Cutting out reality Self injury, sexual abuse and substance misuse

1. Cutting out realitySelf injury, sexual abuse and substance misuse Kathryn Daley

2. The research project • ‘How do some young people come to experience problematic substance use?’ • Collaborated with YSAS and Barwon Youth (17 sites) • Mixed methods design • Statistical data mining • Ethnographic elements – in withdrawal units and day programs • Narrative interviews with 61 young people (15-24; 57% m) • Structured interviews with case managers • Accidental phenomenography

3. The young women • 26 women (35 men; stratified sample) • Mean age of 19 years (cf. 18 years for males) • More complex to work with; yet simpler to understand • Where notions of masculinity featured heavily in the young men’s narratives; femininity was not discussed in women’s biographies • Likewise, where drug use and friendships were often inextricably linked for males; females had few friends • After the first five interviews, a very distinct pattern emerged

4. Sexual assault, self injury and suicide • Obviously, all participants had experience problematic substance use. Cannabis and heroin were primary drugs • Almost two thirds of women had a hx. of sexual abuse • Self injury was noted in 80% of cases • At least 50% of women had attempted suicide

5. The path less travelled • There were a small number of cases where self injury was not present • Six young women did not mention self injury • Perhaps some of them had SI, but did not disclose • However, not one of these six mentioned sexual abuse or suicide either • The path from sexual abuse to self injury seems almost causal; however, I will discuss later a key mediating variable

6. Telling their story • This presentation will look at the 20 young women who had histories of self injury • My interview schedule did not ask participants about sexual abuse, self injury or suicide: these stories told themselves • This said, young women were much more comfortable telling me about drug use, or sex work, than they were about self injury or suicide. Stigma a key theme.

7. The early pattern ‘I liked feeling like I could control things – I liked hurting myself’ - Jessica, 16 ‘I just felt like I deserved it … Yeah, so I knew that I was alive’ - Lizzie, 21 ‘It’s the only thing that makes you feel some other way than what you are feeling’ - Mary, 20 ‘I’d just hate myself so much, and I’d just feel so much pain, and just feeling … I don’t know how to put it … just seeing myself hurting, I don’t know … it’s because you hate yourself. I don’t know. Seeing the pain when I did it – it helped’ – Riley, 21 ‘It made me feel like I was alive and that I could feel things other than hate and negativity and depression’ - Stevie, 20 ‘It was like a release. After I’d seen the blood, it was like a release of anger’ – Alex, 20 ‘It just made me feel better. I felt like I was punishing myself … it got out pain’ – Christina, 19 ‘Like, at the time, it was the only thing that made me feel alive’ - Katte, 17

8. Understanding the self-loathing Ebony (18) ‘I’d never go home, ‘cause I’d never get bashed or, you know, hurt in other ways, at friends’ houses. I’d always try to prevent going to my parents. Kat: So there was a lot of abuse at home? Yeah, I got, er, ah … by my so-called stepdad. He, um - ‘cause I went clean for seven months and I was staying there and I was staying in the living room - and he raped me. I was only 15. He bashed our family … he bashed everyone. From when we were young, like four years old. Yeah, we’ve bled a lot over him’

9. Understanding the self-loathing ‘I have been raped 13 times since I was 13 to 15 … Kat: How do you process that? I can’t. Like, with my girlfriend, we can’t have sex at all … Like I’d have flashbacks and everything Kat: Oh, Darling I don’t know if it will ever go away. I pray it’ll go away, but, yeah, we don’t have sex for that reason. We don’t do anything besides kiss … that’s why I could never be with a guy again in my life – it’s just too hard’

10. Understanding the self-loathing ‘I had a partner of two years, who I was with, and he raped me too. He was an arsehole, he used to strangle me, and yeah, he was, I was with him one week before I turned 16 and he was 41. I was there for two years.’ Kat: When did you think that drugs started to become a problem? ‘When I started working for it, selling myself, then I was thinking, “whoa, okay”. I didn’t even want to. The first time I worked, I didn’t want to do it. I had a friend who was a year younger than me, and I think she started using needles when she was about eight. Seven or eight. She started selling herself when she was 11. I just started hanging around her and saw the money she got and how easy it was so I started selling myself, just buying drugs, taking heroin’

