“THE FIRST time was a scratch, done almost without thinking about it. I had found a way to say: here, I’m suffering”.
Angela and Franca don’t know each other, but they are both just 13 when they start getting hurt. Sole, closed in the bathroom, secretly. Often when the parents are away, without there being a specific trigger every time.
Initially unaware gestures that gradually become rituals. We are talking about self-harm, acts done with the intent of getting hurt and facing the pain of the soul. A ritual that at the same time gives dependence, security and the momentary illusion of feeling better, of emerging from the darkness. A self-harm that often also includes severe eating disorders.
The bodies under siege of Angela and Franca become the external diary of the evil they feel inside, the battlefield that leads them both, just over thirteen, to attempt suicide.
This is their story.
In the audio documentary ‘No more scars’ we listen to the voices of Angela and Franca, collected by Sara Sartori, journalist and radio author, in collaboration with the doctor Arianna Terrinoni, medical director in the Department of Adolescent Neuropsychiatry of the Policlinico Umberto I Hospital in Rome, who followed and supported the two girls in their healing path.
A podcast that tells in first person, with sensitivity, what self-harm is, a growing phenomenon that increasingly leads the very young to seek death.
But the voices of Angela and Franca tell us above all how both, today, can tell what they went through from a different perspective, reached after having made a profound path of therapy that lasted several years, thanks to the help of specialists including the doctor Terrinoni, who explains to us: “Angela arrives in the emergency ward at the age of 13 and a half, with a first diagnosis of severe anxiety disorder. Franca is also still a child when she is hospitalized for attempted suicide, but in another facility. And when she is 17, she is taken to my office to start a new therapy. “
“When I talked to Dr. Terrinoni about my idea of making this audio documentary – says the author of the podcast, Sara Sartori – she identified these two patients because she thought they were able to expose themselves and tell their past with the right distance, also because I am now out of it. And when I met Angela and Franca, I realized that it was very natural for them to talk about what they had been through. The thing that struck me is that they were both aware that these things can happen to everyone, that there must not be a taboo. Talking about it was also a form of redemption for them, like saying “Here, I exist.” For this reason there are no experts or narrators, I wanted to make them completely protagonists, I wanted to try to immerse the listener in their world. The stories of these two girls accompany us in reflections and thoughts that seem to show us a way to go “.
As it was for Angela and Franca, many adolescents need help and specialist assistance, but throughout Italy there are only between 80 and 92 beds in Child and Adolescent Neuropsychiatry. Many regions do not own them and rely on pediatric wards or, even worse, adult psychiatric wards.
The Umberto I Polyclinic Hospital in Rome has been waiting for four years for the new Department of Adolescent Neuropsychiatry, already existing but still closed, to be finally made operational, with which eight beds could be added to the eight already operational.
Angela is now 21 years old and, as we hear on the podcast, she loves singing a lot. Franca is 19, she moved to the United States and wants to become a doctor. Both are still in supportive therapy, but they are fine and can tell about it.
Because getting out of it is possible if you are treated and for these troubled boys and girls there is a way to build a future. The important thing is to find the right therapy. The Department of Adolescent Neuropsychiatry of the Policlinico Umberto I Hospital in Rome every year helps dozens of young people to deal with these disorders.
Professor Terrinoni, how do you help these ‘fragile’ kids. What kind of therapy did you choose?
“For this type of patient we indicate and adopt DBT-A (Dialectical Behavoiur Therapy for Adolescents), the most used in cases of self-harm. The patient is initially ‘trained’ to follow non-dysfunctional behaviors that induce him to counteract the impulse that pushes him to hurt himself. The standard format is an individual therapy with the boy accompanied by that of a multi-family group. For us the goal is to put the young patient in a situation of protection and survival by learning to recognize his emotions, then if he will be able to follow other psychotherapeutic paths “.
What are the risk factors in this type of pathology? How to notice that the teenager is sick?
“They are subtle and non-specific diseases, often difficult to recognize. All self-harming behaviors are a serious alarm signal and may or may not be accompanied by sudden mood swings or a lack of control of emotions, such as impulsivity. a decline in school or a progressive social withdrawal must be kept in sight “.
Sometimes parents are unaware of self-harming behaviors
“Often boys cleverly hide their bodies with long-sleeved shirts in the height of summer or with rubber bands or bracelets on the cuts. They keep blunt instruments in secret places in the room or leave bloodstained pajamas or sheets. Everything must be observed and it could be a an indication of an attack on the body. Children in this condition lock themselves in the bathroom for a long time and refuse any kind of incursion by their parents into their rooms “.
