The child secretly cut himself, and the parents fell into a collapse and confusion: "I feel that the tears are dry"

Prick with a needle, cut your hand with a knife, cut your thigh, bang your head against the wall...... These behaviors, which do not involve suicidal intent but attempt to harm the body, are medically referred to as non-suicidal self-injury (NSSI) and are particularly pronounced in adolescents. The prevalence of NSSI in adolescents around the world ranges from 5% to 37%, and in China, the detection rate of NSSI varies among different regions. A paper published in 2017 estimated that the overall NSSI detection rate of secondary school students in Chinese mainland was 27.4%. NSSI is often accompanied by depression, bipolar and other mental disorders, and in severe cases, it can cost the adolescent life.

The nursing team at the Guangdong Provincial Mental Health Center interviewed 19 parents of adolescents who self-injured and found that the causes of self-injury come from many sources, among which family causes can be broadly divided into two categories: one is that parents are too controlling and children try to release pain through self-injury, and the other is that parents neglect to accompany them, and children use self-harm to get parents' attention. Both models reflect the problem of communication between parents and children, where parents feel that their children are unwilling to communicate, but from the perspective of their children, they think that parents are always criticizing their own choices. Some parents do not know how to deal with it, and try to restrain their children's self-harm in a simple and crude way, but it backfires, and some parents feel deeply guilty and want to try their best to compensate and blindly meet all the needs of their children, but make self-harm a bargaining chip for their children to threaten their parents.

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We interviewed Li Huiping, Xie Meixiang and Sun Chunyan from the nursing team. In their view, the plight of parents of self-harming adolescents also needs attention, and their stigma is even stronger than that of their children. Fearing that their child's illness would be discriminated against, most parents hide their child's illness from friends and family, and they have no one to talk to in their daily lives, and they can only find an outlet in the hospital. Seeing the child's wounds, some people are angry, some people blame themselves, more people fall into confusion, and some even wash their faces with tears all day long.

Exposed to the plight of different families, they increasingly feel the lack of social support. Ideally, hospitals, schools, and communities should work together to build support networks, but the reality is that self-injuring adolescents have become a "ticking time bomb" in schools, and some adolescents have been forced to suspend or drop out of school. Broken social support networks have left families of self-injuring teens siloed.

The following is an oral testimonial from the nursing team interviewees, partially based on their paper, "A Qualitative Study of Parental Care and Coping Experiences in Nonsuicidal Self-Injured Adolescents."

Living in fear every day

Since 2017, we can clearly feel that the group of patients who come to the department is younger. Previously [we met] mostly middle-aged people, now there are college students, and even teenagers between the ages of 12 and 18. At present, most of the patients with depressive disorder and bipolar disorder admitted to the ward have non-suicidal self-injury behaviors. Many children have expressed that the pain of self-injury makes them feel alive and release the pain through physical stimulation.

There are group chats about self-injury online, where these children share patterns of self-harm and graphic photos. Some children start out secretly hurting themselves out of the sight of others, and then want to find their own kind, so they post their experiences of self-harm on social media. Out of the psychology of self-help, some people will take the initiative to tell their parents and teachers, or directly hurt themselves in front of them.

Listening to a pair of parents tell that after an argument, the child cut a deep wound on his hand with a knife, and the parents were terrified. In addition to psychotherapy, they also take the child to stitches, do aesthetic treatment, and remove the scar. When they talked to us, they would cry as they talked, "How could this happen?" Complaining that the child is too fragile to understand the hard work of the parents.

A hospitalized boy tried to injure himself after an argument with his mother, and he was taking pictures and texting the girl he had a crush on, saying that he was hospitalized with psychological problems and wanted a little attention from the girl. happened to be seen by his mother, who didn't want the school to know about it and told the boy not to send it again. Unexpectedly, the boy suddenly lost control of his emotions and began to injure himself.

His mother didn't expect this at all, and hugged her son and cried bitterly. Her son was very emotional, saying that his mother controlled him and didn't let him do anything, "My life has been ruined!"

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In clinical work, we can feel that the parents of these children are very confused and helpless. Once we invited the families to get together and talk, the event had no theme, just to provide an outlet for the families to vent their emotions. Many people are crying, worried about the future of their children, and do not know where the way out is. In 2022, we interviewed 19 parents of self-harming teens. No one turned down our requests for interviews, and some parents couldn't stop talking about their experiences, and an hour or two was not enough.

