It was a memorable email.
A young girl wanted to know how to cover up her self-harm scars so she could look great in the sleeveless gown earmarked for an upcoming High School formal.
Her friends didn't know about her cutting.
But they were going to find out - if she wore the coveted strapless dress which had now taken pride of place in her wardrobe.
Recovering from a period of self-harming behaviour and doing well in school, she was ready to have fun at the most important social night of the year. And maybe, just maybe, she was ready to have a conversation with her group about self-harm and how it had taken over her life - for a while.
I found myself in tears, because, yes, she had recovered and yes, she was brave, BUT she didnt know whether her friends would accept that damaged and vulnerable self - the one who took a blade to her bare arms when she felt overwhelmed by emotion. And maybe she wasn't sure whether she felt OK about that history and that other, troubled and troublesome self.
Stigma is a terrible thing.
It can stop us from telling people how we are really feeling and it can stop us from seeking help. It can stop us from taking a chance and talking to the people who matter about the more vulnerable parts of us. Maybe our friends aren't ready to hear, maybe they will shrink away, maybe they will judge us, or even reject us. Peer acceptance is so important at this time and fitting into the group can seem like its the most important thing in the world.
As a clinician specialising in young people's mental health, I have helped many young people with self-harming behaviours. In "Young Minds Matter" a summary of the second Australian Child and Adolescent Survey of Mental Health and Wellbeing published this year, the authors find that "1 in 12 adolescents aged 12-17 have self-harmed in the past 12 months." A worrying statistic - unfortunately, self-harm is becoming more and more common.
So why do young people do it?
I think it is for many reasons, not all of which can be summarised here. Often it is a coping mechanism for feeling states which are overwhelming to the young person, who may be struggling with the stresses of home and school or coming to terms with discovering who they are and how to be. Adolescence and young adulthood is a time of tumultuous emotions and some young people find cutting or other forms of self-harm will help them to ride the storms - temporarily. It can become the go-to "solution" which they revisit when everything becomes too much.
Parents who discover that their child is self-harming are often too shocked and overwhelmed themselves to understand that for the young person the behaviour is intrinsically rewarding - it helps them feel better. Often a discovery of self-harm can lead to a power struggle - a tussle between child and parent over what is, for parents, a very distressing behaviour. Its important to get to the bottom of why a child is behaving in this way, rather than just trying to prevent them from doing it.
For the girl who sent me the email, things had improved. She was recovering and no longer used self-harming behaviour to help regulate her emotions. But for many other young Australians, its something that they do - and keep doing, because it makes them feel better and nothing else can provide that reprieve. Taking away the safety net of self-harm can cause more distress. Talking through the issues, and finding distraction techniques to manage overwhelming emotions can help. But in the long run, we need to help them come to a place where the behaviour isn't necessary anymore. That is something that can only happen through the work of therapy.
If you would like more information on self-harm, if you are worried about a young person who is self-harming or about your own behaviour, please contact me via the "get in touch" button.