|
Making meaning
from tragedy
February
8, 2001
Author and
playwright Sharon Lefevre committed suicide in 1999. But her psychiatrist
Dr Phil Thomas listened attentively to her theories on self-harm.
By Adam James
.....
On September
10, 1999, Sharon Lefevre, a mother-of-three, hanged herself at her
home.
The local newspaper
in Dolgellau, North Wales, reported the death as a suicide by a
troubled woman who had a history of depression and psychiatric hospital
admissions.
What they missed
was that during the previous five years lefevre had made a dramatic
impact on the mental health scene, vociferously challenging orthodox
understandings of why people self-harm.
In her 1996
semi-autobiographical book Killing me Softly 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 violence and pain. Usually childhood sexual or physical abuse.
To be hurt was part of their identity.
Self-harm could
not be cured, argued Lefevre. Instead it should be accepted and
managed.
“Self-harm
is a way of relating to your past truth,” she wrote.
“It may
appear very negative but it is very positive. The language of self-harm
is keeping the person alive.
"For the
family or friend involved with the self-harmer this may be tough
and I can not pretend that it is not. The self-harmer can only ask
for patience and understanding from such people. Maybe even a little
compassion. But if it is too tough then so be it - for self-harm
is not curable," asserted Lefevre.
Lefevre’s
written contribution to mental health received little recognition
from main stream professional circles.
Afterall Lefevre
was neither a qualified practitioner nor an academic - but a patient,
diagnosed with borderline personality disorder, who when most distressed
would inflict terrible cuts all over her body.
But Killing
me Softly, graphic in Lefevre’s personal accounts of self-harm,
was embraced by many open-minded professionals brought up on dry,
clinical texts on self-harm.
Although Killing
me Softly did not offer a treatment, it gave readers insights into
the tormented subjective world of a self-harmer.
Above all Lefevre
pleaded professionals to reappraise their attitude towards self-harming
patients. Sometimes she pulled it off.
“Before
I read Sharon’s book I did not have that much sympathy for
people who self-harmed,” admitted Prof Christine Deane, Clinical
Director of Wolverhampton Mental Health Services.
“I saw
them as manipulative and difficult - people who I should not be
terribly nice to because otherwise they would keep on self-harming.
This is not an uncommon view in psychiatry.
“But after
Sharon’s book I could see the association between the pain
a child experiences from those they loved, to how inflicting pain
on themselves later on in life was the only way they had learnt
to love themselves. Subsequently I found that the best clinical
strategy when working with self-harm patients is to develop a relationship
with them and to like them as people. I enjoy working with self-harmers
now.”
However, perhaps
the most remarkable contribution Lefevre made to mental health was
the relationship she forged with Dr Phil Thomas, her consultant
psychiatrist at Gywynedd 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 her drama degree at Aberystwyth
University.
The drama, whose
aim was to expose the inadequacies of biological psychiatry, was
so intense and challenging it left audiences in tears.
On the Edge
of a Dilemma was the pinnacle of an extraordinary psychiatrist/patient
partnership unparalled in the history of mental health.
Lefevre first
consulted Thomas in 1995, five years after hospital admissions for
her acts of self-harm which caused upset to everyone - not least
Lefevre’s children.
“I will
never forget my first meeting with Sharon,” remembered Thomas.
“She was
surrounded by four nurses and was cutting herself. There was no
way we could stop her.”
Thomas, who
admits he “did not understand much about self-harm” felt
powerless to stop his patient from self-injuring.
“I had
no solution to Sharon’s problems, neither did psychiatry,”
he conceded.
“And Sharon
wanted something more than medication.”
However what
Thomas was able to offer was eagerness to listen.
He empathised
Lefevre as she decried psychiatry for being unable to relate to
her distress.
She complained
that previous psychiatrists interpreted her self-harm as attention-seeking,
and that the behavioral treatment programmes she had expereienced
were dehumanising and patronising.
Above all she
felt punished by psychiatry’s coercive powers which would only
increase her cutting.