11. Understanding the self-loathing Lisa (20) ‘When I was in Primary School, Dad wasn’t there, because mum had to go … what it feels for me … I am just trying to get the words – I am not very good with words. Sorry … Kat: No, take your time … … what made me, when I first was young, what started everything, being angry and sort of wanting to, I don’t know, knick off somewhere or just drink, was because … it was when Mum put me in after-school care and like, I feel that’s what cause me to go off the rails a bit. Because, like, what happened … it was one of the ladies son’s or something … I couldn’t tell my mum what he was doing, because, well (starts crying), I felt like I was going to get in trouble or something. Yeah, he just kept … I had to go there every day. Mum sent me. Mum asked him to babysit me … he just kept making me do shit with him (sobbing) Kat: Oh, sweetheart … … and I didn’t tell my mum. I didn’t tell her until two years ago. I just thought I was in real trouble (sobbing) … She was shocked. … The whole time she didn’t know, because I was always crying all the time for no reason, and she was like, “why are you crying?” and I just wanted to tell her, and then after being in the city (sleeping rough for 3 years), I had to tell her, ‘cause she didn’t understand why I wanted to go and do stupid stuff’

12. Understanding the self-loathing Riley (21) ‘It was always a lot of hate with each other, even though I was only so small. But yeah, it got to the point where she just didn’t want me anymore, and I had gone to my friend’s house – Jane’s. … I was in year eight … their dad sexually assaulted me. He always sexually assaulted me.’ Later on I ask, what did you like about self injury? ‘I’d hate myself so much, and I’d just feel so much pain, and just feeling … I don’t know how to put it … just seeing myself hurting … it’s because you hate yourself, you hate yourself. I don’t know. Seeing the pain when I did it, it helped.’

13. Why self injury is not self ‘harm’ ‘To be honest, I can’t imagine myself, the state I was in, dealing with what I was dealing with any other way. I think that if I didn’t do drugs, I would be dead - to be honest. I would have committed suicide by now. There would have been another time in hospital and I wouldn’t have come out. Or I wouldn’t have gone to hospital – if that makes sense? So yeah, I don’t think … I think I used it to cope, and now I am interstate, and I have set myself up, so I can be away from the problem and deal with it in other ways’ - Jazmine, 18

14. Abandonment ‘I felt very lost. Very very lost. I needed rules. I needed a mum. I needed a dad. I needed stability and someone to help me’ – Jess, 22 ‘She got a bit sick of me being, just, um, just having a daughter I guess’ – Lisa,20 ‘I’d love to have a parent to tell me what to do. I’d love to have someone love me, or tell me what to do. Or to congratulate me when I achieve something – that’d be fantastic. But I guess that’s not there and there’s nothing I can do about it. I have to move on’ – Jazmine, 18 ‘Mum sent me up to Melbourne, she just didn’t want me anymore and she just sent me up to Melbourne’– Ebony, 18

15. What’s the link between sexual assault and self injury and substance abuse? • These young women have internalised trauma that has not ever been dealt with • A dissociation of their emotions from their body • Their relationship with their body is frequently impaired – their discomfort in their skin, their terror around men – is all associated with their body being sexually objectified and commodified

16. What’s the link between sexual assault and self injury and substance abuse? • The emotional pain is compounded by feelings of abandonment, a loathing of oneself, an absence of support and an overarching sense of fear • Because all of this pain is inside of them, to cut themselves open, to let it – quite literally - pour out, serves a purpose • Typically, cutters graduate into a more socially acceptable coping method: substance abuse

17. Stopping cutting • These young women rarely recalled their first or last episode of self injury. It was a pattern that they gradually moved in to, and subsequently out of, without distinct delineation. There were two exceptions: ‘My partner who I am with now, his younger brother killed himself and it, sort of like, well it wasn’t that he was angry with me when I would do it, but it, well it became too much of a problem. It was easier to not do it; to find another way to cope, because it was too much’ - Kate, 22 ‘I didn’t need scars up my arms to remind me how shit my life is’ - Roxanne, 21

18. Implications for AOD service providers • Are staff adequately trained and confident in understanding and working with SI? Big barrier • Drug use may be more comfortable to deal with, but is often more harmful that self-injury – need to be mindful of language around the behaviour • Important to understand the function of the self-injury rather than focus on its cessation, tends to have a natural recovery • Harm-reduction strategies essential (clean equipment, hierarchy of options)

19. Some hope amidst the despair ‘My biggest motivation is my fear of going backwards. It’s scary when you feel like there’ s no way out and, you know, when you think about killing yourself and that kind of shit – it’s scary. And I don’t want to go back there. I am trying to change things so that I don’t have to’ – Jessica, 16

20. Acknowledgments • I extend my sincere gratitude to the young women who shared so much of themselves with me. • This research was part-funded by a FARE Innovative Project Grant.