Nicky

Age at interview: 48

Brief Outline: Nicky’s daughter started self-harming when she was about eleven years old. She was eventually diagnosed with borderline personality disorder, and has worked hard on alternative coping strategies. Nicky is very proud that she has not self-harmed for some time.

Background: Nicky, aged 48, is married with a son aged 26 and a daughter aged 24. She works part-time as a lecturer. Ethnic background: White British.

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Nicky’s first marriage broke up when her daughter was seven; both children stayed with their father. Nicky married again and when her daughter was eleven she decided to come and live with Nicky and her husband. She had had behavioural problems since early childhood. One morning she told Nicky that she had taken an overdose of painkillers. She was treated in hospital and referred to the Child and Adolescent Mental Health Service (CAMHS) but continued harming herself in various ways, including cutting, drug taking and excessive drinking. She was discharged by the CAMHS when she was 16 as she was no longer in full-time education, so had no mental health input until a year later, when she told Nicky that she was worried because she wasn’t coping. Nicky took her to the GP, who referred her to the Community Mental Health Team, but their response was that she should go to a drop-in centre. Nicky wrote them a strongly worded letter, followed by phone calls, which resulted in her daughter being assigned a Community Psychiatric Nurse (CPN), who was extremely supportive. He diagnosed Nicky’s daughter as having borderline personality disorder. She has since had a course of dialectical behaviour therapy and has not self-harmed for some time.

The CAMHS provided family and individual counselling. Nicky says this probably kept her marriage together as it provided her and her husband with a space to talk about how her daughter’s behaviour affected the family and to consider ways to deal with this. She felt uncomfortable with CAMHS advice about safe methods of cutting and would have appreciated an explanation of why they did this. Her daughter also had brief contact with a counselling service provided by the local council, which Nicky says was very unhelpful and damaging. The counsellor refused to discuss Nicky’s worries about her daughter, claiming it was an issue of confidentiality. Nicky was very pleased with the CPN who, with her daughter’s permission, kept her informed and supported her in dealing with the self-harm. She says the most useful thing was knowing there was a professional person who recognised the importance of family and carer support in helping the person who is self-harming. She would have liked more information about why people self-harm.

Nicky’s first husband has mental health issues, and her daughter told her that she had started self-harming while living with him, to show him how bad she was feeling. Nicky’s son doesn’t talk to Nicky because he is resentful of the support she has given his sister. Nicky says her daughter’s mental health problems have put her second marriage under a huge strain, but her daughter realised this and has now moved into her own accommodation. Nicky’s husband is very supportive and she has a large circle of friends and colleagues who she can talk to.

Nicky had a difficult childhood herself but she can’t understand why anyone would use self-harm as a coping strategy. Her daughter is a beautiful young woman and Nicky is angry and upset to see her damage herself. She says the skills she learnt as a Samaritan have helped her deal with feelings of guilt and responsibility, and cope with her daughter’s behaviour by distancing herself a little. She works part-time so has been able to be flexible to support her daughter. She recently turned down an offer of full-time work because she wants to be available if her daughter needs her.

To clinicians, Nicky says ‘Please talk to carers. Don’t exclude us. We may be part of the problem, but we can be part of the solution too with your support.’ She advises other parents to seek out potential sources of help, and to recognise that ‘your child is in a dark scary place which is scary for you too if you don’t understand it. If you can put your fear aside to be able to support them through it, you can help them find a better way, a different coping strategy, a less painful and destructive one for you and for them.’

Nicky thinks her daughter may never stop self-harming, but the gaps between episodes will get longer as she matures and learns new coping strategies. She has a lovely relationship with her now and is really proud of how well she has done.

Nicky’s daughter said she started to self-harm because she wanted to show her father just how bad she felt.

I don’t know if that was when it first started.  I suspect there had probably been elements of self-harm before that. When we’ve talked about it, she has said that she said that she started to self-harm because of her dad’s mental health issues.  Everything is always about him. He’s always the centre of absolutely everything, even now, you know, at fifty odd, he’s still, everything is still always about him and she said to me, “I felt really dreadful. I was depressed. I wasn’t coping. I wanted to hurt myself.” And he’d just go, “You haven’t got any reason to feel like that. Grow-up.” Sort of attitude and she said, “and I did it because I wanted to show him just how bad I felt.” And she says that was why she started and she does say that she did start before she moved here but I think she must have been self-harming before that, cutting before that but I wasn’t aware of it.

Nicky thinks the Child and Adolescent Mental Health Service (CAMHS) team’s refusal to discuss a possible diagnosis of bipolar disorder made her daughter’s behaviour more extreme.

