Self-harm or Self-care?

TRIGGER WARNING: suicide and self-harm

As I have already indicated in earlier posts, I’m not very good at self-care, but over the years I have proved to be exceedingly good at self-harm, whether emotional, psychological, spiritual, or physical.

It might sound a tad silly, but one of the challenges when it comes to my engaging in productive self-care is that I’ve never been very good at any form of self-care at all, even when friends tell me what I should be doing.

It’s not all bad though, hauora has discovered me and I love it.

Seems a long way back now – around 2003 – that I had the misfortune to be prescribed fluoxetine hydrochloride by my GP. I blame Cushla because it was her idea to get medication to enable me to sleep through the night. Blaming Cushla is a hugely unserious (and unfair) quip even though it was her kindness that set this part of my journey in train. Without Cushla’s interventions I’d have been gone a long time ago.

Finn was around eighteen months old and still feeding from Cushla (this in itself is another story) and I’d taken it on myself to be the night watch. He’d wake up, I’d get up, change him, and give him to Cushla for sustenance, then I’d go online until the feeding was done, change him again if needed, and, usually, we’d then watch The Lion King until he was ready for sleep. We didn’t know about his autism at that stage but, in the light of what was to come, it all makes sense.

After weeks of this I was a bit of a wreck – full time job, two master’s papers, and this night activity on top of the rest, and Cushla decided that she could do the night shift, and I could sleep. Nice idea, but when Finn woke so did I so the plan didn’t work, in part because I liked looking after him and doing my bit. It was fun.

Next came the suggestion that I see my doctor and get some meds to help the sleep process, which was also a good idea, so I did just that. My doctor was great. He’d guided me wisely through the process of finding appropriate counselling to address my childhood sexual abuse (not a family member) that became the backdrop to my transition, and he was just as careful with this, making sure that the meds he prescribed didn’t react badly with my hormones and blockers. Having don’t his due diligence on my behalf, he prescribed Fluoxetine Hydrochloride.

Fluoxetine Hydrochloride is sold under the brand name Prozac, among other names too, It’s an antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class used for the treatment of major depressive disorders, anxiety, obsessive-compulsive disorder (OCD), panic disorder, premenstrual dysphoric disorder, and bulimia nervosa, none of which I had to any great degree. It was also approved for treatment of major depressive disorder in adolescents and children eight years of age and over.Again, not me. It has also been used to successfully treat premature ejaculation, again, not me. It’s also a relaxant so was seemingly logical for those, like me, with minor sleep concerns.

Fluoxetine is taken by mouth which made it really convenient for someone, like me, a person who has a deep love of, and long history with, needles. 

Some of the common side effects of Fluoxetine Hydrochloride include loss of appetite, nausea, diarrhoea, headache, trouble sleeping, dry mouth, and sexual dysfunction. Headaches and dry mouth, for sure. No real issues with the rest, but it was odd to find ‘trouble sleeping’ on the list.

The more serious side effects included serotonin syndrome, mania, seizures, an increased risk of suicidal behaviour in people under 25 years of age, and an increased risk of bleeding.

I’m not under 25 and I wasn’t then, but I certainly experienced an increased risk of suicidal behaviour, from taking Fluoxetine Hydrochloride, and also an increased risk of bleeding which, though Prozac-related, was entirely self-inflicted.

The list of side effects has been updated since 2010 and this is a very good thing, because, before that, there was no mention in any of the pharmacopeia of an increased risk of suicidal ideation or behaviour. The idea that anyone with a brain would knowingly prescribe a drug that increased the risk of suicidal thoughts to a young person who was depressed and suicidal anyway is beyond belief, but that’s exactly what was happening.

Two friends lost teenagers in exactly this manner.

It’s my understanding that, at that time, the available pharmacopeia didn’t define what the psychological side effects of these drugs were. I recall sitting for extended periods with my doctor as he pored over those fat pharmaceutical tomes ‘just to be sure’. The negative side effects were known but couldn’t be clinically proven so publicising them risked costly litigation hence these serious, sometimes fatal, risks remained lurking in the shadows, reliant on medical gossip for their promulgation, gossip that my doctor simply had not heard.

For some young people and their families, this critical updating came way too late.

My subsequent personal research – also too late – revealed that Prozac had a troubled history, a history of exacerbating mental health challenges, especially in the area of suicidal ideation.

I am a suicide survivor but, by 2003, thanks to my transition and my settled family life, this had ceased to be an concern for me. Had I known, however, I might have seen the ‘danger Will Robinson’ red lights flashing and suggested to my doctor that we look around for an alternative.

Initially, my issue with the drug wasn’t related to my own mental health, but it quickly became one.

We had a new baby; I was doing two papers for my master’s and had a full-time job. The negative impact of the drug on me, and as a result Cushla and Finn, added another serious issue to our existing challenges. Cushla’s suggestion that I get medication to help me sleep through the night while she took care of the baby was a great idea, but this otherwise ‘great idea’ had hideous and unintended consequences through no fault of ours.

The good fit between the drugs, my sleep, and a calm and happy family life that we had anticipated simply didn’t happen. After a couple of days, I began to seriously self-harm, cutting myself with a craft knife and other blades. I had never done this before. I became violent. It was awful and, on the advice of a friend, Cushla took out a Protection Order against me without knowing what that meant.

I did, and for weeks we were both entangled with a justice system that thought it was helping when, in fact, it wasn’t, it was making everything worse.

