a harm-reduction guide to cutting. (an early version)

This is a guide I’ve been working on for quite a few months now, and while I was going to wait until I had edited it further, added pictures, and compiled it into a printable format, I am presently facing imminent homelessness once again and so at the moment I have to attend to personal matters. That said, I do feel that the information presented here is important to have out there, so I’m posting what I have so far, and I will likely come back to this later. I am also asking that if you have any strong opinions about why this information is dangerous, or that I am “enabling” cutting, that you please don’t harass me about this. I’m dealing with enough as it is at the moment, and I don’t need people trying to shame those of us who practice self-injury on here. If you have any technical corrections though, feel free to let me know, and I will be sure to make what changes I can in the next version.

a harm-reduction guide to cutting:

DISCLAIMER: These are suggestions on how to be safe about self-injury from personal experience, basic first-aid resources, and advice from knowledgeable friends. I am not a doctor or a lawyer, and nothing included here should be considered professional medical or legal advice. I am simply compiling resources and sharing what I’ve learned through my own personal experiences with cutting. As such, be careful and consult a doctor if at all possible for any real medical advice. If you are currently experiencing related legal problems, please consult a lawyer. Use this information at your own risk. I am not promoting or disparaging cutting as a coping mechanism, nor encouraging people to start or quit cutting. I am not attempting to place any judgment one way or the other about cutting. This is simply a resource for those who currently cut themselves, as this information is scarcely available. I am not liable for what you or anyone does with this information, so please, handle with care.

Thanks to my friends Moira, Kennedy & Alexandre for helping out with many of the technical details & fact-checking, and to everyone who has helped me stay alive these past months. <3

Contents:

P. If you think you might be suicidal, please read this.

I. Introduction

II. Things To Know

(a) Potential Health Concerns & Warnings

(b) Legal Issues Surrounding Self-Injury

III. Supplies

IV. How To Cut Safely: A Step-By-Step Guide

V. In Case Of Emergency: What To Do If Something Goes Wrong

VI. Further Reading

Preface: If you are feeling suicidal, please read this.

While I am well aware that most people who practice self-injury are not suicidal, some people are and it is a very serious concern. If you need urgent help or resources, call The Listening Ear (u.s.) (http://www.listeningear.com/crisis_hotline.html) at 989-772-2918, the National Suicide Prevention Lifeline (u.s.) at 1-800-273-TALK (1-800-273-8255), or for queer/trans* youth The Trevor Project (u.s.) at 866-488-7386. I have no personal experience with any of these, however so I cannot vouch for their helpfulness.

- If you are feeling suicidal or have been considering suicide, let your support network (friends, family, partners, etc.) know right away what is going on, and what you need. Make sure you trust your support network, and make sure they will not report you to the authorities, as this can result in involuntary hospitalization or institutionalization which can sometimes only make things worse.

- Know your rights as a patient in your area, this is incredibly important, especially if you do end up hospitalized either voluntarily or involuntarily.

- If you are afraid you might end up killing yourself, make sure someone you trust is around you who can keep an eye out and give you any care you need.

- Make plans with your support network in case you seriously injure yourself, and figure out where you should go and what they should say ahead of time.

- If you don’t have a support network you can trust, consider going to a psych ward or emergency room as a last resort. If possible, ask around for recommendations first. If you are trans*, try to figure out which places have a reputation for being better with trans* folks, if there are any harm-reduction services available, etc.

For more in-depth resources around suicide, please check this out: http://thedistantpanic.wordpress.com/mental-health-resources/self-harm-suicidality/

And remember, it’s not your fault, and you don’t have to feel guilty. Being sick is an understandable response to living in a sick world, and mental disabilities often have no visible cause or explanation at all.

I. Introduction

My name is Amelia, and I am a poor, queer, neurovariant trans woman with psychiatric disabilities. I’m an activist, sex worker, and writer. I’m also a rape, abuse & physical violence survivor, a recovering addict, and I currently practice self-injury. At some point along the way, I realized there were no comprehensive harm-reduction resources out there around cutting, or at least none that were accessible enough to be found after spending hours and hours scouring the internet. The information and resources I did find, were mostly about how to quit, what cutting can be a symptom of, emotional support for people who practice self-injury (very important, but can only do so much), first aid for after you cut & emergency situations (which is important and I will also include in this guide), or what someone should do if someone they know is practicing self-injury. However, there was almost nothing on how to cut oneself safely, and definitely nothing simple, to the point, and readable. I am writing this guide to partially fill that gap, as I feel it is incredibly important to have this information available and accessible. I also believe it is important to have resources available from someone who has personal experience, as opposed to someone trying to guess or make assumptions about cutting.

