Helping clients experiencing chronic pain

Dr Lizzie Croton 

GP and SIRPA practitioner 

Introducing – the SIRPA Programme 
Who are we? 

SIRPA (Stress Illness Recovery Practitioners Association) is a revolutionary approach to chronic pain. It was founded in 2010 by Chartered Physiotherapist Georgie Oldfield in Huddersfield, UK. The aim of this blog is to give you an overview of the SIRPA programme and how it works. I’ll also be explaining a little of how I became involved with the association and how the programme fits in with the Western medical approach. 

Chronic pain is now a leading cause of disability affecting 7.8 million people in the UK.(1) The term “chronic” essentially means that that the pain has persisted for more than 3 months or has persisted after healing is complete (2). Typically patients experiencing chronic pain are cared for by their GPs or in multidisciplinary pain clinics. Usually they will be given medication to suppress the symptoms together with various “talking based” therapies aimed at helping patients cope better with their symptoms. Physiotherapy aimed at improving functioning through physical interventions is commonly used

This approach works for some patients but in my experience as a GP, there are a fair number who are not helped by this approach. For these individuals, we need a different paradigm. 

The origins of Stress Illness – Dr John E Sarno MD 
Dr Sarno MD was Professor of Rehabilitation Medicine at the New York University School of Medicine. Back in the 1970’s, he became curious about why the conventional approaches for chronic pain were not more successful. He noticed that 88% of his patients with pain were also experiencing symptoms that were commonly held to be caused or exacerbated by stress. These included medical conditions such as heartburn, migraines, IBS and tension headaches. These conditions were “emotionally induced” in that strong emotions in the body were triggering physical symptoms. The concept of an emotion triggering a physical symptom in the body is not an unusual one – think of, for example, the physiology of a erection during sex or blushing when we are embarrassed. 

Dr Sarno hypothesised that chronic pain had the same underlying cause and over the years developed his own unique programme of recovery from chronic pain. His results were exceptional for many conditions that had previously been deemed incurable. He coined the term Tension Myositis Syndrome which later became Tension Myoneural Syndrome (TMS) to encompass the involvement of nerves in the process. SIRPA founder, Georgie Oldfield travelled to the US to meet him in 2007 and was inspired to create SIRPA here in the UK. This work continues to develop at a hugely exciting pace and there is now a network of SIRPA practitioners working throughout the UK and Ireland. 

The SIRPA Philosophy 
SIRPA offers a revolutionary alternative to the traditional medical chronic pain management approach. Traditionally Western medicine splits the body and the mind into two and maintains that they are different systems that have little connection between them. This has resulted in different specialities of medicine having different responsibilities for different parts of the body.  

Traditionally problems that could be treated using medication or surgery were the responsibility of physicians and surgeons. Problems involving the emotions or psychological problems were the domains of psychiatrists and psychologists. We now recognise that the mind-body split is not an accurate representation of how the body works. The whole body works together as an integrated whole and in fact emotions are felt in the body as sensations rather than in the mind.  The huge vagus nerve in humans runs from the body into the brain and carries nerve impulses in both directions between these two sites. It simply doesn’t make sense to split the body and mind into two! 

The SIRPA approach maintains that chronic pain and indeed many other medical conditions such as migraine and IBS are driven by strong unconscious emotions arising from the body-mind. These very often have their origins in past traumas that we have experienced earlier in our lives. We many not consciously remember these events or even regard them as significant. Stressful events experienced in childhood may seem insignificant when viewed through an adult’s eyes but to a child an event such as an operation or a parental illness can be interpreted as a very real threat to life. 

We tend to find that many TMS symptoms are experienced by people with certain personality characteristics. These people tend to be highly conscientious, good people who want to be liked and seen as good and reliable. They may be highly successful, with perfectionist traits but struggling with medically unexplained back pain or neck pain. These personality characteristics are highly sought after in society but can lead to huge reservoirs of unexpressed anger and fear. These may be people who feel that they run around after everyone else but have little time for themselves. They may fear expressions their emotions (or may not even know what they feel) but are struggling with physical bodily symptoms. 