Many parents' stigma is even worse than that of their children, and some children are hospitalized and send to Moments, hoping to get the care of friends, and the Moments comment "What's wrong with you", and the children will reply very seriously. But parents do not approve of this behavior, fearing that their children will be ordered to withdraw from school, and that their children will be labeled and stigmatized for being hospitalized for self-harm. Parents often hide their child's illness from friends and relatives until they get to the hospital.

Most parents' first reaction after finding out that their children have injured themselves is that they are overwhelmed and "the whole person is confused". Some parents said that they felt that their tears had dried up, and they felt like they were sick. Generally speaking, when a child is sick, one of the parents has to quit his job to accompany him or her throughout the journey. A mother is always on the alert for her child to hurt herself, and when her child takes a shower and goes to the toilet, she also asks the door to be open all the time. In order to prevent the child from touching sharp objects, even the cans must be opened and thrown away.

In the tense mood, some internal conflicts within the family erupted. A pair of parents blame each other every day, the father blames the mother for being too fierce and strict with the child, and enrolls in too many study classes, which puts too much pressure on the child, and the mother complains that the father is busy working outside most of the time and gives the child too little company. In interviews, the father described his family's life as a "mess" and that he himself lives in fear every day for fear that his child will get sick again.

Self-injurious behavior occurs repeatedly, and some parents gradually lose patience. The aforementioned parents were able to come to the hospital to accompany them at the beginning, and then they hired nurses throughout the whole process, and then let the children come to the hospital by themselves. During the quarrel, the child began to row again, saying that he was going to commit suicide, and the parents were impatient, "If you want to die, die outside".

This sentence was told to us when the child came to the hospital, and we called the parents to ask why they had said such things to the child. The parents admitted that it was a momentary anger, and they also confided in us their helplessness: they couldn't take care of their work, they couldn't take care of their family, and their children's illnesses were repeatedly hospitalized. When they see their children hurting themselves, they can't control their emotions.

We formed a family care group for self-harming youth, which provided an emotional outlet for hundreds of parents. "Collapse" is a high-frequency word in group chats, and a single mother recounted a recent self-injury to her child, who found her child trying to cut his hand with the edge of a can of fish during a meal, and the mother lost control at that time, grabbed the can and threw it away, shouting at the child, "If you want to die, die!" The child tried to run out, but she suddenly pushed the child back and locked him in the room. She complained in the group, "The child wants to die every day, when is this situation a head, I feel like I'm going crazy." ”

Family causes of self-injury in adolescents

Family of origin, interpersonal relationships, and academic pressure can all be the causes of self-harm in adolescents. We have been exposed to a large number of clinical cases, and few of them have particularly harmonious families. The causes of the family can be divided into two categories, one is that parents are strict and give their children too many restrictions in the name of love: how good the grades must be, they must wear clothes when it is cold, and they must come back before the time. Too much control does not allow the child to leave the safe range of the parents' perception, and when the child no longer agrees, it is easy to have a violent conflict.

When we interviewed, there was a mother who cried very sadly and felt sorry for her child. She is a stay-at-home mom who is dedicated to taking care of her children's daily lives. When she found out that her daughter had hurt herself, she couldn't believe that in her heart, her daughter had always been obedient and excellent, how could this happen?

The mother later reflected that she usually used the banner of "good for her children", but ignored her daughter's wishes. Every time she enrolled in cram school, she emphasized the benefits of taking this course, and when she asked her daughter what she wanted, she always acquiesced. In her heart, her daughter is very well-behaved and can meet her parents' requirements. During the interview, she cried and said that she used to compare her daughter with other people, but now she realizes that she should not put this kind of pressure on her daughter.

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The other type is more common in families of left-behind children, where parents neglect to accompany them and leave their children with grandparents, and children want to get parental attention through self-harm. From 2018 to 2019, we also found that because of the birth of "two treasures" in the family, children felt that their parents gave less love and attention, resulting in self-harm in children. There was a girl who became irritable after having a younger sister at home and felt that her parents no longer paid attention to her. She destroys her sister's toys in an attempt to regain her parents' attention by self-harm.

A Brazilian study showed that adolescent females were more likely than males to engage in non-suicidal self-injurious behaviour, with 72.73% of NSSI adolescents being female. Physiologically, women are more likely to have mood swings after puberty, such as hormonal changes during menstruation, which can affect mood. Patriarchal attitudes in society also play a role in this phenomenon, and in one case we received, the harm came from the girl's grandmother.