II(a). Potential Health Concerns & Warnings

Know where your major arteries and veins are, and be sure not to cut over them. It’s best to avoid cutting near them altogether, if possible.

Be aware of where you cut, as it will leave visible scars. Self-injury is often criminalized, and fresh cuts can lead to involuntary hospitalization in some cases.

Some medications or drugs, such as aspirin, can thin the blood and inhibit clotting. It is important to be careful if you are taking such a medication as you can lose a lot of blood if you accidentally cut too deep. This does not mean I am saying you shouldn’t cut in this case, but that you need to be more careful and attentive when you do. It is a good idea to ask your doctor or pharmacist if anything you are taking is an anticoagulant. You do not have to give them a reason why you are asking this either, but if you are pressed about it, I would not mention that you are cutting. Even sympathetic doctors may be legally liable to report you, possibly leading to involuntary hospitalization. (In my experience, good doctor/patient relationships around self-injury involve some form of mutual understanding of not asking and not wanting to know.)

Here is a short list of common medications that are anticoagulants. This is not an extensive list by any means, and once again I am not a medical professional:

  • Estrogens
  • Testosterone
  • Aspirin
  • Acetaminophen (Tylenol)
  • Tagamet
  • Barbiturates
  • Pepto-Bismol
  • Some SSRI/SNRI medications
  • Some anti-anxiety medications
  • Some antibiotics & antiretroviral medications

Here is a more extensive list, but once again this is not professional medical advice:

http://www.rxlist.com/script/main/srchcont_rxlist.asp?src=anticoagulant&cat=rx-desc

Be aware of the material your blades are made out of if you have metal allergies. Most blades are made with stainless steel to my knowledge, but it never hurts to check.

II(b). Legal Issues Surrounding Self-Injury

(Due to knowledge & time limitations, I am only providing information for certain places in the u.s. However, much of the information here may still be helpful, even if you need to research the local laws in your area separately.)

Unfortunately, not only are many people’s lives criminalized, the ways in which we cope are themselves criminalized. This goes for self-injury too, especially if you have been previously diagnosed with a psychiatric disability or mental illness. Even if you have not been diagnosed, self-injury can be used as “evidence” to diagnose you with something, regardless of the accuracy of such a diagnosis. It is important to note that simply by being diagnosed with a mental illness or psychiatric disability, many assumed rights become quite precarious. Complicate this with existing forms of institutional racism, disablism, transphobia, sexism, ageism, etc., and it becomes extremely difficult to secure and maintain your legal rights in practice. That said, there are many things you can do to protect yourself and others legally, and the more you have to work with, the better.

General Info:

At least two (in all but a few states, three) forms of court-ordered “treatment” are allowed by state laws. States use different names to describe each, but they all mean pretty much the same thing. They are as follows: emergency hospitalization for evaluation (or, “psychiatric hold” or “pick-up”), civil commitment (inpatient), assisted outpatient treatment (outpatient commitment or mandated outpatient treatment).

Psychiatric hold or emergency hospitalization is typically a short period of incarceration in a mental health facility, usually for a few days.

Inpatient civil commitment is where a judge orders someone to be incarcerated in a hospital or mental health facility for a longer duration, typically up to 90 days.

Assisted outpatient treatment (AOT), is where a judge orders someone to an involuntary treatment plan that they must adhere to, but without direct incarceration in a facility.

The criteria for these all vary from state to state, and it is important to know the laws in your area, and what your rights are there.

Illinois specific:

I am including more specific information about the state of Illinois, because it is currently where I reside, and where this guide will likely be distributed at first. In later versions I may make, I hope to include information about the laws in each state.