An essential part of the SIRPA philosophy is that anything suspicious of a disease process needs to have been ruled out before beginning the SIRPA programme. For example if a person was experiencing severe headaches it would be appropriate for them to have a full medical assessment so that we can be confident that the symptoms are not being caused by a physical problem in the brain such as a tumour. This may involve scans such as an MRI, blood tests and a neurological review by a specialist. It’s important to emphasise that the symptoms experienced by people with TMS are REAL. They are not made up or imaginary or “all in your head”. This is something that thankfully the medical profession are becoming more aware of and it is our hope that this will continue to improve as awareness of this work grows. 

Dr Howard Schubiner MD is a internal medicine and paediatrics specialist in Southfield, Michigan. He is a recognised expert in Mind-Body medicine and has worked extensively with Dr Sarno and Georgie Oldfield in this field. He has produced a very informative video explaining the difference between the pain and symptoms of TMS and the pain of symptoms which are caused by disease processes. This is available on YouTube with the link to the video given below (3). Typically pain (or any symptom) can be caused by actual tissue damage e.g. a broken leg will cause pain. Doctors are generally very good at finding the cause of this type of pain through medical tests or surgery. 

There is another cause of pain which is caused by “nerve pathways” being activated (the mechanism of TMS/stress illness). These are collections of nerves between the body and brain which fire in repeated patterns to certain triggers Here the organs and tissues where the pain is perceived to be originating from may be completely normal. There are “pain” nerve pathways and “no pain” pathways.  “Pain” pathways are activated by fear and stress and other triggers. “No pain” pathways are activated by confidence, knowledge of what is happening and a sense of personal power. This is why a knowledge of stress illness and a belief that they can recover are so powerful in an individual’s recovery. Recovery from TMS/stress illness involves helping the individual turn off these “pain” pathways so that their symptoms disappear. This is achieved through a combination of knowledge, behavioural work and emotional work and is the basis of the SIRPA programme. Dr Schubiner explains this beautifully in the video and I highly recommend that you watch it to gain a greater understanding of this concept. 

What can I expect from my session with a SIRPA practitioner? 
Initially we will chat with you over the phone or face to face in an introductory session. This will be to find out more about you and what you hope to achieve through our work together. We also need to check if the programme is suitable for you at this moment in time. It may be that you have physical symptoms that have not been discussed with your Doctor and if this is case we would require that you do this before starting the programme. If you have a diagnosed mental health condition we would also ask that you discuss the suitability of the SIRPA programme with your doctor or psychiatrist. We would also recommend that you read Georgie Oldfield’s book “Chronic Pain: Your Key to Recovery” which is available on Kindle and in paperback (4). 

This book not a prerequisite for starting the programme but we have found that it gives an excellent overview of the concepts of stress illness. For many people with TMS symptoms, this book is an “epiphany moment” when they can actually “see” themselves in the case studies and the descriptions of typical TMS symptoms. This is an important part of the recovery process. 

Once we have concluded that the programme is suitable, you will be sent an assessment questionnaire to complete which is a detailed history of your symptoms and also your personal history from childhood. This can be an emotional but very freeing process. All information in the questionnaire will be kept strictly confidential and will be used for the basis for our work together. Once we have the completed questionnaire, we will then schedule our face to face meetings where will go through the personal history together looking for any patterns of symptoms and their relationship to any life stresses. Then based on the information from the history, together we will work together to help you resolve and integrate these stresses from your life. This may involve a number of techniques such as unsent letter writing, expressive writing and mindfulness work as well as other techniques that have been shown to help in the recovery from stress related symptoms. 

Typically we will work together until you feel that you have gained enough knowledge and empowerment to more forward with your life. This will usually result in the reduction or (most commonly) the elimination of your symptoms and a greater confidence in your ability to live life. There is no average number of sessions and everyone is different and so the programme is as individual as you are.  There is also a SIRPA online programme which can be worked through from home and details can be found on the SIRPA website link detailed below (5).

SIRPA practitioners gain their qualification though a quality assured training course followed by a rigorous case study based assessment where they are required to demonstrate that they have the necessary skills to guide a client through the recovery process. They then have to show that they are up to date in the field through participation in continuing professional development (CPD). SIRPA also operates a system of clinical supervision run by Georgie Oldfield and the organisation has the support and endorsement of experts in the Mind-Body field such as Dr Schubiner and Dr Dave Clarke MD who is Assistant Professor of Gastroenterology at Oregon Health and Science University. This system of certification and support ensures that SIRPA practitioners have the necessary skills and expertise to support and guide you in your recovery journey. 