The girl felt that she was always ignored in the family because her grandmother always served her brother vegetables and saved the good things for her younger brother. The girl made a mistake with her brother, and the girl was the only one who was criticized by her grandmother. This experience has caused deep damage to the girl. She said she hated her brother and that her grandmother was the one she hated the most.

Unconditional companionship is the best antidote

In the hospital, we will hear parents crying and complaining, the child is very well-behaved when he is a child, and he can still talk together, how can he grow up and not say anything?

But in our daily contact, we feel that the children have a strong desire to confide and are willing to share secrets with us. Many parents can't accept the idea that their children have self-harm, and habitually criticize and blame. And we will be willing to listen to the children talk about why they hurt themselves at that time and what they feel like. No matter what negative emotions they have, we can catch them.

We once asked a boy why he didn't communicate with him because he felt that his mother cared about you? He likes to play games, and at first he would share them with his parents, and he was very happy to play this level and made friends in the game. The parents immediately poured cold water on them, "What's there to be proud of? You have abandoned your studies." Under the blind denial of his parents, he also put away his desire to talk.

Our parents and children are not very good at expressing their emotional feelings and needs actively and clearly, for example, when a child complains that "if you had studied like me, you would have broken down a long time ago", what he wants to hear is the encouragement and understanding of his parents. But your parents will think that if I spend so much money on you to study and provide you with the conditions to the greatest extent, your situation is much better than when I did. This kind of negative communication has blocked the bridge of mutual understanding.

Can we think differently? Don't be critical, don't judge rudely, "You're not right," and replace right and wrong judgment with feelings. Take the classic "Mom thinks you're cold" as an example, if the mother expresses her feelings, "Mom is worried about you and wants you to wear an extra piece of clothing, can you take an extra piece of clothing out to meet Mommy's needs?"

Depressed Teen Works © Visual China

In the interview, we were impressed by the change of a father. He works odd jobs, has an unstable economy, has a bad temper, and often beats his wife and children when he drinks. He first knew that the child had injured himself when he found blood on the sheets. I heard that self-harm on the Internet would make children imitate it, so I forbade my daughter to play with her mobile phone. The child was unwilling, so he smashed the phone in a fit of anger, and his daughter cried. After that confrontation, her daughter's self-injurious behavior escalated, slashing her arm in front of him and stabbing him several times at once.

Only then did the father realize that conflict and confrontation would only make his daughter's self-injurious behavior worse. He began to restrain his temper, asked himself not to speak loudly to his daughter, took the initiative to go to the child's room to chat with her, find her for a walk, and spend more time with her. Now the daughter is willing to communicate with him, and her father accompanies her to see a doctor.

In some families with higher economic incomes, parents may go to the other extreme to blindly meet their children's unreasonable needs in order to prevent their children from harming themselves. A mother found that her child was in a better mood when she traveled, quit her job to take her child on a trip, and her child was responsive to wherever she wanted to go and whatever she wanted. In the short term, this behavior can relieve the child's emotions, but in the long term, if self-harm allows the parent to meet all their needs, the child feels like a reward, and the self-injurious behavior may be reinforced.

In the cases we interviewed, some children threatened their parents with money by self-harm or even suicide, "like a bottomless pit". If you want 500 yuan, the father only gives 300 yuan, and the child cuts his wrists. There are also children who repeatedly use self-harm to resist going to school, and their parents have no choice but to follow her.

Every family's situation is different, and there is no absolute answer to how to meet the needs of children in moderation. A common idea is that parents and children should establish a set of rules together and then follow them together.

When the children are in the hospital, we make some schedules, such as what time to play checkers and what time to play shuttlecock. Some children spend too much time playing with their phones, so we make a small contract with them not to play with their phones for more than an hour. When the contract is completed well, we sometimes give small gifts such as a book, rag dolls, etc. as encouragement.

One mother came to us after her child was discharged from the hospital and printed out a few more schedules, saying that it worked especially well for her son. Her son used to hurt himself a lot, looking at his phone every day and doing nothing. The things on the schedule are all things that the child is willing to do, and he has a sense of purpose in life and smiles more.

Returning to the original home-school environment, children's emotions may recur, and words such as "want to die" may be on their lips again. The unconditional companionship and support of parents is the best antidote for children. We will tell parents that they should not be afraid to talk to their children about self-harm/suicide, and that they can make an agreement with their children that they must tell their parents when they have thoughts of self-harm/suicide. When people are in a bad mood, they can be extreme enough to want to end their lives, but we need to show him that there are many ways to solve the problem.

