fluid until I am in a stumbling black-out.

good times
posted by nervousfritz at 5:00 AM on February 6, 2006

I worked with a lot of kids that are cutters. While this technique probably wouldn't work with adults, I ask the kids to substitute the knife for a pen, encouraging them to draw/write on the parts of the body they used to cut. While not a perfect solution, cutting behavior can be effectively redirected, which should be done rigorously. I see the clean blades thing as a last ditch effort.
posted by moonbird at 5:25 AM on February 6, 2006

this is an excellent issue. It really brings out the difference between people whose morality is based on some sort of abstract principles, and who don't really care what the actual effects of enforcing those principles are on actual people in the actual world, and people whose morality is based on pragmatics & observation of the real world.

People with strong religious beliefs tend to be the first type. Atheists & rat/mats tend to be the second.
posted by lastobelus at 5:57 AM on February 6, 2006

Some years ago, I read an article in Harpers (I think) in which a nurse suggested that bolemics coat their teeth with baking soda before vomiting to prevent the damage to the enamel that occurs from the acid.

I think that the analogy to that sound advise is more appropriate than the heroin analogy.

Of course it's bad for you; just don't make it worse is the philosophy.
posted by leftcoastbob at 6:02 AM on February 6, 2006

We're missing the obvious question here: When would nurses even have the opportunity to provide cutters with razors and feel that it's an adequate caution?

I would imagine it's when they're in the hospital and some have tried to get into the "used sharps" container on the wall when left alone for a few minutes.
posted by mikeh at 6:41 AM on February 6, 2006

Also, I would imagine if the blades are sharp, it won't hurt as much, and the people might be compelled to cut deeper, or something. Maybe aluminum cans would be better?
posted by delmoi at 6:48 AM on February 6, 2006

If one actually goes to a program such as any of the SAFE programs, the first thing they do is take away anything that you could use to self-harm; however, that's in an extremely restricted environment, basically a psych ward. It is a situation which is otherwise impossible to deal with. I've seen people self-harm with nail clippers and tweezers- supplying sanitary means and at least giving people some sort of support system would be amazing.
It's a really tough question. A few years ago, someone very close to me began self-harming, and it really, really saddens me how much time we spent wondering if it was for attention, whether we should ignore it, whatever. In retrospect and after other person experience, I realize that's all bullshit. If someone's cutting themselves, they need help, regardless of their reasons, and this is certainly better than nothing.
posted by 235w103 at 7:01 AM on February 6, 2006

Oh, and I can't suggest the SAFE programs enough; I believe the first-time success rate is something like 80%, just wonderful for any sort of psychological program. If anyone reading even thinks they might have a problem with self-harm (and it is actually a hard thing to see sometimes), please call the number or otherwise use that information.
posted by 235w103 at 7:03 AM on February 6, 2006

Wish I'd got this thread earlier because most of you have no idea what the hell you're talking about. Lots of great outrage, but it's all based on uninformed opinion.

Vancouver, BC, runs a safe injection program. We actually supply the needles and the heroin. Nurses are there in the shooting gallery to ensure things are under control and to assist as needed.

It works.

On the whole it is true that no one wants to be addicted. And on the whole it is true to say that most addicts don't know how to stop.

That's where the nurses come in. They become familiar faces to the addicts, and this opens the opportunity for the addicts to ask for help in a safe, supportive environment without judgement and risk.

It is less costly, in both dollars and social damage, to have a safe injection program than it is to ignore the problem.

The same will apply to cutters.
posted by five fresh fish at 11:10 AM on February 6, 2006

It's hard to say much about this without knowing the full proposal. But, from the stories my mom tells as a nurse, wound care is a bitch, and the care of infected wounds is even worse.
posted by KirkJobSluder at 12:14 PM on February 6, 2006

Methadone is given to people trying to get off of heroin simply because it doesn't give you the happy warm feeling. From my experience with people getting off heroin they say that it's the structure and support offered by the rehab clinics that makes the difference, not the Methadone.

this is true and untrue. it's the structure and support that allows patients to get off heroin, true. But it's the methadone that allows them to survive the withdrawal from heroin. It's given to patients because it doesn't foster the psychological addiction and helps wean the physical addiction. How long it takes, the mood problems, the rest of the problems with methadone: doesn't matter when you consider that people taking methadone get to clinics and other forms of help more often than people who aren't.

as far as the heroin addict thing: my bad. I failed to notice that this was a british newspaper. read too quickly I guess. I know nothing about british and other nations' treatments for drug addiction.

on the other hand, five fresh fish's example makes no sense to me. The program she describes works because of the nurse's intimate involvement in the process of doing heroin for the patinet. Will the nurses be cutting the patients for them? Will they be insuring safer use of the instruments? The article I read just said they'd be handing the implements over to the patients, to reduce risk of infection. I really don't see the comparison.
posted by shmegegge at 12:23 PM on February 6, 2006