So she carried on self-harming.  Things didn’t get any better. Things got progressively worse.  Her behaviour got worse. She started indulging in behaviours, I’m not sure, I think if you look at self-harm as a broader topic, you probably would consider them to be self-harm, although at the time I never did, but part of her, she was diagnosed with borderline personality disorder just short of her eighteenth birthday. They’re very reluctant to diagnose mental, to give mental health diagnoses prior to eighteen, particularly BPD but I think, but she she’d researched it when she was about fourteen or fifteen and decided that that was probably what was wrong with her and she found it very unhelpful that CAMHS [Child and Adolescent Mental Health Service], that the person she was seeing at CAMHS, because we had family counselling at CAMHS and she had individual counselling at CAMHS, she found it very unhelpful that the person she saw individually at CAMHS wouldn’t engage with her in a discussion that this was a possible diagnosis. It’s one of the things, when we’ve talked about the things that made life difficult for her when she was a teen, is the fact that the person involved wouldn’t even have a conversation going, “I can understand why you feel like that, [daughter’s name], we can certainly talk about it but you must understand, we don’t diagnose until eighteen.” She would have been quite happy with that.

But instead, what she felt she got was a, “I’m not discussing it period.” And I think that what that did was it prevented her from engaging fully with CAMHS and I think, as a result of that, the destructive behaviours that we witnessed might, in some ways, have been more extreme because I think she felt she had a point to make by then. 

Nicky could see similarities between her ex-husband’s behaviour and her daughter’s.

Any serious mental health problems, apart from…?

Yeah, yeah, yeah, unfortunately, we’re all rife with it I think. There’s, well, what is it, one in, one in four is they reckon? Yes, my mother was an alcoholic. She had a nervous breakdown when I was thirteen and suffered with suffered with some elements of coping with life and her alcoholism until she died when I was, she died when I was thirty one.

So I kind of grew up with it, which was not very pleasant. My ex-husband has been diagnosed as various things but both my daughter and her CPN think he’s probably an undiagnosed borderline personality disorder. I would agree with that, having lived with my daughter I think that’s probably it, and having lived with him for a lot of years, I think that’s a fairly accurate description. But a lot of her behaviours are very reminiscent of his. His, I think there was something quite seriously wrong with his mother but I’m not a professional and I wouldn’t like to diagnose it.

Nicky’s daughter woke her to say she had taken an overdose.

And I don’t know, was I walking round with my eyes shut? Possibly. She woke me up, the first I think I really knew about it, really, really knew about it, was five o’clock one morning and she woke me up in floods of tears and says, “Mum, I’ve done something really stupid. I’ve taken a load of paracetamol.” At which point, of course, hysteria breaks out. We get up. We take her to the hospital. They, she hadn’t taken that many, thank goodness, so she didn’t need anything other than a bit of observation and a stern talking to and we got referred to the community mental health team. No, sorry, we got referred to CAMHS, Child and Adolescent Mental Health Services because it was a suicide attempt and I think, at that point, I probably started to realise that maybe I hadn’t been looking at her as closely as I had and there was some evidence of self-harm, of cutting predominately and that became more and more pronounced as time went on, in spite of our involvement with CAMHS.

Nicky was angry about her daughter’s self-harming.

And I know this probably doesn’t sound like an appropriate therapeutic response, but given the nature of her illness and his knowledge of it, when I picked her up from the police station the following day, you know, she’s like got her arms all bandaged up to the elbows and everything. And they weren’t deep. That that was the thing, I think that was one of things that made me very cross, her self-harming makes me cross a lot. It makes me angry and upset but mostly it makes me cross. It makes me cross that she does that to herself. She’s a she’s a beautiful young woman. Really, she is inside and out and to see her do so much damage to herself is something I find distressing to the point of being very angry about it. 

Her training as a Samaritan helped Nicky deal with her feelings of guilt.

I think being, using the skills I’ve learned as a Samaritan for not getting emotionally involved with callers’ problems, has probably been the one thing that’s saved my sanity and kept us together. That ability to be able to take a step back from it and to kind of go, “This is really difficult but it’s her decision and I can’t make her stop.” That that has that has helped, it’s helped deal with some of the guilt that I think you feel as a parent, when you see your child purposely hurting themselves and wondering how much of that’s your fault or your responsibility or what you should have done differently to stop it happening or to or to stop it starting. All those really difficult, painful, hard emotions that you get as a parent and I think for me that little bit of distance was the thing that that helped me not to beat myself up quite as much as I might have had a tendency to had I not had those skills in place. Because I’m very good at beating myself up. 

