Friday, July 14, 2006

Making the cut.

An expression in common parlance among those who favour what Sam L Clemens allegedly termed "A good walk spoiled". It's something to do with surviving the first few rounds of a competition so as to be allowed to play for the title / prize on the last few days I gather.

It's also what brought Carly to the surgery yesterday. Not that Carly, in all her fifteen years on the planet to date, has ever, in so far as I am aware, been near a Niblick. The problem with Carly is cutting. Specifically, last weekend she wanted to go out late. Mum and Dad said no, so she stropped off upstairs, took a glass fragment, and used it to carve a succession of parallel lines in her left forearm. It now transpires she has been doing this on and off for the past six months, often as a "social" activity with a mate of hers who finally "outed" them both to her own mum last week.

So here are mum and Carly. Carly wondering what all the fuss is about. We tend to label cutting, along with overdoses of tablets and booze, and breaking things, as "acting out" or "attention seeking" behaviour, but the present attention is plainly not what Carly was looking for. In the whole consultation (which lasted nigh on twenty precious minutes) she probably uttered no more than half a dozen words and offered a few disconsolate shrugs. I never got to see her eyes from beneath the brim of the baseball cap that stayed firmly welded to her head throughout. It's safe to say rapport was not established, and not for want of trying. I even asked mum to step out for a few minutes to give her a chance to express heself, but she was plainly disengaged and even talk of psychiatric referral didn't really bother her.

I did manage to get a look at her arm. Five days on there were four very neat, very faint lines on the inside of her forearm. They are healing fine and were never deep enough to leave a permanent reminder. Unless she has been very lucky it looks like Miss Carly knows just how much pressure to apply not to leave a scar. And if her friend hadn't said anything I'm not sure mum would have been any the wiser. But now we have a dilemma.

Mum has freaked. Her little girl is carving herself up which "can't be normal" and Carly won't talk to either of us to help figure out if she has a problem or not. I actually suspect not, but with nothing more to go on I have had no option but to accede to mum's request for a specialist referral.

Many primitive cultures have rites of passage way more painful than anything Carly has so far attempted. If Dan Brown is correct grown men and women practice self mortification now in the name of faith every bit as much as in the Middle Ages. All Carly and her peers have to look forward to is the cringeworthy American import that is the High School Prom. I'm sure in America they are fine, no, hold on, actually I'm not, but that comes from a prejudicial view fostered by the media, and the envy of someone who is the product of an all male education,but the thing is, watching British kids trying to be American is every bit as painful for us parents as it must be for the kids.

It is just possible that Carly, her mate, and the many hundreds of other teens engaged in similar rituals are inventing their own rites of passage. I'm just not sure whether the speciallist referral is an integral part of it or not.

What I do know is that Carly has now made the cut, and is progressing to the next round.


Geena said...

Yeah but what exactly is the next round? Drugs?

No - America has a lot to answer for, and the idealistic society they portray on TV and movies is so far removed from reality it is frightening..I grew up with a lust for America..and when I finally got there, in 1994, and travelled and lived with Americans and tasted their lifestyle...I was disappointed and sickened right down to my core..they are unnnaturals twats, all of them. Life for an American is life anywhere else. Same problems, same social injustices..same governmental need to be weaned off the crap that is offered up for daily consumption on TV.

*Ahem...on a lighter note...long live France and the deelishuss wine and cheese they produce..and long live men and their Johnsons...*


I probably made zero nada silch sense but there you have it..Sunday night and life is alright....

oh bloody hell the WV is mad today...

Doctor Jest said...

Geena-- Do I detect the effects of Marvin Gaye style healing at work. Now aren't you glad you touched the screen when you did. It's ok though, no thanks necessary, it a gift you know...

Re Carly, I doubt very much that we shall be reaching for chemicals very soon. A session or two with a competent psychologist (as much for Mum's benefit as for Carly) should start to work things out. If only they can get Carly to engage....