Case studies 
(These are real cases published with the permission of the individuals concerned – names have been changed to protect their confidentially) 

S (34 year old female) 

Anxiety and migraines 

“I was experiencing really severe migraines with anxiety that were affecting my ability to complete my university work. All my medical tests and scans had been normal. I was really struggling and had no idea how to help myself. I turned to the SIRPA programme out of desperation. After I started the program, I realised that I had a number of TMS personality traits. I was a perfectionist and a people pleaser. I had very little time for myself and was constantly bowing to the demands of my father back in my home country. I was actually very angry towards him but didn’t feel I could express it. Once I worked through this anger and set boundaries with him and took time out to relax, my symptoms reduced dramatically. I felt much calmer and today if I get a migraine (it’s rare!) I take it as an instruction from my body that I need to relax. I am so much happier – thank you!” 

D (47 year old male) 

Back and neck pain 

“This programme has changed my life. I had severe back and neck pain which the doctors couldn’t find a cause for. I was taking strong medication and was very limited in my ability to look after my kids and socialise with my friends. I discovered the SIRPA programme and was at the stage where I would try anything. I wasn’t at all in touch with my emotions – typical man I suppose! I realised through my work that I was very angry about several things that had happened in my life. My work redundancy and a family argument were the two main culprits. Expressive writing really helped me get in touch with my emotions. The most amazing thing was that my back and neck pain has almost completely gone. I’m really grateful for this programme.” 

My story Dr Lizzie Croton 
I’ve been a GP since 2008. I see a number of patients with chronic pain and also other TMS related conditions. I was used to treating these patients with medication but deep down I was deeply dissatisfied that many did not recover or feel any better. Many suffered from the side effects of these drugs and seemed to get worse. Some improved and I was deeply curious as to why this was the case. Similarly many people would have X-rays for various conditions and incidental findings such as arthritis would be found. Many of these patients had no pain whereas some people with mild arthritis on X-ray would have severe pain. Why was this so? It seemed deeply inconsistent. Now Dr Schubiner’s “nerve pathway” explanation helps us to understand why this is happening. 

I was chatting through my frustrations with a fellow doctor one day and she recommended Dr Sarno’s book “The Divided Mind – The Epidemic of Mindbody Disorders”(6). She said that it had helped her to understand what was likely to be happening with some of her patients. I ordered it that day and must have read the whole book cover to cover in under a day. It made so much sense and I wanted to find out if anyone was doing this type of work in the UK. I subsequently contacted Dr Sopher in the US who is another specialist in Mind-Body medicine who has worked with Dr Sarno. He put me in touch with Georgie Oldfield and SIRPA. I have found my SIRPA work a fascinating and rewarding aspect of my medical work and I’m really excited to be part of the ongoing development of this field in the UK. 

References 

1. Donaldson L. Annual report of the Chief Medical Officer for 2008. London Department of Health 2009. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/DH_096206

2. Merskey H, Bogduk N, editors. Classification of chronic pain. 2nd Rev ed. Seattle: IASP Press; 1994 (Rev 2011-2). www.iasp-pain.org/PublicationsNews/Content.aspx?ItemNumber=1673&navItemNumber=677

3. https://m.youtube.com/watch?v=XM5hdlEOSFM

4. https://www.amazon.co.uk/Chronic-Pain-Your-Key-Recovery/dp/1910077755/ref=sr_1_1?ie=UTF8&qid=1470922615&sr=8-1&keywords=georgie+oldfield

5. www.sirpauk.com

6. https://www.amazon.co.uk/Divided-Mind-Epidemic-Mindbody-Disorders/dp/0715637274/ref=sr_1_3?ie=UTF8&qid=1470922882&sr=8-3&keywords=John+sarno

Screen time and kids’ wellbeing – How should we proceed?

We all know that kids are exposed to screens in today’s world. They are part of families and in our household, we currently have more devices than people. My niece learnt how to post pictures on social media at the age of 3.

But what of the effects of screens on our kids’ health and wellbeing?

Recently, the UK Chief Medical Officers have produced a commentary (published February 2019) entitled, “Screen-based activities and children and young people’s mental health and wellbeing.”

