Wednesday, 7 December 2022

Some thoughts on self-harm

 Content/trigger warning: Mental health, depression, anxiety, self-harm

Is there a meaningful distinction to be made between direct physical self-harm such as cutting yourself and more indirect self-harm such as deliberately not looking after yourself (for example, not eating) or putting yourself in danger? Self-harm in general is taboo, but the former is what normally comes to mind when we think of people self-harming. The latter, though, also captures a huge range of damaging behaviours that can have long-term health impacts to at least the same degree as inflicting (direct) physical harm on oneself. And both undeniably amount to self-harm - at the risk of stating the obvious, not eating, exercising excessively or deliberately having unprotected sex with someone you know has an STI poses a great risk of harm and it is something one does to oneself. 

But something feels different, aside from the obvious, between the two. Generally speaking, I think we are less concerned if someone skips breakfast than if someone were to confess they were pinching themselves to cause themselves pain. To be clear, I do not mean to equate the two and suggest that somehow they are equally bad, merely to give one example of each where the magnitude is not widely different. Perhaps we would become more concerned if the confession was that someone skipped breakfast because they felt they did not deserve breakfast or to punish themselves or because they are actively avoiding looking after themselves. Even then, though, I still do not think we view the act in the same way, something intuitively (maybe it is just me!) feels less concerning - though, I am not sure it is. Moreover, our concern is also less with the action per se and more with the motivation, which then demonstrates some deeper underlying issue. We are then concerned about that issue and maybe even concerned because it might lead to what we feel are ‘worse’ forms of self-harm. However, if someone says they pinch themselves, their underlying motivation is less important - it already triggers a response that something is wrong here. 

Maybe not looking after ourselves is all too common, there are, often, a plethora of genuine and understandable reasons that can explain such behaviour. The same is not true of directly physically harming yourself. After all, we would not want to characterise every instance of skipping a meal as ‘self-harm’ even if, in theory, every time you do skip a meal, it is harmful to yourself. But even if we know someone is going through a difficult time, we are probably less likely to intervene if someone tells us they routinely skip meals but alarm bells immediately ring if someone tells us they cut themselves, even if the injury seems or appears trivial. It feels bigger, scarier. 

I am not sure that is right. Aside from the obvious (not looking after yourself is, of course, harmful and should, of course, be concerning), I think it perhaps misses something from our analysis of why people self-harm. I think there’s an ignorance about why people, say, cut themselves and, more specifically, why people who do not but engage in other forms of self-harm have ‘chosen’ (I use ‘chosen’ incredibly loosely here given the multitude of competing factors at play that often leave people feeling they precisely have no choice) not to cut themselves, or similar. To put it bluntly, cutting yourself hurts - obviously. But that is not (always) the aim of self-harm. Moreover, I think there is a misconception that somehow people who self-harm do not feel pain or feel pain less and that is (at least part of) why they are able to hurt themselves. Of course, some people do hurt themselves precisely because they want to feel something, their life has made them numb and where the intent is intense physical pain, not eating might not seem sufficient. However, that is not all cases of self-harm. 

Rather, self-harm has all manner of underlying causes and reasons. Some of the individuals whose self-harm manifests itself in not looking after themselves have tried but failed to, for example, cut themselves because it hurt too much. Because they still feel pain even though they want to hurt themselves. So they find other ways of harming themselves that allows them to avoid that intense, immediate pain. An individual might feel the emotions they are feeling are not adequately expressed by hurting themselves directly. Self-harm is not always about feeling pain. It can be emotional distress that prevents you from eating, for example. Or about punishing yourself and not with pain but by denying yourself food. Or about taking control of something, anything in this life and you cannot cut yourself but you can avoid food. Or maybe you just cannot hide the injuries so you choose to self-harm in a more hidden way. Or maybe you’re scared of yourself, you’re scared that you’re able to cut yourself so you force yourself to stop because it scares you and you fill the void left with something else. 

I guess the point is that the underlying reasons that motivate some to cut themselves, will motivate others to respond completely differently. The underlying reasons, the emotional distress or deeply overwhelming situations will not necessarily differ - our concern, equally, should not just because there aren’t bruises or scars or other injuries. 

Wednesday, 4 May 2022

The Politics of Judging

Something has been missed in all the furore surrounding the leaked Supreme Court opinion - and that is that it's completely mad that in any democracy the judges are picked by the president. Judges are supposed to be fearless arbiters of the law, unswayed by outside pressure and, crucially, independent of the legislature and the executive. They cannot do their jobs properly if they are beholden to outside interests nor will they be seen to be doing their jobs properly - as the old adage goes, judges must not just be independent but must be seen to be independent. Trust in the judiciary and the rule of law depends on it. Perhaps it's easy to worry about judicial independence when you live 4000 miles away and will never have the ultimate decision on whether to terminate a pregnancy. But it matters. And it matters not just because of philosophical principle, but because of precisely what's happening in America now. 

