Whatever the problem, self-harm or drugs are never a solution

YOUTH IN FOCUS: My best friend is quite stressed nowadays since we are in class twelve and lately she has been hurting herself. She has little scars all over her arm and I’m very worried for her. She says she wants to die and that she enjoys the pain. She said she’d kill herself but she said that she didn’t have the courage to do so. I try cheering her up but I don’t know if it helps. I need advice and I feel that Lama will be able to help her.

Concerned friend

Well, concerned friend, it is wonderful that you are caring for your friend, and I hope that the information below will be of some help.
Self-harm is actually a way of coping with problems. Obviously, it is ineffective as a solution, but it gives a kind of high and so acts like a drug, and is similarly habit forming. It is not usually an attempt at suicide.
There is no single reason for someone to harm themselves, but from my experience I would say that these are some of the main triggers:
Stress due to parents’ unreasonable expectations,

Self blame associated with guilt or perceived failure,

A breakdown in parent’s or personal relationship,

A deep sense of frustration with no obvious way forward,

Guilt from having suffered sexual abuse.

Actually, your friend will require a lot of support to regain her stability, and her parents are in the best position to offer the kind of help she will need. However, they should be nonjudgmental and certainly not angry or hysterical. Instead, they need to reassure her that they just want to understand and help. In this way, even if she is initially unwilling to discuss her problems, she may slowly open up. If her parents are closed-minded, then perhaps the school or hospital counsellor can speak to them. Otherwise, she can identify a trusted aunt, uncle or elder member of her community to be her mentor.
In a modern urban environment, the old-style parent who doesn’t talk to their offspring about emotional problems doesn’t work. The new generation of youth require elder family members to act more as wise friends rather than authoritarian figures.
In this respect, your friend’s parents need to be there for her. In particular, they should be home in the evenings, helping her with homework and chatting about her day’s experiences. They should also have fun times together.
Anyway, to deal with the issue effectively, the underlying causes need to be explored and she should speak out and not suppress her feelings. Furthermore, as she is expressing suicidal thoughts, I strongly recommend that she seeks help and advice from a professional counsellor (Psychiatric Ward, JDWNRH).
In reality, all human beings suffer with basic anxiety. It is a condition of human life, but rather than face the causes directly most of us try to escape the symptoms, and we often do so in unskillful ways, such as drinking heavily, taking drugs, having outbursts of anger or self-harming. Actually, running from our fears is like running from a pack of dogs. It doesn’t work, because they will just follow us.
In this respect, we need to understand that problems do not go away until they have taught us what we need to know. This is an important point. In a practical sense, this means that when possible we allow disturbing emotions to remain and do not try to escape them.
OK, I know this is a difficult idea to grasp and even harder to do, and so I’ll give an example. When someone criticises us, we feel a sensation in the body, right? Maybe there is a sense of emptiness in the chest, but most probably there is a feeling of discomfort in the head. Instinctively, we want to escape this feeling, and so we may shout at the person who said the hurtful words. Otherwise, we might take a drug or even cut ourselves. Whatever the response, it is ineffective. We can shout at all of Thimphu, but we will still be vulnerable to harsh words. We might even move to another town, but very soon we will again get hurt by someone’s comments. Likewise, taking drugs or cutting our body may bring some relief, but it is temporary. Soon the numbing effect will wear off, and we have to repeat the process.
Instead of endlessly escaping, it is better to observe the sensation in our head or chest. In this way, we do not indulge the thoughts, nor escape them. Like waves on the ocean, we let them rise and fall naturally. I know this isn’t easy, but through repeated practice we can slowly move from reacting and escaping to observing and letting go. Later, when we are calmer, we can ask ourselves why certain words hurt. If they are true, admit it. If they are untrue, then just let them go.
As an example, imagine that someone calls us stupid. We may feel hurt and try to escape. Now, instead of running away, we watch the physical reaction and later consider whether the comment is true or not. In reality, we’ll probably discover that we do sometimes commit errors, and so we could respond: “Yeah, I agree. I do make mistakes and I’m sorry if these have caused you trouble. I’ll try to do better in the future”. Take it lightly. Learn to be kind to yourself and accept that your weaknesses are as much part of your character as your strong points. Having failings doesn’t make you bad, but human.
Incidentally, if an emotion is too overwhelming to just observe, then your friend can consider healthy responses – such as going for a long walk or listening to music. Once she realises that she can survive a crisis without self-harm or drugs, she will be more encouraged to try watching a disturbing emotion rather than escaping from it. However, if she finds herself in a situation that is dangerous or abusive, she needs to get out immediately and seek help and protection.
I’m guessing that her anxiety maybe at least partly due to a family breakdown. If this is the case, try to reassure her that it is not her fault. She did nothing wrong. Whether we are rich or poor, super intelligent or not so intelligent, we will all encounter problems during the course of our life. Although some people obviously get more of their share of suffering, still everyone will at some time encounter pain, loss, blame, embarrassment and finally the grief of death. Joy and sorrow are like mountains and valleys. One cannot exist without the other.
Therefore, instead of trying to escape difficult situations, your friend should slowly learn to relax with discomfort and watch her emotions. If she can do this, she will no longer reach for a knife, drugs or whatever the moment she feels disturbed. Even though tough situations are difficult to accept they actually make us mentally richer and more kind-hearted, but we have to be open to the experiences for them to transform into something positive.
In realty, I wish I could give your friend a magic formula to clear away her sufferings, but unfortunately I cannot. Life naturally contains both pain and joy. Like being on the ocean in a storm, we cannot avoid the force of the wind but we can learn to sail the boat. In this respect, I suggest that she meet a professional counsellor at the hospital and, at the same time, learn to watch her mental unease and not immediately try to escape these feelings through self-harm, drugs or whatever.
Finally, she should also chill out more. I’m not suggesting that she becomes indulgent, but just have some harmless fun.  Request her to organise a hike for you and her friends. Take guitars and sing your lungs out.  This might offer a gap her pain and so allow her see her situation in a more open and clear way.