You can find the document here:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/777026/UK_CMO_commentary_on_screentime_and_social_media_map_of_reviews.pdf

There is currently insufficient conclusive scientific evidence to prescribe an appropriate amount of daily screen time for children. There is evidence from a recent BMJ Open article https://bmjopen.bmj.com/content/9/1/e023191 that there may be an association between higher levels of screen time (around 2-2.5 hours per day) and being overweight, having an unhealthy diet and experiencing depressive symptoms.

Much of the literature included in the BMJ review related to television viewing which is a different entity to smartphones and tablets. Hopefully in time, more scientific evidence will emerge that looks more closely at portable device use.

The Royal College of Paediatrics and Child Health have produced guidelines for health care professionals and parents on screen time which can be found here:

https://www.rcpch.ac.uk/sites/default/files/2018-12/rcpch_screen_time_guide_-_final.pdf

This piece of work is based on a survey of 109 UK children and young people aged 11-24. It acknowledges the positive and negative aspects of screen time and digests the scientific evidence available on this subject.

The RCPCH recommend four questions be asked as a basis or discussion in families:

1) Is screen time in your household controlled?

For example younger children should be supervised by adults and older children will have more age-appropriate limits to screen use which will be negotiated. As kids copy adults, parents would benefit from examining their own use of screens particularly at times when face-to-face communication would be more appropriate.

2) Does screen time interfere with what your family want to do?

The article suggests keeping screens off the table when eating and encouraging face to face communication instead.

3) Does screen use interfere with sleep?

And finally,

4) Are you able to control snacking during during screen time?

The resources above provide some food for thought (excuse the pun and the cliche!). I’ll round up with a YouTube clip from Simon Sinek https://youtu.be/la1lRcq2-LU which needs no introduction and provides some more “food for thought”.

Birmingham! Three interesting ways to get moving for 2019

Park Run

http://www.parkrun.org.uk/aboutus/

Parkrun is a free weekly Saturday morning run. It’s 5k (3.1miles) and there are events countrywide in UK and around the world. It’s a social event with participants meeting for the activity and then hanging around afterwards for coffee. I’m told you don’t even have to run and there are people who walk around, those who push prams and those who actually do run all or some of the way. It’s entirely staffed by volunteers. Most events take place in parks or public spaces. Our local event in South Birmingham is based at Cannon Hill Park and starts at 9am

http://www.parkrun.org.uk/cannon-hill/.

Participants register once online and then bring the printed bar code for scanning before the run.

Yoga (various locations)

I recommended yoga to a patient the other day – “I couldn’t do that – that’s hardcore and really tough!” I must admit, I used to think that yoga was basically a stretch class that originated in the East – Oh boy! Yoga is more than an exercise. It can have profound psychological benefits as well. I’ve included some links below as to some of the benefits that have been investigated in studies as well as some work that has been carried out in schools. In a city as large as Birmingham, there is plenty of choice with styles of yoga. Many studios have introductory offers for new members. These offer unlimited classes over a specified time period.

I’d recommend trying out a number of different classes to see which style suits you. Bear in mind that your preferences may change depending on where you are in your life. If it’s your first time at a studio, it’s helpful to turn up early to get a feel for where everything is and to complete any health paperwork. If you have any injuries, be sure to mention this to the teacher beforehand and work at a sensible level. Not all classes are suitable for pregnant women and those in the early post-natal period, so bear this in mind if you are female.

https://greatergood.berkeley.edu/article/item/seven_ways_that_yoga_is_good_for_schools

https://www.healthline.com/nutrition/13-benefits-of-yoga

https://www.google.co.uk/amp/s/amp.mindbodygreen.com/articles/the-11-major-types-of-yoga-explained-simply

Stand up Paddle-boarding (SUP)

Being part of a SUP club ticks three health boxes. 1) spending time with others, 2) Getting out in nature and 3) Exercise. SUP developed from surfing and involves standing on a board and paddling it with a long single paddle. It’s fairly easy to pick up the basics and in the Midlands there are plenty of choices with regards to what type of water you paddle it on. We have canals / rivers/ various reservoirs and a good choice of coastal options further afield. The availability of inflatable SUP boards has made the sport very accessible to everyone as this kit can be easily rolled up and put in the boot of a car. I’d recommend getting some basic instruction before going on the water and if you join a club, you can usually borrow kit to give you an idea of what’s out there before investing in your own.

