Hunting for the Reset Button

My son was very young when he discovered talking, and the family joke is that we have been hunting for the Off button ever since.  With my daughter, it is the Reset button we need to find.  What we are all engaged in at the moment is, effectively, trying to reset Julie's body chemistry.

Julie has had four incidents of self-harm in the last two weeks, three of which required stitches at A&E, and one of which was borderline.  The last week has been an endless round of sitting in waiting rooms and having new stitches put in, or old stitches taken out.  When her social worker suggested that we try a reward chart to reduce the self harm I almost wet myself laughing.  We have tried reward charts repeatedly in the past but they have never been much use: Julie's self harm is too severe and too ingrained.  To be blunt, if the threat of stitches and being given a dressing down by a casualty nurse does not stop you, the promise of a square of chocolate is not likely to rein you back.  The addiction model works best for us: Julie has broken her long abstenance, and is now desperately fighting against cravings for the 'drug' of her self harm.  That genie has to be put back in the bottle all over again.  Each new incident trails chaos and disorder in its wake, setting off the cycle all over again.

Her new psychiatrist in the outpatient team seems a very sensible chap, and he agrees with me that lack of sleep is a big factor.  Julie's classes start at 8.30 in the morning, so she is now rising before it is fully light, and will soon be waking in the dark.  Olanzapine has a sedative effect, which persists until the morning.  As distress has increased, it has become harder for her to get to sleep and stay asleep, perpetuating the cycle.  We have agreed with the school that for the rest of the term she will sleep late and arrive late. For the rest, we are focussing on keeping a healthy diet and making sure she gets out and about every day.  Thank heavens Joe is free from work at weekends to help!

This is the point at which my perspective differs radically from Julie's.  If you ask her what is causing the distress, she will list the approach of Christmas, an argument with her brother over the television remote, or the pressure of an assessment at school.  I would never dismiss these issues, which are all real causes of distress, but they seem to me more symptomatic of how fragile Julie is, than true explanations.  If and when we resolve these issues, new ones will arise in their place: they are the background noise of anxiety.  Each one has to be looked at and plumbed for what they mean to Julie, but they are all issues that arise from normal life, not extraordinary in themselves.  All of us have issues like this every day, and most of us can process them quickly and efficiently by having a cup of tea, going for a walk, or a good night's sleep.  Julie cannot.

My perspective would be familiar to mothers the world over.  If she gets enough sleep, some exercise each day, regular meals, and something to make her laugh, I think she will eventually overcome the cravings.  She will then have a fighting chance of tackling her demons.