I Understand Now Why People Cut Themselves

I was supposed to go to work today.  I got up and got ready with every intention of going.  I even went to my PT appointment, which was at 8 AM, so I could get to work sort of on time.  I left PT, turned my left turn signal on, then switched to my right turn signal and came back home.  I work PRN as an occupational therapist on the inpatient psych units of a general hospital. PRN means 'as needed': I am the substitute for whenever anyone else is off.  It comes out to between 1/3 and 1/2 time, which is usually just right for me.  

It is a problem, though, when I am scheduled to work 4 days in a row, like this week (my husband doesn't work Mondays, so neither do I).  By the end of the work day yesterday, I was fatigued, but I went and did my grocery shopping, because I don't have any other time I can do it.  Besides the fatigue, I had a very annoying pain that I just started getting about a month ago.  It is in my arms and back, like the achy, gnawing feeling I get when I have a fever.  I didn't sleep well last night, and still have the fatigue and achiness this morning.

When I got home from PT, I went back to bed for about an hour.  I didn't sleep, but I was able to relax my muscles and mind.  While lying in bed, I started thinking about our patients who cut themselves on purpose.  Some say that it helps them refocus away from their other pain (usually emotional pain).  Others say that they feel numb, and cutting themselves makes them feel alive, able to feel something.  I have accepted their thinking, even though I never really understood it. 

This achiness I have is not strong, but it is unrelenting.  I am constantly aware that it is there, and I thought, "If I cut my arm, I can focus on that, instead of this constant gnawing in my arms and back."  I would just have one, specific area of pain, with an identifiable cause.  I would not actually do it, because I know that cutting myself would not get rid of the achiness, it would just add to my woes.  Having this thought, though, did help me to understand my patients better.

Having one real cut to focus on is manageable.  Having pervasive, unrelenting pain from an undefined source (physical or emotional) can be overwhelming. The impulsive thing to do is to make that cut.  The logical thing to do is to recognize that the cut does not make the other pain go away, it only masks it for awhile, by being a more intense and attention drawing sensation.  If the original pain is not dealt with, the pain from the cutting eventually goes away, and the urge to cut returns.  

I have found that movement helps to calm the achiness for a few minutes, so frequent stretching and position shifting helps.  Sitting and typing allows the achy parts to remain basically motionless, so I should end this post, and do something more active.  If I keep busy, I am less aware of the pain.  I talk with my patients about what they can do when they have the urge to cut.  For some, the urge is so strong, they feel they can't resist it.  For others, often, the key is keeping busy, distracting themselves from the pain.  Ultimately, though, the source of the pain must be dealt with, in order to resolve the pain.