https://www.theadventurejunkies.com/benefits-of-paddle-boarding/

Clubs in the Birmingham area include the excellent Bartley SUP

https://www.bartleysup.co.uk

And further afield, Central SUP

http://www.centralsup.com

In the Realm of Hungry Ghosts – Close encounters with addiction

A very short blog today on the subject of addiction and in particular, to introduce this book by Dr Gabor Mate´ which has recently been republished in the UK as part of its 10th Anniversary.  It’s one of the most moving, empathic and helpful books that I have ever read on this subject.  Gabor is a retired Canadian family physician who for many years, worked as a doctor in Vancouver’s notorious Downtown Eastside. 

https://604now.com/vancouver-downtown-eastside/

Here he saw firsthand the ravages of homelessness, mental illness and addiction. And he tried his best to help in any way that he could.  But addiction is crafty and powerful and the very human stories that pepper the pages take one from hope to horror in equal measure.  The question according to Dr Mate´ is not “Why the addiction?” But “Why the pain?”. It’s a book for everyone, family members, those struggling and those who seem to have it all together.  Because to be human is to have encounters with addiction, in some context.  

https://drgabormate.com/

For those of you who have an hour or so to spare, here’s a recent YouTube video featuring Gabor Mate´ and British GP, Dr Rangan Chatterjee talking about this subject. It’s brilliant. 

https://www.youtube.com/watch?v=2oicQ2xFiIc&feature=youtu.be

Three interesting things – using technology to improve our social connectedness

For this blog, I wanted to focus on some interesting and helpful things I came across recently. None of them are particularly new but have the potential to make our lives better. They are loosely lumped into the category “Using technology to improve social connectedness”. In no particular order, here they are:

Helpfulpeeps
https://www.helpfulpeeps.com/

Helpfulpeeps describes itself as a “new community movement based on kindness”. Basically the idea is that people post requests for help and others locally help them out for free. Examples include – someone who could offer a local floristry workshop for the elderly, someone to feed a cat as a one-off or someone who could teach basic piano. The person asking may offer to gift a skill in return. For example today, someone asking for home improvement advice is offering to gift personal training sessions (they are an endurance athlete).

Sometimes others will offer help and signposting online so there isn’t any direct meet-up but the idea is that people do meet in person and help others. It’s a moderated site with ground rules – no selling, financial help, that kind of thing. The usual safeguards with meeting strangers would apply, but in its essence, I think it’s a fantastic idea. It’s also available in an app and people can opt to become Patrons where they offer a small monthly donation to keep the platform running.

Interestingly as an aside, GPs in South Birmingham can now refer patients to the Gift Exchange service https://www.healthexchange.org.uk/services/gift-exchange/ where members of the local community can get together to share their skills and support each other. If you are in South Birmingham and this would be of interest, please ask at your practice for a referral form.

Young Minds
https://youngminds.org.uk/

I was really impressed with this organisation. I found out about them yesterday when a colleague sent me a link for their “Crisis Line”. They are a charity working with young people (under 25s). They offer information about mental health, self-care and wellbeing. They also have a dedicated parents line where parents or carers can talk to an advisor. I mentioned the crisis line earlier and this is a text service where young people can text for help if they are struggling and receive urgent advice and support. Here’s the link for this service https://youngminds.org.uk/find-help/get-urgent-help/

Mindbody Online
https://uk.mindbodyonline.com/get-the-mindbody-app

This is an app and a handy way to find out what’s going on in the way of fitness and wellbeing locally to you. It searches on post code and gives details of local fitness classes (in every modality you can think of) as well as beauty and wellness outlets. These might be services like nutritional and meditation classes or circus skills workshops. It’s a huge list and all in one place encouraging people to get out and meet up with others. The app also syncs with the FitBit wearable device and calculates calories burned per class. You can also pay for classes via the app and save favourite classes so that they are easier to find for next time.

Tips for navigating Christmas and reducing stress 

We are heading rapidly towards Christmas and this is traditionally a busy time of year for us all.  I see many patients around this time of year who are experiencing stress and looking for ways to reduce or manage this.  I’m always interested in approaches that work and I’d like to share some tips that have helped others navigate Christmas and enjoy the holiday period. 

