Seeing the person behind the symptoms
February 9, 2001
Psychiatric nurse Ian Murray's method of helping people who self-harm is innovative - and some say controversial. He spoke to Adam James
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Ian Murray first encountered self-harm 21 years ago.
He was in charge of a community-based hostel for people with mental health problems when, one evening, there was an urgent knock at his door.It was a 19-year-old girl who asked Murray, a registered mental nurse, to attend to her 18-year-old friend who had locked herself in a bathroom.
On arrival, Murray saw a pool of blood seeping from underneath the bathroom door, behind which cowered the distraught teenager. She had cut her wrist.
To Murray's alarm he realised the other young woman who had come to his door had also cut herself.
Murray, who had by then worked eight years in psychiatric nursing, faced two choices. Either to bundle both of them in his car and drive them to the nearest psychiatric ward. Or take them to a casualty ward to have their wounds stitched.
Murray chose the latter - a decision which he believes helped prevent the vulnerable teenagers becoming "career" psychiatric patients.
"Rather than making a huge fuss about what had happened, the three of us later discussed what had happened informally and made a commitment to get their problems sorted," remembers Murray.
"It just did not make a lot of sense for me to go down the medical route and ship them off to psychiatric hospital. I think I did the right thing. Later, in what was a reciprocal act, the girls cleaned my front door step for me to remove the blood."
This is just one example from Murray's 29-year mental health nursing career documenting his working philosophy towards people who self harm.
He is scathing of traditional psychiatric hospitals which he refers to as "bins". "I would never return to work in one," he vows.
The 46-year-old Belfast man is disdainful of the medicalisation of distress, and the coercion and dehumanisation of patients which psychiatric care is, sadly, often criticised for.
An opportunity for Murray to practise his more "humanistic" nursing of self-harming patients came in March 1993 when for three years he was nursing manager at Dryll y Car Support Bed Unit in Barmouth, North Wales.
The unit, which over the years developed a reputation for its innovative care, attached less importance to a patient's diagnosis and the treatment of symptoms.
Instead more emphasis was put on relating to and engaging with the person behind the distress. This often involved finding ways of attending to traumatic life events, such as abuse, which lay behind self-harm and admittance to hospital - a fact supported by research at Dryll y Car which suggested 50% of its patients had been sexually abused.
During his time at the eight bed unit Murray supervised a change of role for psychiatric nurses - from less of a depot injector to more an "ally" of self-harming patients.
"The lesson I have learnt is that there is a human component [to self-harm] that must be taken into consideration," he says.
For Murray this involves finding a "common language" to support patients. One of Murray's examples is that of a 19-year-old who carried out extreme acts of self-harm. The teenager once revealed to Murray that it was his inability to express his experience in a meaningful way which caused him so much pain.
Later, Murray and the young man discovered they were both fans of American poet Ron McKuen. "The lad started to write poetry which we used to share together. It became a means of expression and started him on the road to recovery," recalls Murray. "Later he no longer self-harmed."
A second innovation at Dryll y Car was the inclusion of user volunteers into Murray's team. This led Murray to establish a network with those from the mental health user movement who appreciated the change of practice Murray was introducing into mental health nursing.
Subsequently, Murray worked with Ron Coleman of Action Consultancy and Training and the Hearing Voices Network, to produce training material for nurses.
Yet what may be innovation to some, is controversy to others - demonstrated by Murray's decision to work with Sharon Lefevre, a former self-harming Dryll y Car patient and author of Killing me Softly, a gruelling subjective account of self-harm.
Together they ran training workshops for nurses and other professionals examining the connection between voice-hearing and self-harm. The workshops featured Lefevre, a dramatist, simulating sex with a doll. While the performance was designed to reveal to professionals the sexual abuse which can underlie self-harm, critics said it was an extension of Lefevre's pathology.
Some, mainly psychiatrists, were so incensed they stormed out of some workshops. But, for Murray, his participation was consistent with his philosophy.
"The thrust of what we were trying to get across was how, as professionals, we view our clients. Too often we look for bad behaviour and symptoms. So often we refuse to see the person."
Yet Murray, now a CPN in Meirionnyd also in North Wales, remains dedicated to changing psychiatric nursing. He prefers to do this "from within" by adhering to the "basic principles of empowerment and support." "Medication does have a place but giving support to people is the significant thing that happens in normal society," he says. "In society we support each other to recover in reciprocal ways. That is what we should try and do in nursing"
Murray's workbook for working with self-harm patients is available from Handsell Publishing. Tel: 01452 380319
© Copyright Psychminded, Feb 2001
Thinking about you Ian
Self-injury Awareness Day – today! | FirstSigns
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SIAD is an annual international event to raise awareness about the difficult subject of self-injury, and although at FirstSigns we do just that every single day of the year, the 1st March is of course special to us.