I was required to undertake 12 weeks of a men’s anger management course. I went to one and it was awful. The system didn’t – still doesn’t – understand gender identity and forcing me – a transgender woman – to spend hours sitting in a circle in a grotty little room with a dozen or so recidivist, violent, male offenders doing the course as an alternative to gaol was hell. I was sniggered at, flirted with, demeaned, and humiliated, and the probation officer in charge of the course was not in the least empathic to my situation and simply threatened me with the vilest consequences if I failed to front the following week.

Cushla came to pick me up after the session and found me standing on a motorway overbridge guardrail ready to go off.

I didn’t go back to the course.

My failure to attend resulted in threats to invoke the law – three months gaol – but the threats didn’t work. In situations like this I am usually compliant, but I simply could not go back. Even if I’d wanted to, Cushla wouldn’t have let me. Eventually the threats stopped, but the cutting didn’t.

Cushla and I were supposed to live apart. We did. For one day. We stayed together in our home and worked it out. She was amazing. So was Finn. I did my best. Court officers visited. I hid in the bedroom.

The courts insisted that we be evaluated so set us up with meetings with a lawyer. Evaluated for what I have no idea, but it seemed like a good idea, so we went. From memory we weren’t supposed to go together but we did. Cushla’s meeting time was before mine and it seemed to go well. She left, and I waited in the reception area alone. I told the receptionist who I was scheduled to see, and after that she ignored me. For ninety minutes. Every so often a man would come out of the office Cushla had been in, would look around the area where I was waiting, and disappear again. Eventually he spoke to the receptionist who gestured towards me. I recall he looked shocked, but he came over and apologised for making me wait.

I’m sorry, but I let him have it. Both barrels.

I accused him or being transphobic and ageist – he was expecting a man Cushla’s age (27) and not a 57-year-old tranny. He owned up to that which I thought was pretty cool. He said he had a lunch appointment so couldn’t see me now, which was fine by me. He suggested I make another appointment, and he pottered off to lunch. I never did make that appointment, so I guess what we’d had was ‘a meeting’. I have to admit he was likable. Pleasant even. Simon somebody. All lawyers are Simon, aren’t they? Private school Simon. It seems that way anyway.

Our paths have crossed often since.

A year or so later ‘Simon’ was elected chair of the Board of Governors at Finn’s school so, at every official school function we would meet and someone would introduce us. Neither acknowledged knowing the other – of course – but he always twinkled which was nice. As an ONZM I sometimes get invited to the same events he attends. Our eyes connect, and there’s always that twinkle.

I’ve stayed out of trouble since, well, the sort of trouble that would have seen me in his court, and now he’s even more important so I only see him on TV. He’s very lovely and I admire him immensely, but no apology ever for the serve I gave him in his chambers in 2003 when I was doped up on Fluoxetine.

During all that time, work was complex. The need to self-harm, to cut, was relentless. I was caught by my boss, in a toilet, cut, with blood everywhere. He cleaned up while I ranted angrily in my office. He found me a counsellor paid for by the university. I went once. The counsellor was an evangelical Christian and didn’t believe in people like me. Mind-numbingly stupid, but he gave me great advice during our brief meeting: ‘when the need to cut happens, draw lines on your body in red pen, if you need to, bandage first’.

Good advice. Rare from an evangelical. We shook hands and that was that.

The horror, the blood, the bandages, and the ideation went on for five or six weeks, By then I had over 1000 cuts on my body, our family was holding on by a thread but we hung in, we stayed together, all while we waited for the medication to kick in.

We trusted that it would kick in, that it would all work out.

It didn’t. It got worse. Much worse.

Fortuitously, a friend, who knew I was getting medication, phoned me at work and asked, innocently, whether the sun had come out. I said ‘no’ and her response was ‘go back to your GP. Straight away. You’re on the wrong medication.’

She was adamant. She’d been there. She knew.

Coincidentally, at the same time, a Time magazine was mistakenly delivered to our post box and in it there was an article from Australia about a woman whose circumstances were almost identical to mine. It was an eye-opener. Same drug. Same mindless cutting. Same outcomes.

I went back to my GP with the research I’d found. He was horrified. He instructed me to come off the drugs but not immediately as the drugs have a half-life and can continue working in the system for up to six weeks.

Good news, but not quite. I still had to wait.

It was the start, however.

I survived three serious suicide attempts, my body is covered in scars as a result of my actions and this ill-informed prescribing (not the doctor’s fault), and who knows what psychological damage has been done to Finn, to Cushla, and to me. We don’t talk about it. It’s over, It’s not fun, though, to come home from work to find your spouse at death’s door in a blood-soaked bed or perched on a motorway guardrail ready to go off.

So, when it comes to self-harm, I have a fairly good idea of what’s involved with that beast. I had never cut myself prior to taking the Prozac nor have I done so since, but there are a million ways in which poor self-esteem can impact the self, and society being a bitch all day every day can make you regularly question just exactly who you are.

I certainly have an extensive track record and plenty of knowledge and experience with all that. Strange to say, but I wouldn’t change any of it.

I would like to say that 2024 was a clean slate year but it wasn’t.

The periods of depression and confusion about who I am, and what comes next, have been exacerbated by government threats and the international situation as regards, transgender people. It’s been awful and it’s unlikely to get any better anytime soon.

We just have to gird our loins, hold hands, and fight for some sort of positive change.

It’s not going to be easy.