Nicky’s teenage daughter thought her mother couldn’t possibly understand her.

She, as a teenager, refused point blank to discuss it with me, partly it was the BPD [borderline personality disorder], partly it was also the I think the very normal teenage, “You’re really old. You’re a parent. You couldn’t possibly understand. I’m not going to waste my breath talking to you about it,” attitude that that comes with those hormones and that age. So we spent a lot of time not talking about it and kind of skirting round the issue and I suspect that’s fairly common as well for lots of us.

Nicky’s in-laws were judgemental before her daughter explained things to them.

And that was very difficult and my husband’s, my husband’s a lovely man and his family are very lovely too  but they don’t talk, so all the stuff that goes on in the family, you kind of find out third hand via somebody else in the family telling you, you know, “Because we don’t talk about those sorts of things.” Which has made my daughter’s situation, actually, quite hard because I suspect that there, over the years, might have been some judgements made about things because people didn’t have the full, the full information.

But I’ve been able to overcome that, as my as my daughter has got better, she’s been able to engage with people about her illness and about her behaviours from her perspective and she’s been able to say things like, “Mum did x and actually it was very helpful.” Because one of, one of my in-laws, one of my sisters-in-law, was quite judgemental a few years ago, when things had been very difficult and my husband had said to his oldest sister, so the maternal one in the family, the matriarch I suppose, because they’re quite a big family, and she been a bit, “Well, do you really think that’s an appropriate thing to do.” She was quite judgemental about how we’d chosen to deal with my daughter about it because it had been very much a case of, “Sort yourself out or, you know, you need to leave because we can’t live like this anymore.” 

And she was quite judgemental about it and I’d tried to explain and my husband had tried to explain and she was still a bit sniffy and then we’d had a bit of a family get-together a few weeks later and I’d mentioned to my daughter and she said, “Don’t worry, mum. I’ll put her right.” And she sat down with her and she said, “You know.” And my so my sister-in-law says to [my daughter], “Oh, you know,” sorry, to my daughter, “Oh how have things been?” And my daughter goes, “Well, blah-dy blah-dy blah and Mum did this and so and so, my husband did that, and, actually, I know it seems like a bit harsh but it really was the right thing to do.” 

And she, so the in-laws have been, the in-laws have been much better about it since then but it is quite hard I think if people aren’t open about it to help dispel some of the myths about it and, where you’ve not had, and his family have had very little experience of, you know, mental health issues and behaviours like that and I think where you haven’t had much experience of those kinds of things, if you don’t talk about it, it’s very easy to make judgements.

Nicky and her daughter disagreed about why she made her three ‘suicide attempts’, but Nicky is worried that if she tries again she might die.

And do you think that she wanted to die at those times?

Definitely not in the first one. We have a significant disagreement over the second one because she says she wanted to and I always say, you know, “In the thirty minutes between your CPN leaving and you getting an ambulance, that is not serious. If you’d have been really serious, you wouldn’t have phoned your best mate up and gone, ‘oh guess what I’ve done.’” And she always says, “That was a really serious attempt and I really wanted to die.” And me and her CPN are going like, “Yeah, right.” Not that we’d do that to her face but in terms of, she and I have had a bit of a disagreement over it.

The final one, I don’t know. I honestly don’t know. I think it was probably the most serious of the three in terms of intent. She has said to me, and this is, this is something that, this is one of those things where you think, “In a way I’m pleased that you can share it with me but, as a parent, I’d really rather you hadn’t” moments is, is, she has said to me, “I will never try to kill myself again, mum.” She said, “Because if I do it, I’ll do it for real because it will be that I don’t want to go on living.”

And that that’s a very hard thing to hear, as a parent, but, as I say, I’m, I suppose in a way, it’s some comfort to know that she has voluntarily told me that she’s not going to, I’m trying to think of a polite way of putting this because I know it’s being recorded and I’m struggling, she’s not going to mess around again with attempts that are, are or could be perceived as a cry for help.

It’s do it or, it’s literally, I think she, you know, her view is kind of it’s do it or die. Do it and die or don’t do it at all is where she is in in terms of that but I, as a parent, I hope it never gets there.

Do you worry about that?

Oh yes. I mean on a, on a scale of, we had this conversation the other week, when we were talking about, I said, “You, you need to get back into therapy. This is nice mummy has gone away, bully mummy is out in force.” You will get some therapy or else, was where we ended up and I said to her, she said, “But I don’t need you to worry about me.” And I said, “But love, it comes with the job description, you know. As parent.” I said, “As a parent, you always worry.” 