“Initially
I did not see Phil as anyone different,” Lefevre revealed to
me in 1996 at a conference.
“I think
he thought, ‘Oh no! Not another bloody cutter’ But he
used to ask me what I thought about things. He would listen. He
did not patronise me and showed respect for me. He seemed to care
about me and my distress. He looked for my qualities.”
And when Lefevre
asked Thomas to perform in her play, he agreed.
“Performing
with Sharon in her play seemed the most constructive thing I could
do to help her. I would no longer be her psychiatrist, but a co-worker
on this project.”
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.
Lefvre took
the part of the patient, and Thomas the psychiatristst, and the
play revolved around the patient’s efforts to teach her psychiatrist
how to reach the suffering person behind the diagnosis.
Performed to
trainee psychiatrists and at 30 mental health conferences in the
UK and abroad, On the Edge of a Dilemma captivated its audiences
who knew they were watching important chapters in each of the performers’
own lives.
First Thomas
concerned with his profession’s blind allegiance to a medical
model.
And then Lefevre,
distressed and angry, but desperate to be understood.
Particularly
shocking scenes were when Thomas threatened to cut himself with
a razor blade in a naive attempt to understand the subjective world
of his self-harming patient.
And then when
Lefevre removed her shirt to reveal rows of disfiguring scars up
each arm.
“When I
performed the play in my own department there was a stunned silence,”
remembered Thomas.
“The professionals
all found it very threatening. It was challenging the kind of relationships
they had with patients”
Sadly however,
behind Lefevre’s confident and articulate public persona, remained
her deep-seated despair.
Everyone close
to Lefevre recognised she had struggled to find a way to resolve
her own abuse.
In 1997 Lefevre’s
informal support network was to disappear and she had to face her
hurt alone.
From 1995 Lefevre
had been supported in Wales not only by Thomas but her friend Ron
Coleman, a former self-harming patient who ran Handsell Publishing
which published Killing me Softly.
Thomas, Coleman
and Lefevre were united in their committment to promoting alternative
approaches to mental health practice.
Coleman and
Lefevre also ran self-harm workshops for professionals.
In hindsight,
Thomas and Coleman were sources of validation for Lefevre.
But when Thomas
left Wales to work in Bradford, and Coleman moved to Gloucester
Lefevre became more depressed.
And when she
was admitted back into hospital after cutting herself (her acts
of self-harm were never suicide attempts) Thomas was no longer at
hand to supervise her care.
It got to the
point that her daughter, Kelly, had to return from America to look
after her mother
“My mother
was left struggling about what to do,” says Kelly.
“She had
put so much hard work, artistically and personally into developing
the play, the workshops and her friendships.
“Over the
next two years I witnessed my mum being fobbed off from one place
to another and from one psyhiatrist to another. The consistency
of her health care dilapidated.”
But without
Thomas at hand Lefevre was eventually sectioned and compulsory treated
- the very thing Lefevre had always insisted was was contrary to
a self-harmer’s interests.
Prof Deane agrees:
“I have learned that that cutting and self-harm is not a suicide
attempt. If self-harm is seen as this and a patient is sectioned
and restrained they will get worse.
“Taking
control away from the patient worsens the condition.”
Nevertheless
Kelly blames no one for her mother’s death, and recognises
her mother was responsible for her choices.
But seven months
on she leaves an important message for providers of mental health
care.
Thomas, who
writes a regular column for MIND’s OpenMind magazine, remains
one of her admirers.
He insists professionals
should avoid restraining a self-harming patient, believing it is
“profoundly liberating” for professionals if they seek
to help in other ways rather than control.
“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.
“This may
mean discovering situations for the patient where it is less necessary
to self-harm, finding ways of self-harming that is 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.
Finally Thomas
accepts Lefevre’s argument that self-harm keeps the person
alive.
“Self-harm
actually kept Sharon alive for a longer period of time,” he
says.
“The reason
Sharon died was her great vulnerability. That was the tragedy.”
© Feb,
2001 Copyright Psychminded.
|
