This is going to hurt

Three people walk into the emergency room. One is the patient; the other two are responsible for getting her there and to offer support, provide information to the medical staff, hold handbags (ever notice how impossible it is to keep track of handbags the minute you get to a hospital?) and be useful in a general way.

The patient has, with the help of a kitchen knife, cut into her arm – yes, her very own God-given arm – far enough that she needs both internal stitches and the regular kind.

She was not trying to kill herself. She was not looking for attention. She does not suffer from a compulsion to visit health care facilities.

Non-suicidal self-injury (NSSI), more commonly known as self-injury or simply cutting, is not a psychiatric condition but it is a real affliction. About 17 per cent of adolescents worldwide have some experience of it. Self-injury is seen at all ages, from children to adults, but it seems like 13, that most awkward of all the awkward ages, is the sweet spot for starting.

Back to the emergency room and the family of the knife-wielder.

A young man – her brother/cousin/schoolfriend/boyfriend – paces, frets, keeps checking on her behind the inadequate curtain partition before returning to his waiting place. As he sits, the third member of the group – her mother/aunt/cousin/trusted family friend – turns to him and says: “These doctors must be so annoyed.”

Not really what he was expecting, and frankly, a bit confused, a verbal response is beyond him and he lets his eyebrows and hands ask why this should be.

The woman, who really didn’t need an invitation to continue, says: “All these people here are really sick. They didn’t ask to be sick.

“What a waste of time! This girl carrying on sticking knives into herself like a piece of meat. Herself! Not an accident. Nobody did this to her. Bad enough they will say she mad, but to take them away from people with real problems!”

You know, it happens. Self-harmers must be among the most misunderstood, maligned and shamed of all groups that are regularly misunderstood, maligned and shamed.

They are also often bullied or dismissed (either as a cause or result). They’re really easy to ignore and stay unhelped because the shame, disbelief and torment that surrounds their condition encourages them to stay in the shadows wearing long-sleeved shirts and pants to cover their secret wounds.

They cut their arms and legs, stomachs, chests. It’s hard to cut behind yourself.

They burn themselves with cigarettes, matches or heated instruments. They hit their head or fists on walls, on glass.

They’ll rub their skin to create a burn or use their nails to pierce themselves.

What kind of crazy is this, you ask.

It’s not any kind of crazy. It’s not listed as a psychiatric condition (though it is under consideration).

And now to the why of it: incredibly, it relieves pain. For some of us, there is a level of emotional pain that we simply cannot process on a mental level. It’s a coping mechanism; a release. People suffering from depression, anxiety, eating disorders or substance abuse may hurt themselves. Ever went for an injection you were a bit afraid of and your mother pinched you so you’d be distracted? Like that, but much, much more intense. And, of course, you’re doing your own distracting.

It’s also a way to feel something – anything, even pain – if you have become utterly numb. That’s a discussion that is easy to have in the abstract: is it better to feel pain or to feel nothing? It’s a lot more complex when the psychological distress is beyond endurance or the numbness makes you wonder if you’re alive.

Self-harm hurts. It hurts as much as if the injury was the result of an accident or inflicted by a malicious third party.

So I’m saying it hurts, but I’m also saying that those who do this experience temporary relief from a greater, harder-to-reach pain.

You’re seeing cuts and bruises, but you’re hearing this person does not mean to end their lives. And, if all of this wasn’t difficult enough to process, there’s a really good chance that if and when you see it (or if and when you have already seen it) it was on what looks an awful lot like a little girl.

The teenage girl is the poster child for self-injury, but boys are not out of the picture, they’re just more difficult to trace because of under-reporting. And even though the figures are significantly lower for adults, they’re still potential sufferers.

Two people get ready to leave the ER. The patient is being kept for observation.

The young man is steeling himself for a long talk with the older woman about trying to understand how real this is.