Mental Health

How I came to understand the gap between self-harm and suicidal ideation

Kat Zettler

Reprinted from "Young People: Self-Injury" issue of Visions Journal, 2017, 13 (2), p. 20

From 2011 to 2013, I lost track of how many times I pulled myself up off the bathroom floor, post–vomit-session. My weeks consisted of extreme self-criticism, weighing myself after the smallest morsel of food, hiding my meals under napkins at restaurants so that the people I was eating with wouldn’t suspect I was restricting my food intake. On some occasions, I’d go so many days without eating that I would wake up physically ill, eventually dry-heaving for hours on end.

After one of these sessions spent with my head against the cool porcelain, I would drag myself in front of the mirror and examine my post-vomit appearance. I would be ashamed and disgusted at what I’d just put my body through; the reflection in the mirror felt alien to me.

Today, looking back on those years is still painful for me. Although I no longer restrict meals, it’s still a work in progress to eat three meals a day, and I still encounter frequent bouts of guilt when I eat. But with years of recovery behind me, I now understand what led me to engage in self-harming behaviours and to develop an eating disorder.

When I was younger, I would often experience a shaking, head-to-toe sensation that would last for hours on end, making me feel light-headed. My mother can remember me saying, when I was as young as five or six, “I’ve done something terrible. I have no idea what it is but I should be punished.” I remember wondering often, Why am I shaking so hard? Why do I feel ashamed? There must be something wrong with me.

Over the years, this feeling escalated, often presenting itself in the most inconvenient of situations. I’d begin shaking so bad that I would drop things and hyperventilate; I would have to excuse myself to the bathroom to “re-centre.” Feeling ashamed, powerless and sick to my stomach, I’d have to actually lie down in order to avoid vomiting.

When I was 10, my father died of alcoholism. When I was 13, I disclosed to my mother that I had been repeatedly sexually abused by another family member. In hindsight, I know these events were likely closely related to my childhood anxiety and my eventual decision to self-harm. At the time, however, I didn’t connect the dots.

At that point, I frequently showered during bouts of anxiety to calm down. During one shower of panicked breathing and shaking hands, the razor slipped against my skin while I was shaving. The cut was surprisingly deep. As the water washed the blood away, I was suddenly overwhelmed by a euphoric release: the nausea in my stomach lessened, and the pressure in my chest lifted. Curious and confused, I stood for a moment, wondering what this meant.

And then I made another incision...

Fast-forward two years, and cutting had become a once-weekly insurance practice to keep the Anxiety Demon at bay. I developed strategies. Cut in the wrong area, and the scabs would be noticeable. Cut too deep, and the scars would be noticeable. Too many cuts? Pick the scabs, or cut into an old wound. Nothing to cut with? I’d slap myself continuously until I achieved the same euphoric rush. But while cutting temporarily freed me from anxiety, in the days following a cutting session, my sense of worthlessness and emptiness would escalate, creating new anxieties that would lead me back to another session.

I was acutely aware that my behaviour was unhealthy. By the time I was 15, I had made several attempts to discuss my self-harm with counsellors and other adults. Each time, I was asked the same question: “Well, are you feeling suicidal?”

Understandably, this is an important question to ask. But unfortunately, as soon as the adult knew I was not suicidal, my self-harming behaviour was immediately taken less seriously—or dismissed as a cry for attention.

The irony was that I was crying for attention! I had no idea how to cope in a healthy way with my life experiences. I could not understand why that very real cry for help wasn’t being taken seriously!

When I was 16, my best friend died by suicide. When I saw the impact that her suicide had on the community, I vowed I would never make the same choice. But I was still far from healthy. I had run out of places on my body that I could cut and still keep hidden. I was desperate to change my behaviour and yet every time I reached out for support, I was characterized as being melodramatic. I felt unheard and exhausted.

One morning, after I’d been fighting the urge to cut for days, I woke up with anxiety so strong that I couldn’t leave my house. I tried to drag myself from my bed into the shower, but I collapsed on the floor, sobbing, overcome with the desire to throw up.

With the simple goal of not feeling ill, I forced myself to vomit. To my surprise, I experienced the same rush of euphoria that I experienced when I cut. The relief was immediate, and a new behavioural pattern was born.

When I cut, relief was fleeting. But with daily meal restriction, I was acutely aware of bodily harm each day. This sense of control gave me daily release. If anxiety overwhelmed me, I’d purge until that sense of release soothed my body. Why continue to cut when I could do something that was far less “scarring” and had “better” results?

But with that new sense of control, I really did lose control. Within a little over two months I had lost one-third of my body weight. I was hospitalized and diagnosed with anorexia nervosa. I was immediately referred to several care providers—suffice to say that my eating disorder was not treated as a melodramatic “cry for attention.”

After the diagnosis, navigating the complex mental health system in my small-town community was difficult. Finding the right care provider can be a frustrating course of trial and error. But these challenges are compounded in rural settings. In my hometown, there are few mental health resources. Referral lists can be several months—even years—long. Until recently, the closest youth-care facility was a five-hour drive away.

But while the road to recovery has been long and hard, I know I have moved mountains since those nights on the bathroom floor.

Although I experienced a few particularly low points, I can honestly say I wasn’t ever suicidal. My experience with my father’s death and my best friend’s suicide helped me to see the impact my own death would have had on my community. This prevented me from being at a substantial risk for suicidal ideation.

Ironically, it was because I wasn’t at high risk for suicidal ideation that my self-harming behaviour was dismissed for so long. Yet I can’t help but feel that if I’d been able to access proper supports during those earlier years of self-harm, my experience with anorexia may have been entirely avoidable. If self-harm can be a pre-cursor to suicidal ideation, why do we continue to stigmatize those who self-harm without the wish to die?

Now, at the age of 23, I’m honoured to be working in a new health services building in my hometown—one that provides integrated youth services for youth up to age 24. It feels incredible to work with other youth, to hear their stories and provide support.

I’ve come to accept that there is a huge gap in our understanding of the difference between self-harm and suicidal ideation. As a society, we must work hard to bridge this gap so that those who aren’t suicidal can still receive the supports they need to achieve wellness. I hope that by sharing my story, I can help do that.