Illinois is one of 27 states where involuntary treatment is based on a person’s “need for treatment” rather than the likelihood of being dangerous to oneself or others. While this may sound like an improvement, the criteria for a “need for treatment” is much broader and more open to interpretation by a judge. What this translates to in practice, is a disparity in the sentencing based on the judge’s personal racist, transphobic, & disablist biases. In other words, it means for many of us, that we’ll be more at-risk because judges and cops are assholes.

It is extremely important to note that resisting or refusing to be transported to a mental health facility by a police officer for evaluation or admission may result in arrest and criminal charges. This means, that even if you are unaware of why you are being taken in, or if you are being taken without warning, you cannot legally resist. Unfortunately, there’s not much that can be done in this situation other than try to keep track of who is taking you, what they have done to you, etc. should you wish to report any violations of rights or police brutality/misconduct. It should also be noted, that psychiatric hold in Illinois is currently for 5 days. During that time, you will be subjected to psychiatric evaluation to determine if they think you need an extended stay.

There are certain criteria however that must be proven for incarceration in a mental health facility, no matter how dubious the claims may be. Knowing these can help fight involuntary incarceration in court, and help to prevent giving them ammunition to use against you.

For inpatient treatment, a person must meet the following criteria:

  • be a reasonable expectation of danger to self/others
  • be unable to provide for basic physical needs so as to guard against serious harm without the assistance of others, or
  • refuses or does not adhere to treatment, unable to understand need for treatment, and, if not treated, reasonably expected to suffer mental or emotional deterioration and become dangerous and/or unable to provide for basic physical needs

For outpatient treatment, a person must meet the following criteria:

  • in the absence of outpatient treatment, meet criteria for inpatient commitment; and outpatient treatment can only be reasonably ensured through court order; or
  • mental illness left untreated reasonably expected to result in qualification for inpatient commitment, and has more than once caused the person to refused needed outpatient care.

Additional Legal Resources & Guides:

http://www.equipforequality.org/resourcecenter/Involuntary%20Admission%20to%20Mental%20Health%20Facilities%20in%20Illinois.pdf

http://www.equipforequality.org/resourcecenter/Mental%20Health%20Self-Advocacy.pdf

http://www.equipforequality.org/resourcecenter/Rights_While_in_Mental_Health_Facilities_in_Illinois.pdf

III. Supplies

Some of these may not be available to everyone, however it’s a good idea to try and have some around if cutting is something you do often.

  • Gauze
  • Bandages (including elastic bandages)
  • Antiseptic (bactine or 70%+ isopropyl alcohol are suggested. iodine can be used if nothing else is available, but be aware that they induce scarring and increase healing time. also, be sure to wash with soap and water if able.)
  • Alcohol wipes
  • Clean blades, non-serrated, preferably single-edge.

IV. How To Cut Safely: A Step-By-Step Guide

1. Wash your hands thoroughly.

2. Use a clean blade, and sterilize the blade before use with isopropyl alcohol (or, less ideally, iodine. if nothing else is available, use a lighter but be cautious as the blade will get hot.), then rinse it with water. Do NOT under any circumstances share blades with others, as diseases such as hepatitis and hiv can be transmitted this way. Even if you know the person you would be sharing with well, it is not worth the risk, however seemingly insignificant. Sterilization is not a perfect process either, and even if you sterilize your blades before sharing, diseases can still be transmitted. If there is absolutely no way to acquire more blades and multiple people are feeling the urge at the same time, I would suggest finding or making a separate instrument and sterilizing that. (Once again, these are my personal suggestions. I’ve seen people get real messed up from sharing needles, even after they tried to sterilize them. A couple folks I used to know got hepatitis that way.)

3. Wipe the skin where you intend to cut with alcohol wipes. Ideally, start from the center and wipe outwards in circles.

4. Make a shallow incision(s) on the surface of the skin horizontally, not vertically. It is best to keep cuts to the bare minimum necessary for your desired result.

5. Pad the area gently with gauze or a paper towel to soak up some of the blood, if desired. If the cuts are minor, it is okay to just let them bleed for a little, but be wary of accidentally getting blood on your clothes, as it can stain and can bring unwanted attention and awkward questions. (I am speaking from personal experience here. It can also draw police attention depending on where you are.)