  1. Be mindful of alcohol consumption Alcohol consumption “appears” to provide a predictable and quick way of calming racing thorghts and difficult emotions which is possibly why we can reach for a drink when stressed. It’s better to be mindful instead of the underlying emotions and stressors and look for ways to problem solve.  Also alcohol may blot things out for a time but prolonged use affects sleep, mood, relationships and comes with a host of other health consequences.  If alcohol use is costing you more than money, then it’s worth looking closely at your consumption.  Talk to your GP or find out more information below (1).
  2. Schedule some time to “switch off” More than one patient of mine has experimented with a “smart phone switch off” over Christmas.  I think the record was one week, which for a daily iPhone user was quite impressive.  Smartphones and tablets can easily get in the way of face to face relationships and it’s so norrmalised now, that we don’t really notice it. Those that do “switch off” report feeling closer to people, having more memories of amusing conversations and funny anecdotes and less stress.  Social media can make people feel quite miserable, particularly if there is a sense that others are having a better time than we are.  So switch off, go for a walk and spend some time paying attention to your surroundings.  You may notice new things about your environment that you haven’t seen before.
  3. Making time to practice relaxation. Modern day life is hectic and busy has become a new normal. However, we seem to function better with periods of “doing nothing” incorporated into our days. A great way to do this, is to use one of the commercially available apps such as Headspace or Calm. There are also a number of free relaxation meditations available on YouTube. The key is to practice regularly (at least daily) and pick one you enjoy. It doesn’t have to take long, 15-20 minutes once or twice daily is beneficial. 
  4. Repeat prescriptions. Every year, a few of my patients run short on their medication as they forget to request it from the GP or pharmacist. It’s worth thinking about it 2-3 weeks before Christmas, checking supplies and making sure it is ordered in time. If you use a local pharmacy, many will order the medication in for you and collect the prescriptions from the surgery on your behalf. If you have elderly relatives taking medication, it’s a good idea to check that they have enough to tide them through the festive period. 
  5. Volunteering. Helping others is a fantastic way to build relationships in the community and make a difference to others. Many of my patients have spent part of Christmas helping out at homeless shelters or working to make Christmas special for those who would otherwise be on their own. Groups of people you could consider volunteering with are the elderly, asylum seekers, international students of those spending the holiday period in hospital. The Do-It website provides a searchable index of opportunities available locally. (2) 
  6. Relationships.  This is something that a lot of my patients worry about over the holiday period.  Christmas is traditionally a time when we spend extended periods of time with relatives.  Sometimes these relationships can be difficult for all manner of reasons.  People often feel quite stressed with all sorts of divided loyalties to in-laws and immediate family.  Accepting people how they are takes the pressure off wishing that they were in some way different and also perhaps cutting them some slack depending on the nature of the difficulty – if only for one day.  A colleague of mine, really stuggles with the behaviour of one of her relatives and so decides beforehand to visit them earlier in the day so that they have the option of leaving after a few hours to do something else.  In doing so, they have the chance to connect but also the option of leaving in a timely fashion.  That said, if someone’s behaviour is grossly abusive or violent, it’s completely acceptable to limit contact whilst the behaviour persists.   
  7. Count your blessings. Being grateful is a very powerful practice and it really doesn’t take much effort.  Simply writing down three things that you are grateful for morning and evening is a fantastic start. Being grateful has been linked with all sorts of health benefits (3) and there is a really neat app called Five Minute Journal which allows you to record gratitudes and pictures together.  It has a really nice interface which is downloadable and exportable as a PDF to help you reminisce 

Dr Lizzie Crotonn

GP 

www.boundlessflow.co.uk 

  1. https://www.alcoholconcern.org.uk/
  2. https://do-it.org/
  3. https://greatergood.berkeley.edu/article/item/is_gratitude_good_for_your_health

Some thoughts about self-harm – a guide for those affected

Self-harming behaviours are common – estimates from the Royal College of Psychiatrists suggest that one in ten young people may self harm at some point in their lives. Self-harm can happen at any age and the figures quoted here are probably an underestimate. It’s important to know for those who do self-harm that you can get better. It doesn’t have to be a life-long problem. I’ve included a link with information from the Royal College of Psychiatrists about self-harm which may be helpful: https://www.rcpsych.ac.uk/healthadvice/problemsdisorders/self-harm.aspx
People self-harm in different ways. Cutting is common (probably the most common behaviour that I see as a GP) but there are other methods individual to the person involved. I think the common denominator in all behaviours of self-harm is the presence of emotional pain. Emotions are part of what makes us human and can feel very powerful and overwhelming at times and we tend to want to move away from pain and get rid of it as quickly as possible. This is very understandable. Sometimes when people are in immense pain, something quick and predictable that affects the experience of that pain may be used. Self-harming behaviours may do this.

