Self-harm/self-defence

by Adam James

Extract from Openmind 106, Nov/Dec 2000

In September 1999 Sharon Lefevre, a mother-of-three, hanged herself at her home. The local paper in Dolgellau, north Wales, simply reported the death as a suicide by a depressed woman. What it missed was that Lefevre had made a dramatic impact on the mental health scene, vociferously challenging orthodox understandings of why people self-harm.

In her...semi-autobiographical book, Killing Me Softly (Lefevre, S. 1985), Lefevre argued that self-harm was not a symptom of a biologically-based mental illness. Instead, she wrote, self-harm was a coping strategy used by those with past experiences of abuse, where being hurt had become etched into their self-identity.

Lefevre argued that self-harm could not be cured. Instead it should be accepted and managed: "Self-harm is a way of relating to your past truth. It may appear very negative, but it is very positive. The language of self-harm is keeping the person alive."

At the same time as giving such a truthful and powerful insight into the subjective world of the self-harmer, Lefevre pleaded with professionals to reappraise their attitude towards self-harming patients. In general her account received little recognition from mainstream health circles, but there were noteworthy exceptions...

Perhaps the most remarkable contribution Lefevre made to mental health was the relationship she forged with Dr Phil Thomas, her consultant psychiatrist at Gwynedd Hospital in Bangor. It culminated in Thomas performing with his patient in On the Edge of a Dilemma , a one hour play Lefevre wrote during a drama degree.

Thomas and Lefevre began their extraordinary psychiatrist/patient partnership in 1995. "I will never forget my first meeting with Sharon," says Thomas. "She was surrounded by four nurses and was cutting herself. There was no way we could stop her." Although Thomas felt powerless to stop his patient from self-injuring, he listened. "Initially, I did not see Phil as anyone different," Lefevre told me. "I think he thought, 'Oh no! Not another bloody cutter.' But he seemed to care about me and my distress. He looked for my qualities."

Thomas subsequently agreed to perform with Lefevre in her play. Set in the kitchen of a psychiatric ward, On the Edge of a Dilemma told the story of a soul-searching discussion between a psychiatrist, disillusioned with his profession's inability to help patients, and a self-harming patient. Lefevre took the part of the patient, and Thomas the psychiatrist. Performed in the UK and abroad, the play captivated its audiences, who were aware they were watching chapters in each of the performers own lives...

Sadly, however, behind Lefevre's confident public persona remained a deep-rooted despair. When Thomas, and also Ron Coleman, a service user and trainer who published Killing Me Softly , both moved away from Wales, Lefevre became more depressed.

When she was admitted back into hospital after cutting herself (her acts of self-harm were never suicide attempts), Thomas could no longer supervise her care. Lefevre was eventually sectioned and compulsorily treated - the very thing she had always insisted was contrary to a self-harmer's interests. It was not long after that she killed herself.

Yet Lefevre leaves an important message for mental health care providers, and Thomas still carries her flag: "We should be telling self-harm patients that medication is not going to cure you. But we can find something that is helpful for you," he says. "This may mean discovering situations for the patient where it is less necessary to self-harm, finding ways of self-harming that are less disfiguring, making sure a patient has access to sterile packs and good casualty care where wounds will be stitched up carefully and with an anaesthetic. The message to take on board is that for many people self-harm is necessary, because it helps them deal with the most unbearable things that can happen to a person."

Thomas agrees that self-harm prolonged Sharon's life. "The reason Sharon died was her great vulnerability. That was the tragedy."