It seemed nursing staff thought Nicky’s daughter was ‘highly manipulative’. Nicky works with Samaritans to help hospital staff understand self-harm.

And the nursing staff were very unimpressed, very, very unimpressed because she was highly manipulative and they said as much on the ward. And that’s something else I’m very conscious of from my work as a Samaritan that often people who self-harm or attempt suicide get a very raw deal in A and E departments. That is something and it’s something certainly that locally, I know lots of Samaritans branches, you know, kind of look for ways of getting into A and E departments to talk to staff and other associated departments to talk to staff to say, you know, “Yes, we understand that it’s difficult and that you can see it as a cry for help or a waste of time, you know, a drain on resources, all the really negative stuff that people say about self-harm but, actually, you know, there’s a nicer way of treating these patients than being so dismissive.” 

Nicky thinks carers should be included as ‘part of the solution’.

Do you have any messages for other parents and carers and for clinicians?

Oh for clinicians, please talk to carers. Don’t exclude us. We’re part of the solution. We may be part of the problem. I think often clinicians’ perception, certainly in my experience, can be that you’re part of the problem. Well, I maybe but actually, if you help me out I can maybe be part of the solution too and that the National Health Service has more and more that it’s being asked to do and to deal with and to support and not to use the people who really want to be used to help deal with this, to help support people who are going through it, seems like a really short-sighted and wasteful thing to be doing, so engage with carers. Find out what carers want. Wherever possible, if it’s if it’s helpful, and I know it isn’t always, but if it’s going to be helpful to get the the the patient to agree to let the carer know about what’s going on, do that, that made the biggest difference for me.

Was having [my daughter] give her, was having my daughter give her consent, that made the biggest difference because that meant that me and her CPN could talk about how she was and he, you know, he he never divulged anything huge but he would say, I would say things like, “Oh she’s been doing blah blah blah and I’ve been behaving x, y, z and it’s caused these kind of problems.” And he’d say things to me like, “Yes, she did mention that she’d been behaving like that and she did say, you know, and yes, I know that that, your response is really winding her up but, actually, that’s okay.” You know and it was it was just being able to have that frankness. He never divulged anything hugely detailed and, if he wanted to share something specific with me that she told him, he would ask her and if she said, no, that was an end of it. But there were a couple of occasions where he’d say to me, “She said something, she said x to me and I asked her if I could share that with you and she said that was okay.” And I found that really, really helpful.

Because, when you’re really worried, when you don’t understand and you’re really worried, you need that reassurance. You need to know that you’re doing the right thing or some gentle guidance if you’re not doing the right thing as to what the right thing is. 

Nicky’s Samaritan training gave her ‘that tiny bit of distance’ that enabled her ‘to hold it all together’.

Samaritans has been a huge influence. I have I have got a number of very, very good friends people who’ve been Samaritans colleagues, who’ve developed into friends. My Samaritans training has probably been one of the best supports I can have had, that ability to take a step back. I’ll never forget saying to her, and it went down like a lead balloon, one time she was standing in her bedroom door screaming at me, “I’m going to kill myself if you keep on doing this.” And I turned round, I took a deep breath and I turned round to her and I said to her, “If you choose to do that, I would be very hurt and very upset but it’s your choice and I can’t stop you and I really would rather that you didn’t, but if that’s what you choose to do then that’s your choice.” 

And I turned and I walked away and there was this completely stunned silence because what she was really looking for was some kind of highly emotional response. She didn’t speak to me for about a day and a half because she was so annoyed. She said to me afterwards, “You weren’t supposed to say that. You were supposed to say something else.” And it was like, “Well, that was the day I decided we were playing by different rules.” So actually, that that training has, I found it really helpful in in distancing myself from, only a little bit because I’m because I’m a mum, but it’s just given me that tiny bit of distance that’s enabled me to hold it all together when I’ve needed to.

Yes.

And that’s been most useful for me.

Nicky thought life experience helped her daughter deal with things which would have made her want to cut herself in the past.

So yeah, I mean I mean things, I don’t think she’ll, I don’t think she’ll ever stop doing it. I think I think the better she gets, the longer the gaps will be between her hurting herself because she, because she will find, it’s not just that she finds that she’s found other coping strategies but the things that she found very difficult before that would have made her feel the need to cut, are not so scary anymore or not so uncope-able with anymore, for want of a better way of putting it. Do you know what I mean?