There is a scientific definition of this attack on the body. After all, even in eating disorders one attacks one’s body by not eating or eating too much.
“In 1990, the Italian-American psychiatrist Armando Favazza defined self-injurious behaviors (Self-Injurious Behavoiur today NSSI) as destructive and intentional acts directed towards different parts of the body, without suicidal intent. They can be distinguished in direct forms, for example, through a razor blade or a knife, or indirectly through substance or drug abuse. Even self-induced vomiting can be part of these “.
How do you win the trust of these guys who often want to hide?
“We do not judge them. Accepting the symptom is part of the cure. If a guy remains completely silent during the visit, we try to make him understand that we are there to help him, that he / she is not a waste of time. It is his point of contact. view that brings us, and it is a moment that must be honored. In this way we happen to slowly open a passage and to be able to dialogue after long silences “.
Has Covid made things worse or has it just brought up problems already present?
“The coronavirus has certainly been a powerful accelerator and has also made some situations worse. The first wave was less problematic. Many ‘social retreats’ were very happy to be at home, but many young people slowly did not accept the lack of sociability. second lockdown was much heavier. Teenagers need mental regulators, so families, relationships, sports associations, which help kids build their days and structure themselves. Covid has pulled them into new and altered rhythms, it has expectations for the future have been lowered even more, precariousness and uncertainty have increased, and for many of the most vulnerable there has also been the problem of less access to care “.
How are the children’s days structured in your ward?
“Typically patients come via the emergency room to our ward after an episode of self-harm or in case of a TS or psychiatric acute illness. We try to favor their personal resources which will be the ground for a cure. Typically a hospitalization. it lasts an average of 15 days. Their days are timed out by various activities because we don’t just treat them as patients. They are mostly teenagers. They attend school lessons, go to the library, exercise and even go to the pool. Then there are walks in the neighborhood, games with Wi-Fi and, followed by an operator, can surf the net. Friendships are born at times deep. But there are also crises, impetuous, protracted; difficult moments. In any case we try to create an alliance with guys”.
Among the problems in cases of self-harm is that of emulation
“It is often a trigger factor that we must pay attention to and it is an effect that we know well even in the ward. If a boy arrives who cuts himself, we know that he could seriously affect the others as well. We try to explain to the boys the danger of these gestures. , but always with a non-judgmental approach “.
In this type of mental disorder there is a lot of talk about familiarity
“There is a genetic component, a greater biological vulnerability, but it is not only this. There are several factors and in particular the environment in which the child lives. If the child is not provided with proper emotional mirroring, between him and the child. he environment will trigger ever greater dysfunctions up to the structuring of a real psychic disorder. Traumas also play an important role. It should also be remembered that most psychiatric diseases begin in adolescence. The sooner you access the treatment and the sooner you can always manage this disease”.
When a boy tries to take his own life or voluntarily causes an injury, it is often referred to as a demonstration act. What do you think?
“In my opinion, there are no demonstrative acts. Often when adults catalog an episode of this type in this way, the boy repeats it and harms himself even more. We must be careful and interpret these actions as a genuine need for attention anyway. They should not be underestimated. We need to be close to these adolescents to care for and support them at a critical moment in their lives.
There is also a lot of talk about the effect of social media on these gestures
“In the past it was said that young self-harmer emulated emo, for their particular look, or wanted to identify with a Johnny Depp or an Amy Winehouse. Psychiatric illness, the over-the-top character, the ‘damned’, always have had a perverse fascination with children. Today the net offers everything: great opportunities but also ‘wrong’ models to follow, dangerous paths. Adults must monitor all this, become curious with them about this unknown world. Teenagers should not be forgotten in their rooms, because the network can be treacherous “.
How do you help parents?
“Parents must be educated and supported. They must be given a diagnostic restitution and provided with all the information on the usefulness of the drugs that always remain a frame of care. They must interpret the child’s self-harm according to multiple meanings. It can represent self-punishment. child, the inability to tolerate joy or sadness or simply, the inability to deal with boredom. It is difficult to cope with emptiness in a society where everything is organized. Often breaking free from childhood and growing up can cause a great disorientation. When a teenager tries to commit suicide he does it because he aspires perhaps to a second life or another chance. They must understand that they can imagine a possible future in their own lives too. Furthermore, the fascination of mental disorder must be fought. negative gives a stigma but can still give a shape: it is attractive yes but in the long run it is only destructive “.
.