August 13, 2009
PARENTING: The Space course, run by Temple Street Hospital, helps parents of children who self-harm to calm down and cope, writes SHEILA WAYMAN
ALAN MALONE used to be a happy child. But that began to change after the death of a much loved grandfather, when he was 10, and the onset of adolescence.
"He became very rebellious and difficult to control," says his mother Margaret, whose relationship with Alan's father ended during her pregnancy when she was 21. "He had no male role model."
A civil servant, she has raised Alan on her own. Although she remains good friends with her former boyfriend, his involvement in Alan's life is limited as he lives in the US.
At home in north Co Dublin, rows between Alan and his mother began to escalate into violence. "He would break things and throw things and I would try to restrain him and we would hurt each other on occasion," says Margaret.
After a particularly bad episode one evening, when Alan was 14 but already six foot tall, she phoned his father.
"Alan had a big row with his father on the phone and he came to the conclusion that he was never wanted," she says. "We ended up in a row, and he took a knife to my throat."
She managed to push him out of the way and ran to a friend's house a couple of doors down, to seek refuge and give him a chance to cool off.
"He followed me down about half an hour later and told me he had taken an overdose."
He had swallowed a cocktail of prescription drugs which Margaret had in the house after injuring her back.
After initial panic, Margaret's practical side took over. "I remember bending him over the loo and sticking my fingers down his throat and getting up as much of them as I could. Then I phoned my sister and she said 'put him in a car and bring him straight to Temple Street [Hospital]' which is what I did.
"I remember just being numb at the time as if I wasn't there. I was annoyed at him and annoyed at myself with getting into the argument in the first place."
Little did she know that this was only a stage in what was to become a cycle of domestic abuse.
Margaret lived in fear of not only what he might do to her, but also what he might do to himself, leaving her seemingly powerless as a parent.
"You are afraid to rock the boat with children who self- harm," she points out, "but at the same time you don't want them thinking that every time you say no, that if they do this it is going to get them what they want."
Things were quiet for a while after that first admission to Temple Street Hospital, then his out-of-control behaviour resumed.
"I lived with unbelievable stuff for two years. I was no angel and I often retaliated or reacted," she admits. She believes it is "absolutely ridiculous" that "in this country they do everything to protect children and nothing to protect parents".
Several times she asked social services and the Garda to remove him from the house and he did get several cautions.
After his violent outbursts, Alan would always be sorry afterwards. He overdosed several more times with alcohol and prescription drugs; on one occasion he cut his wrists.
"He was saying things like, he wished he was never born, that he was never wanted. That he was different from everybody else, in that I would have been a very controlling mother. I watched everything he did. Then he rebelled against all that."
By the age of 15 Alan was drinking a lot and using cannabis and ecstasy. It was then that the Children's University Hospital, Temple Street, contacted her about a course being run for parents and carers of children who self-harm, known as the Space programme.
A Deliberate Self Harm (DSH) team was set up at the hospital seven years ago because of the increasing number of cases of self-harm and suicidal behaviour coming into its A&E department. Since January 2002 and June of this year, they have seen 566 cases of children aged 16 and under following self-harm or suicidal behaviour.
"The figures for last year were up very significantly, and looking at the figures for this year, they seem to be up once again," says child and adolescent psychiatrist Prof Carol Fitzpatrick, one member of the multidisciplinary team.
"We have had children as young as five or six in Temple Street, infrequently, but they do present with self-harm or suicide attempts. As adolescence approaches it becomes more common."
An estimated one in 10 adolescents in Ireland resorts to self- harm, usually as a way of coping with difficult or painful feelings. The 2008 annual report of the National Registry of Deliberate Self Harm, published by the National Suicide Research Foundation last month (July), highlighted an increase in self- harm among those aged 10-14 years – 197 cases of girls and 63 cases of boys in this age group were reported by hospitals.
"I think young people are under a lot of pressure, just as their parents are," says Fitzpatrick. "I think we live in a much more pressurised society than we did 15 years ago and young people experience that pressure in their own way."
Temple Street hospital's DSH team soon became aware that while there was some support for the young people, who could be referred to other services, there was no help for their parents. They were devastated and frightened, wondering not only how they were going to support their child but also how they were going to deal with discipline. Would the same thing happen again?
In devising a support programme, with funding from the hospital and the HSE, the DSH team consulted parents who had experienced self-harm by their children. Consisting of six, weekly evening sessions, the course deals with the things parents said they wanted to know about, such as: information on suicidal behaviour and self- harm; recognising depression in young people; communicating with adolescents and how to be a parent without making a situation worse; looking after yourself and how to help siblings, who can often be very angry and frightened too.
An important issue is how to deal with provocation. "Young people of that age can be very provocative to their parents," points out Fitzpatrick.
"Parents understandably rise to the bait and can be very provocative back and that can get out of hand and lead to somebody being hurt. With the help of other parents, they can see another way of responding to something and not taking it personally."
Up to now, the Space programme only involved parents who were referred by hospitals or social workers but, following more funding from Electric Aid – a charity supported by ESB staff – it is now able to offer the course free to any concerned parents.
For Margaret, doing the Space programme in 2007, "probably saved somebody's life in this house to tell you the truth".
It made a huge difference to how she handled Alan.
"It was good knowing that you could go and talk about it and that the people in the room knew where you were coming from: it wasn't like talking to your friends who had regular situations in their houses and were trying to advise you," she says. "You were guided by the professionals on the course, but you felt like you were doing the work with people who were similar to yourself."