The enormity of these things has diminished to the point where they’re now normal everyday things rather than big scary things that she couldn’t deal with, which would have made her want to cut herself and now she goes, “It’s not very nice. Oop, never mind, okay, we’ll get on with it.” So rather than going, “Oh, panic, need to cut because I can’t cope.” She deals with things so it’s, for her it’s part of a bigger picture I think in in terms of therapy, life experience, I think life experience is a huge part of it.

You know, I, you see, as a Samaritan, you see lots of e-mails from, we get lots of e-mails from younger callers and you see lots and lots of teens particularly, talking about [coughs] stuff that they find difficult, stuff that for them is just the hugest catastrophe in the whole world, you know. End of world stuff, the usual kind of thing you get from teens, you know, splitting up with the boyfriend, all this sort of thing and you look at it and, because it’s not written down I think you’re more conscious of it and I often find myself thinking, from my standpoint at my age with my life experience, “That’s a really minor thing.” But you only get there through living through feeling like it’s the end of the world at fifteen or sixteen.

Yes.

You have to live through that and live through the more painful stuff that follows on from that to be able to go, “That’s a tiny thing.” Because you have something to compare it with. At fifteen, sixteen, it is the most catastrophic thing that’s ever happened to you so you respond like that. At forty eight, it’s kind of like, “Yes, it’s painful but, do you know what, there’s a lot worse out there, actually.” I’ve lived through that and I’ve lived through worse and there’s probably worse to come and, do you know what, we’ll just have to kind of knuckle down and get on with that and it gets here because that’s life. But you don’t have that perspective at sixteen and I think that’s the other thing that’s changed for her is is her perspective has broadened as life has given her more, as she’s gone out there and experienced and done more, that that’s I think that’s a huge part of it.

That kind of going, “Oh okay, what would have caused me to cut myself, to panic and cut myself when I was sixteen, now, you know, so what.”

Yeah, yes.

For lots, for her in particular but I think it happens for lots of people, who maybe grow out it sounds patronising but I can’t think of a better way of putting it, who reach a point where it doesn’t become as necessary as a coping strategy anymore.

Yes.

That that’s an opinion, for what it’s worth, but it certainly been the case I think for my daughter.

When Nicky’s daughter acknowledged that self-harming was not a good way of coping she was able to change her behaviour.

I think the saving grace for my daughter has been an ability to acknowledge that it’s not a productive way of coping. That it’s, that it’s a harmful and a damaging way of dealing with things and I think acknowledging that has enabled her to change her behaviours and I think I think that’s the thing, until you go, “That’s not really a very good way of coping with stuff because it hurts or it leaves me with scars or it causes pain to me and other people.” You don’t ever move on. 

Nicky’s daughter is learning how to deal with her emotions better and is self-harming less often.

I’ve got to the point where I accept that it works as a coping strategy for her but it still makes me uncomfortable. I still wish she wouldn’t do it. I still want to wrap her up in cotton wool and fix it all for her. I don’t think that will ever change either. I think I think life will continue as it does. It will continue to be a roller coaster because of her mental health issues, she’ll have good times and bad times. I just hope that the good times are longer and bigger and better. The older she gets, the more experienced she gets at dealing with stuff and coping with stuff and learning how to how to how to deal with her emotions better because that’s a big issue for her. That that the periods between the self-harm continue to increase and that one day she can come to me and say, “It’s been x years.” Rather than x months.

Nicky thinks parents would be reassured if clinicians explained their perspective more clearly.

And I appreciate that clinicians have the patient’s best interests at heart so when they say things to someone who self-harms like, you know, “Make sure you do it carefully, you don’t cut too deep and make sure you only use clean blades.” Please be aware of the fact that the carer might find that a really offensive thing for you to say and that that’s okay. I think that’s okay. I think that’s okay as a carer to go, “I find that really offensive.” And I think clinicians need to try and have a conversation that says, “I really understand how offensive you find this. The reason we do it is.” And we had a little bit of that but I think more of it would have helped. When she, particularly when they’re in their teens and I think, you know, as a responsible carer, parent, you’re very aware of how vulnerable they are. You need that reassurance and it felt like as a carer, it felt like there was a responsible clinician here advising my daughter on how best to slice her arms up. That’s how it felt from a parent’s perspective and that’s why I think you get, if you get a negative response, that’s why because, as a parent, your perspective is completely different. 

And clinicians I think have a responsibility to help parents and carers see that they need to have a different perspective to help and it’s quite an alien one.

I found it, certainly I found it a very alien one. So in terms of clinicians, you know, please just think about think about how you can engage with carers and offer them a bit of support and a bit of support that’s related to what you’re doing with the individual.