The self-harmer would actually talk to someone about what was going on, which is a great step in the first place. What five fresh fish said re:
...and this opens the opportunity for the addicts to ask for help in a safe, supportive environment without judgement and risk.
is spot on. Self-harm is not something that is commonly talked about or dealt with, and the more that self-harmers realize that they're not alone dealing with this problem the more will be able to stop.
posted by 235w103 at 12:29 PM on February 6, 2006

You guys make it sound like they're just passing out razors and walking away. Teaching someone not to cut while they have the means to do so seems more useful in the longterm than taking away all sharp objects and then trying to prepare them for a real world full of oppertunities. I'm not saying this is necessarily true, but it could be. Let's leave that up to the professionals to try out.
posted by es_de_bah at 12:46 PM on February 6, 2006

or what fff said
posted by es_de_bah at 12:47 PM on February 6, 2006

truex, giving them antibiotics would do more harm to society than giving them clean blades would...

Sorry, I wasn't quite clear. I'm well aware of the problems with growing bacterial resistence, super-strains, etc. I was thinking more along the lines of the basic anti-bacterial ointments and crap you can get OTC. Nothing prescription strength, just sterilization and basic first-aid level cleanliness. Antibiotics was probably not the right word to use.
posted by truex at 12:57 PM on February 6, 2006

And what the article said: what I read indicates that the nurses will be providing an amount of counselling, including helping the cutters choose safer areas to slice, helping them agree to the depth and number of cuts, and helping them look for alternatives.

It's a great idea all around: instead of a secrecy, shame, and a punatative system, we have one that is assistive, supportive, and offers help on terms the abuser can choose independently and without fear.

there's a spelling mistake lurking in this message and i, in an effort to quit abusing my writing, am not going to fix it!
posted by five fresh fish at 1:05 PM on February 6, 2006

Hang on a second. I thought a lot (not all, obviously) of people who self-harm do it because it gives them something they can control.

Now nurses will be "helping them decide" the place to cut, the number of cuts, the depth of the cuts? Somehow I don't think this will make cutters feel better and more in control of all their decisions.
posted by booksandlibretti at 2:45 PM on February 6, 2006

Just have their parents tell them cutting is cool, break open a six-pack of Gillette's, and invite the neighbours and aunt Bessie round for a fondue and arm slicing soiree.

That'll stop the fuckas.
posted by Blue Stone at 3:14 PM on February 6, 2006

I'm a cutter.

I started as a teenager, when several things happened to me that, had they occured in a political context, would have been considered crimes against humanity.

And eventually, in spite of all the help I got from well-meaning educated professionals, I stopped.

I stopped (meaning I had no desire to) for nearly a quarter of a century.

Then another thing happened to me, and the only thing that would bleed out the pain was..... bleeding out the pain.

some people rend their clothing. some get tattoos, or piercings. Some bleed it out in talk, or in art. some swallow it. Some get drunk and lose or destroy things that are precious to them.

Gah. I had a lovely, fluid, magnificent rant going on but I went to dinner first.

My point is.... sometimes extraordinary things happen to people. And sometimes the helping professions, with the best of intentions, take what is a soulful and lifesaving response to a pathological situation and try to make the response the pathology.

I am not a fucking victim. Shit happened. To me. Shit happens to everyone to one degree or another.I was articulate and insightful and all the talk therapy in the world couldn't touch what was inside me. Nor could the drugs the well-meaning helping professionals dosed me with, or the foster homes they put me in (and sadly,two of those homes created their own scars.... they weren't... good for me. {you want specific details? gmail me then.}
but what else did the helpers have to work with?)

Gah again.

Look.

Cutting is marking. Marking something important to you, personally. It isn't about dying, its about surviving.

Until those well-educated helpers understand that, they will continue to have clients who think the only way to get their attention is by bleeding at them.
posted by merelyglib at 6:16 PM on February 6, 2006

"It's a great idea all around: instead of a secrecy, shame, and a punatative system, we have one that is assistive, supportive, and offers help on terms the abuser can choose independently and without fear."

You nailed it, FFF. Except of course, I wasn't the abuser. I was responding to abuse.
posted by merelyglib at 6:20 PM on February 6, 2006

Self-abuser, dude. Which I think you know is what I meant.
posted by five fresh fish at 6:31 PM on February 6, 2006

ever popped a zit?
posted by merelyglib at 7:39 PM on February 6, 2006

I self-harmed for a long while, and the temptation is always there. It wasn't until I went to university and discovered I wasn't the only person in the world to self-harm that I began to get over it.

So I agree with FFF that not having to hide what they're doing will probably help cutters. And having someone say 'well, that might not be the best place to cut yourself', and helping you clean up afterwards, would actually have been appreciated. I know my scars are worse because I didn't really know how to look after the cuts.
posted by featherboa at 3:13 AM on February 7, 2006