Some housekeeping. This is not a legal opinion. This is not an argument for or against abortion or even, really, about abortion. Yes, I know the opinion leaked is just a draft. No, I do not pretend to understand the legal reasoning for that draft opinion. Indeed, it may well be the correct "legal" decision. That's not the point. Instead,  ever since the court's balance swung back in favour of the conservatives, this decision (and, one fears, more like it) has been coming. The formula was simple: a State passes a bill prohibiting abortion contrary to Roe v Wade. The Bill is immediately challenged (as intended by the State) as contrary to the constitutional protections guaranteed by Roe v Wade. The law ends up before the Supreme Court who are asked to decide, in essence, whether Roe should remain good law. If it does, the State's bill is struck down. If it does not, Roe is overturned. 

In theory, this should not be a problem. A country's highest court should be the final arbiter of the interpretation of that country's laws. Leaving aside the merits of being able to strike down law and intepreting a codified constitution, if the law states that abortions are permissible it is the duty of the highest court to faithfully intepret and apply that law, interpret its boundaries and any limits etc. If individuals or organisations bring challenges against that law or aspects of it, those challenges must be given due attention and the arguments heard. This does not change whether the law protecting the right to abortion was judge-made in the first place (as in the US) or on the statute books (as in the UK). If a challenge was brought against the 1967 Abortion Act in the UK, I would expect the Supreme Court (or whichever was the highest court the appeal ended up before) to hear the appeal, the legal arguments and pass judgment in accordance with that legal reasoning. There is nothing, in principle, wrong with a court of law determining whether or not a law permitting abortion is good law.

Where the problem lies is when the judges sitting on the highest court are, with respect, not selected (just) because they are great lawyers and would be great judges, but (also) because of their political opinions. I am sure, as legal minds go, the nine US Supreme Court justices possess good ones but there is absolutely no denying that at least part of why they were picked is because they could be trusted to decide cases, when it mattered, in accordance with the picking-president's political beliefs. Those justices that Trump selected could be trusted to lean towards overturning Roe v Wade should the opportunity arise. Judge Jackson was selected, in part, because she considers Roe v Wade good law and supports a women's right to choose. This is not to undermine any of the justice's legal credentials - they are, I am sure, great legal minds as well as believing the correct things as far as the president was concerned. But that latter point is important. To some degree, their political leanings will have been part of why they were picked and picked by that president. There is a serious problem when one can predict, with almost certainty, how the court will decide a certain case based on knowing their political opinions and which party's president picked them. There is a reason why conservative-leaning States were so keen for Roe v Wade to be challenged under the Supreme Court as currently constituted: there is a 6-3 conservative, anti-abortion majority. 

Whichever way you slice it, the US Supreme Court cannot be said to be an properly independent instution committed to upholding the rule of law - because the rule of law demands that judges be independent of the political establishment, not picked by it. And that should concern everyone. Give it a decade or two and a few conservative justices ending their tenure under Democrat presidents and exactly the same case will be decided in the opposite way. The legal reasoning won't matter so much as the political leanings of the judges. That's not the rule of law. That's not an independent judiciary committed to upholding the law of the land and faithfully intepreting the legal arguments in accordance with existing precedent. Private political opinions should play zero part in how judges are selected. Judges with a well-founded reputation for upholding certain social policies or espousing certain political opinions should be excluded from selection for any judicial role, not actively courted (forgive the pun) precisely because of that reputation. 

Tuesday, 1 March 2022

The Mental Health Stigma

A broken leg is not the same as anxiety; a heart attack different from depression. Aside from the obvious, a more subtle difference presents itself. We know what to do when someone turns up on the tube in a cast (offer them our seat) or when someone clutches their chest and collapses to the ground (call 999). But if a friend started displaying signs of struggling with their mental health, many of us have no idea how to respond. We probably mean well, but it's not immediately obvious what to do. Being anxious does not just go away after a few weeks. Depression isn't cured because your friend bought you a stuffed animal. 

Part of the problem is, of course, ignorance. What having anxiety or depression or mental health issues means. How it affects people. How it comes in waves. How there's nothing 'wrong' one minute and then, all it once, absolutely everything is wrong. How what helped last time, may well be the worst thing in the world this time. How everyone experiences their struggles differently. How it's impossible, sometimes, to put your finger on quite what is wrong but dammit, somthing is wrong. And if you knew, you'd tell someone, of course you would, but you just don't know. When your leg hurts, you can point at it. Tell someone your leg hurts. But how do you explain that your brain hurts. That your mind hurts. That voices inside your head won't shut up or go away. That you do not feel anything or that you feel everything and that sometimes it's somehow both. At the same exhausting time. 

How are you supposed to help in such circumstances? I think it's a fair question. I don't have the answer. I write only as someone who has struggled, and continues to struggle, with mental health. Who has tried - and sometimes failed spectacularly - to help others with their own struggles. I know it starts with going easy on yourself. As someone struggling - you do not need to be okay all the time or even trying to be okay. It's okay not to be okay. As someone trying to help - making mistakes is okay. In my experience being there for someone is littered with errors, words said better left unsaid and actions done regretted almost instantly. Don't be discouraged. You never know when a hug offered makes the world of difference or a letter written changes the course of someone's day. Sitting in silence near someone is often the best thing you can do and requires nothing but time and patience.

If you're struggling, reach out. To me, to your friends, to someone. Or don't. Just know that you could. If that would maybe help. Especially then. But even if you're not sure. The world needs more people talking about their mental health. If you can manage it.