6. Once the cuts stop bleeding, wash with soap and water, and clean the wounds with an antiseptic such as isopropyl alcohol. This only applies for smaller wounds. If a cut won’t stop bleeding, read the section on bleeding in the next part of this guide. (As I’ve stated before, iodine or hydrogen peroxide can be used, but will induce scarring. I have used all 3 of these, and there is a notable difference in scar visibility.) If bleeding persists and does not stop, see the section below about emergency aftercare.

7. Apply bandages over the wound(s). Keep bandages on at least until the bleeding stops, and allow time to heal.

VI. In Case Of Emergency: What To Do If Something Goes Wrong

As with everything, mistakes are sometimes made. Cutting is often a very emotionally charged, intensely intimate act. It’s easy to get caught up in the moment and cut too deep, in the wrong place, with the wrong instrument, etc. Things happen, and I too have messed myself up something fierce. That said, it’s important to know what to do when things go wrong.

Tips for calling 911:

Often, calling 911 can make things complicated, especially for criminalized means of coping. It is important to know your rights, and it is important to make sure to have support. One thing to keep in mind, is how you speak to the operator when you call 911. Ideally, you want to keep calm, and try to not have a lot of noise or yelling in the background. If an emergency situation comes off as having potential for violence or anything else deemed criminal, police will also be dispatched which is what should be avoided. It may be a good idea to tell them that your friend has passed out or had an accident, or something similar but that it’s urgent. You do not need to say if self-injury or drugs are involved (though, once the paramedics arrive it is important to let them know of any drugs in the person’s system).

Shock:

Sometimes, severe cuts or other injury can cause your body to go into hypovolemic shock. Shock is life threatening and can kill you. If you think you are going into shock, call an ambulance. Shock tends to make itself worse, so it is critical to get medical attention quickly.

Symptoms of shock may include:

  • confusion, restlessness & irritability
  • dizziness, faintness & nausea
  • pale, clammy, moist skin
  • hypothermia
  • cold & mottled skin, especially in extremities
  • rapid breathing
  • rapid, weak pulse

Treating shock:

  • Call 911
  • Lie down
  • Control external bleeding (see below)
  • Try to maintain body temperature. If you notice you are experiencing hypothermia, try to cover yourself with a blanket or something similar.
  • Do not eat or drink, even if you feel thirsty which will be likely.
  • Do not raise your head.
  • If possible, try to keep your legs elevated about 12 inches.

Bleeding:

If a cut won’t stop bleeding, first try pressing cloths, paper towels, or any sort of substitute bandage directly on top of the wound. Then, place a large object (like a balled-up sock) over the bandage, and wrap the entire thing tightly in an elastic bandage (or, if not available, gauze). Keep the wound above your chest and check in about 10-15 minutes. If it’s still bleeding, re-wrap it and go to an emergency room.

Infection:

Infected cuts are a big risk should you be unable to keep cuts or wounds clean. This applies to small cuts and wounds just as much as larger ones that may need stitches. That said, infection can be easily avoided under most circumstances.

If a cut or wound is infected, it will likely show some of the following:

  • Redness
  • Swelling
  • Drainage & Pus
  • Local Fever (meaning that the cut will feel hotter than areas around it)
  • Increased or Sustained Pain
  • Bad Odor
  • Not Healing

Should an infected wound go untreated, it may end up becoming a full-body infection, which can cause serious problems and needs immediate medical attention. Warning signs for a full-body infection are:

  • Fever (over 100°F)
  • Nausea
  • Aching

Those with decreased immune function should take extra care to prevent infection as you will be at higher risk. It is important to change wound dressings (bandages, cloth, etc.) daily, and wash your hands and the wound before touching the wound or applying dressings each time. If a wound gets infected, try to find antibiotic ointment of some kind (which you can get at most drug stores or some supermarkets.) If you develop a full-body infection, oral antibiotics should be taken (unless you have an allergy or they will cause complications for you). That said, it really is best to see a doctor or go to the emergency room in this case, but I also know that far too often it’s just not feasible, especially without a stable income, housing, or insurance. So please, take care of yourselves and don’t let something go too long without help if you can help it.

VI: Further Reading

http://healingselfinjury.org/resources.html

http://theicarusproject.net/files/hurtingyourself.pdf

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