Column

From heartsink to hope

Rosa Hudson finds a change of attitude is necessary before healing can begin

Christine stopped in the doorway. ‘These are for you.’ She handed me a bundle of reprints on ‘deliberate self harm’ which she had promised me, papers that explain why Christines everywhere burn, cut and abuse themselves.

Twelve years ago neither Christine nor I knew about this. Together we have been on a long, rocky journey. We have not arrived yet because at twenty stone Christine often binges and vomits and still cuts herself when crises occur, but she now chairs the committee of her day centre and runs a self-help group for women who harm themselves and enjoys a hoard of nieces and nephews who adore her.

I met Christine in my first week as a GP here. She was a ‘heartsink’ patient, cause unknown, not understood, a source of desperation for doctors in the early hours or after a busy day. Today she is a friend, mentor and champion for many with mental health problems.

It took a long time to find the key to Christine’s problem. Now, reading the papers she gave me, I can see the awful pattern she had got into. It took time to unravel, partly because Christine had so much fantasy and was so divorced from the terrible reality that faced her. We were unable to see her truth, hear her real cries for help. Instead we would try to keep calm. Some of us got very angry, and we had a tendency to feel there was little hope.

The answer came both slowly and in sudden leaps. Over time I consciously made an effort to turn her from heartsink to hopeful. Of course it was my attitude that had to change. I had to have hope in order to give her hope. I had to build my own defence against her tidal waves of distress, but with enough openings to let her in, to befriend her and to try to channel her energies in positive ways.

Six years ago, at a time when the floods of despair were controlled enough to make it possible, she revealed her truth. She told about her long term abuse by her father: physical, sexual and emotional. Letting this pain surface produced a deluge of cutting and burning but we patched up the wounds and hung on in there. The practice found it hard but we were all hopeful.

As a practice team our role is sometimes to provide a caring and stable substitute family with enough distance to keep ourselves sane but to nurture a person like Christine as they go through their pain. The therapist has a particular role but the team is the steady background of care. Looking back I see Christine’s behaviour no longer as the ‘attention seeking’ we felt it to be then. On the contrary, she was totally self absorbed, torturing and abusing her body because of what had been done to her. We, the doctors, were hardly noticed. By building trust, we could allow her to try out new relationships with us. Along with intensive counselling, this has allowed her to start to heal.