When I talk to people who have self-harmed, they may often describe feeling numb and the pain “waking them up” or they may describe feelings of wanting to punish themselves or something similar. Self-harm is a strategy for dealing with pain and is at that time understandable for the person concerned. It is not a particularly helpful strategy in the long run (I think everyone would agree with this) but at that time it is felt to be the best or only option available. People don’t always think rationally in the presence of strong emotions. When a behaviour seems to work, it’s easier to do it again and so a pattern may be set up.

Tips for helping yourself

Self-harming behaviours often thrive in secrecy and there can be a lot of perceived shame attached to them. It can feel very difficult to ask for help or speak to friends or relatives. Behaviours that thrive in isolation are often improved by connection. Do you have a friend you could talk to? Or perhaps a parent or older adult? Failing this, speaking to a heath care professional, counsellor or teacher is another option. Seeking professional help is important in the long run and your GP can put you in touch with services that can help. I’ve put some links below of services that we refer to. Please ask us for more information.

Can you distract yourself? The urge to harm can feel overwhelming but it can also be tolerated until it passes. I’m not saying it is easy by any means but it gets easier with practice. People tell me that getting outside, moving, brisk walking, exercise and meaningful social connection helps. If you slip up, start again where you are and try again. This is a practice not perfection. Celebrating small victories will help you to feel better about yourself and extending the compassion that you would feel towards a good friend, towards yourself is also helpful.

I’m aware of an app, CalmHarm that has been promoted on social media and within the NHS https://calmharm.co.uk/. I’ve spoken to people who have used it and found it helpful. If it’s your kind of thing, then it’s out there.

Be aware of the effects of social media and also certain social groups. Self-harming behaviours can thrive in groups as a way to cope and if this is going on in a friendship group that you are part of, it can fuel the behaviour. So too can the “perfect lives” of others on social media. Becoming aware of your mood in these situations and patterns will help you to know whether the environment is helpful and allow you take steps to look after yourself.

Finally and most importantly, if you are experiencing thoughts of wanting to end your life then please seek help immediately. This could from your GP (please ask for an urgent appoint or speak to us over the phone), your local A and E department or the Samaritans https://www.samaritans.org/. If there is immediate risk to life, then please phone 999 for the ambulance service.

Helping others

What people have told me has helped them most when they are feeling desperate is the presence of another person being sitting with them until the urge passes. The most unpleasant, powerful feelings pass eventually and this can be helpful to bear in mind.

If you are that person, it can be helpful to sit with the person for a while and resist the urge to do or “fix”anything. If the person wants to talk about how they are feeling, this is fine. Sometimes people are not aware that they necessarily feel anything, perhaps they feel “stuck” or “numb”. This is also fine. You might make them a cup of tea or perhaps go for a walk with them. There is sometimes a tendency to try to talk someone out of how they feel or rationalise with them. This approach doesn’t tend to work very well when emotions are running high. Once the person is calmer, they may wish to reflect on how they felt and this is fine. Try to avoid any language that implies criticism or blame (even if you feel it doesn’t).

Again, if there is a threat to life or you feel that you are unable to cope with the person’s behaviour, seek professional help using the sources above under “Tips for Helping Yourself”.

The following are sources of support in Birmingham:

https://www.forwardthinkingbirmingham.org.uk/

Sources of non-emergency support

https://www.forwardthinkingbirmingham.org.uk/services/13-pause

For students at the University of Birmingham

https://www.forwardthinkingbirmingham.org.uk/events/120-university-of-birmingham-pop-up-pause

https://www.birmingham.ac.uk/undergraduate/support/index.aspx

Please note: This information is designed for information purposes only and whilst accurate, does not substitute for personalised medical advice. If you are concerned about your own health, then please do contact us for advice.