A single mother once shared her journey in a family care group, and she was emotionally unstable at first, unable to see her child's wounds, and once did not want to take care of it. It wasn't until she was impressed during a counseling session that the counselor was able to calmly discuss with the child how the wound formed and why she wanted to hurt herself. The counselor told her that the mother had solved her emotional problems and that the child would slowly get better.

She decided to make a change, and when her children talked about death again, she asked herself to stay calm and act as natural as possible. The child said that he wanted to cut himself to death, and his mother asked, "How are you going to cut it?" What if you die, it may be difficult for me to live?" The child said to cut his mother a few times first, and the mother said that she was afraid of pain, and the two of them pretended to discuss it seriously, and finally the child said, "Forget it, you are so troublesome, I won't die!"

Such conversations happen every day, and in the words of this mother, "three sentences are inseparable from death". Even if she is sad to hear it, she will always encourage her children to talk about negative emotions. When she felt that she couldn't hold it, she read "Parents Rules", and waited until the child fell asleep in the middle of the night before she could secretly go to the bathroom to cry, tear up tissues, and wake up the next day to continue to catch the child's emotions, no matter how difficult it is. She said that she should believe in the child and go with the child.

Lack of social support

During the interviews, most of the parents mentioned that they wanted help from the school, but in reality, they often faced resistance from the school. If the child is discharged from the hospital and wants to return to school, the school will ask the hospital to issue a certificate saying that the child has met the conditions for going to school for fear that the child will have conflicts with teachers and classmates, or that the child will be responsible for self-harm or suicide again at school.

We cannot issue a certificate of resumption of school that meets the requirements of the school, but only a diagnosis certificate indicating that the child's status has met the discharge criteria, and it is recommended to return to school and society as soon as possible. Even so, some children are still dissuaded because it is difficult to integrate into the group or to keep up with learning, and parents who can afford it will send their children to expensive private schools in order for their children to continue their studies.

We found that the teachers of these self-harming adolescents are also a group that needs attention. We sent out a questionnaire for teachers with a message at the end that if you would like to talk about self-harm or need our help, please leave your contact information. Several teachers contacted the members of the research group directly, and I could feel that they were also in urgent need of professional help.

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We have interviewed 14 teachers so far, and the overall impression is that teachers are also helpless in the face of students' self-harm. They don't know how to warn students of psychological problems, they don't know how to respond to self-injury, they want to pay more attention, but they worry that it will make students feel like they are being watched. The school makes the decision to suspend the student, and the teacher, as the communicator of the decision, inevitably conflicts with the parents.

Teachers refer to themselves as "vulnerable". In fact, they knew that after the students hurt themselves, they were also panicked in their hearts, and even some teachers had insomnia and anxiety, but no one paid attention to their psychological needs. There is a counseling room in the school, but they work in the same school, and they find it inconvenient to disclose their psychological condition to their colleagues.

According to my colleagues in Hong Kong, schools in Hong Kong will not let students withdraw from school easily, and they have a complete set of procedures to deal with adolescent psychological problems. After the student has psychological problems, he or she is referred to a professional psychotherapist who will assess whether he or she needs to take medication and whether he or she needs to be referred to a psychiatric specialist. If medication is not needed, they will assess how often the child needs to see a counselor, and families with poor financial conditions can opt for free social work services. The results of the psychotherapy will be shared with the school, and the school will take into account the doctor's opinion. In Hong Kong, it is the family, the hospital, the school and the social worker who work together to lift the child.

Most hospitals in Hong Kong can find guidelines on how to deal with self-harm in adolescents on their websites, which clearly outlines how parents and teachers can help. If you experience certain symptoms, which agency can you call for support. These are specific and operational, and most of the guidelines we can see on the Internet are still at the level of shouting slogans, similar to "give more care" and "communicate more", and parents and teachers don't know how to do it.

Our social workers here can also follow up with each other and tailor counseling to each case, but these resources need to escalate the child's condition to the community. Parents choose to hide it because they are worried that their children will be discriminated against, and that it will be difficult for their children to go to school, find a job, or even get married in the future. This is actually related to the social climate, and Hong Kong used to have a strong stigma against mental illness. Experts have done a lot of propaganda to replace "schizophrenia" with "psychosis", a word that is more acceptable to the general public, telling the public not to be afraid if they have psychosis, and who to call for help. The public's perception can change little by little. There is still too little science and publicity about us.

作者 | 布芒 编辑 | 江臾 出品 | 腾讯新闻 谷雨工作室

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