It was hearing simple advice such as "push the pause button" that worked for her. "If somebody else said it you'd go 'oh yeah right', but the fact that this was coming from people who knew what they were talking about, made you inclined to try it."
By the end of the course things were already turning around and starting to be calmer in her house.
uppose the difference was, I was more in control," she says. "I realised that I wasn't a slave to whatever was going on. I didn't have to react any more. It was difficult because Alan is a very stubborn child.
"He was smoking at the time and I'd have gone to bed and he would want cigarettes and I'd say 'no, it's 11 o'clock at night' and he would turn on all the lights and turn on the television until I got up.
"On the course I learnt that if I kept giving in he was going to keep doing it. The course gave me confidence to stand up to things. Once he started realising that I wasn't backing down all the time, he backed down."
She also took on board the advice about looking after herself. "I decided to rejoin the gym as I had always been into fitness and I started going two evenings a week.
"I think he started to realise 'my mother is not on my back all the time any more'. And when I stopped being on his back so much, he actually started calming down. It is the weird the way it works. The more you cling and try to control, the more they go against you."
Alan's confidence has greatly improved, he has learnt to control his anger and "he's almost normal again", says Margaret. She convinced him to get some counselling for about six months earlier this year, which also helped.
We got through the Leaving Cert in June, she reports. Last year she had doubted whether he would sit it, having missed a lot of school. But she didn't nag him too much about studying coming up to the exams.
"My attitude was, 'so what if he doesn't do well, it might be the best lesson he has ever had and he can do it again. If I keep pushing him and pressuring him and he ends up doing something seriously to hurt himself, he's not going to sit it again'."
- Names have been changed to protect the family's privacy
- The next Space programme, which is open to any parents of children under 18 who are concerned about self-harm or suicidal behaviour, will run on Tuesday evenings during October/November in Wynn's Hotel, Lower Abbey Street, Dublin 1. An introductory evening will take place on September 22nd in Wynn's Hotel from 7.30pm to 9pm. To register for the course, which is free, contact Lorna Power, tel: 01 7166321 or e-mail Lorna.Power@cuh.ie
"We thought she was a typical teenager but then we saw the cuts"
ANNE COLLINS had become used to her daughter Miriam’s teenage tantrums but she got a terrible shock when she walked into her room one day just over a year ago and caught sight of cuts on the 15-year-old’s arms.
The mother of three knew nothing about self-harm. “I didn’t know where to start. I went over to my GP and he told me to take her straight to accident and emergency in Crumlin hospital. Within a week we had an appointment at the Lucena Clinic in Rathgar.”
It transpired that Miriam had been cutting her arms and legs for nearly a year but had been careful to keep them covered with jumpers and leggings.
“The tantrums were the signs but we didn’t realise, we thought she was just being a disruptive teenager. We should have realised there was something wrong,” says Anne.
The youngest in the family, Miriam had been a “brilliant child” until she went into secondary school and then rebelled against everything. She told her parents she did not know why she was self-harming.
“The way she put it was, the only way she could release the pain that she felt inside, was through pain on the outside,” says Anne. “It was the only explanation we ever got. We still do not know why.”
Child and adolescent psychiatrist Prof Carol Fitzpatrick, who works at both Temple Street and Mater hospitals, says people who cut themselves often describe it as being more bearable and more real than the emotional pain.
“There is some research which shows the physical act of cutting releases endorphins in the brain and that has a slightly soothing effect,” she explains – but very temporarily.
Miriam’s older sister and brother were just as shocked as their parents, but they felt she was doing it for attention and now she was getting it. “It did cause terrible problems with the other two,” says Anne. “They felt she was getting away with murder.”
You give such a child attention through fear more than anything else, she explains. “You feel they have you over a barrel.”
Many adolescents are very secretive about self- harm and generally it is not an attention-seeking ploy. “It does communicate something to other people,” says Fitzpatrick, “but what the person who engages in it wants to communicate varies hugely from person to another.”
The Lucena Clinic recommended the Space programme to Anne and her husband Sean and they both found it “absolutely fabulous”.
“It helped my husband,” says Anne, “because he would be more hot tempered while I am more laid back.”
“I found it very valuable,” says Sean, particularly being able to talk to other parents in similar situations. “It is the type of thing that should be in every town. It enables parents to deal with a huge problem mentally and I think once you do it there and you sort it out in your head, it is a huge benefit.”
Having heard other parents’ stories, he realised how fortunate he and Anne were in having a “less hard case” than most.
“We have come a long, long way with our own child and we are very grateful,” he stresses.
“The comfort we got from the course was huge. It is a very frightening thing. You think you know everything and you really know nothing.”
Miriam is an awful lot better, adds Anne. “We spend more time together now and sit down and talk a lot more.”
- Names have been changed
Facts about deliberate self-harm
- An estimated one in 10 Irish adolescents resort to self-harm as a coping mechanism for difficult or painful emotions.
- Young people aged 15-25 are most likely to self-harm.
- The rate of self-harm among 10-14 year olds is on the increase, with more than 250 cases reported by hospitals last year.
- Most common methods are drug overdose and self cutting.
- Less than 12 per cent of adolescents who self-harm attend medical services afterwards, according to a study by the National Suicide Research Foundation.
- Samaritans: 1850 60 90 90
- www.aware.ie; Lo-call helpline: 1890 303302
This article appears in the print edition of the Irish Times