I did check in at your place. With all that oestrogen flowing I didn't feel equipped to offer a comment, but, as they have it "Down Under", good on ya'.

Geena said...

I shall regularly touch the screen - its amazing....thanks ever so much.

Shinga said...

Cultural shifts can influence the availability of drugs for various conditions - e.g., Paxil for social anxiety disorder. So, I like the idea that cultural shifts should be allowed to re-define what has been accepted as pathopsychology.

However, when it comes to cutting, eek! I have a squeamishness that it based on nothing more than prejudice - which is a reflection of the cultural attitudes that prevailed during my time.

Again, nicely observed on the baseball cap and lack of rapport. Caps and hoodies, mono-syllabic sullenness with the shoe-gazey routine - so familiar, so heart-sinking.

Regards - Shinga

Anonymous said...

Cutting is a wee bit off putting. Back in the day I had a cutter friend. We hauled her into the shrink. Kicking and screaming, three teenaged girs and a poor driver guy. Not a good time.

Was she looking for attention - kind of but not really. Did she do drugs- yes. Alcohol- yes. Sex -yes.

Lots and lots- and then one day she quit and turned her life around and is an amzing woman with a charmed and magic life.

Was it the therapist- hardly. He was an idiot and a nasty man who really had no time for the "foolishness".

Her mom and her friends and her will to succeed made her better.

She was brilliant, and like the canary in the coal mine, her behaviour was a response to dangerous conditions in her life.

Why oh why do we turn kids over to experts when what they really need is someone close to them to give a real live care??? Parents often send their kids to shrinks because they want their kids fixed- not because they want to fix whatever is breaking their kids hearts.

Because it might mean they have to change.

Mom needs therapy, dad needs therapy, and everyone needs to get together and care and do for each other. Be mad, be sad, be happy, but be REAL!!!

Don't pay experts to fix something that you broke without owning up to your part in it.

I am now working with 17 year old kids whose parents have abdicated the parental throne, and these kids are a MESS!! Quitting school, doing drugs, having sex, drinking, and whatever else you can think of. I want to take them all home with me and fatten them up with real food and love.

I just do not get how messed up people are. I just work with my own kids the best I can, and try to make it so they do not have to fill a void in their life with poison and hurt.

Doctor Jest said...

shinga-- there's cutting and CUTTING. Carly fits in to the former group of relatively trivial superficial "scratching" in reaction to any disappointment. Those capable of more significan self immolation for much more complex reasons terrify me. But there does seem to be an emerging trend for "group cutting" as witnessed by Carly's experience which is more a learned behaviour than a real purposeful action.

Anon-- I cannot but agree with everything you say, excepting the minority in whom such behaviour is part of a broader and more obvious pathology. The trick is in knowing where the threshold between *frustrated behaviour* and *illness* lies. As with so many "Clinical signs" there is a spectrum which would see patients like Carly closer to the trivial end if such a word is ever appropriate in such circumstances.

IntelligentLayPerson said...

Hrmmm. Blaming the parent. Yes, that's the way to go. *rolls eyes* When a child is an olympic athlete we give their parents credit. When a child has problems it must be the parents fault. Get real, parents need MORE resources. I was the only person who took my child serious. She pushes me as far as she can push me. It's always been that way, it's her personality flaw. She admits it's due to boredom sometimes and goes as far as to apologize when she comes out of her spoiled blind tantrum.

I'm not supposed to react, I can't give her the verbal candy she wants, the confirmation of her self hatred. It's awful, but we work through it.

Yes the parents of cutters need therapy, but it isn't always because it's their fault. The simple fact that a parent is willing to go to therapy, willing to give what it takes to help their child shows what sort of person they really are.

As for parents that have abdicated their parental rights. Maybe it's possible there are other kids in the house witnessing the abusive behavior that can come from their siblings.

Sometimes a parent has to parent from the bottom up.