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Repeated self-injury: perspectives from general psychiatry

  • Leonard Fagin
Abstract

Patients who repeatedly injure themselves present particular management problems for general psychiatric teams. This article, the first of a series of four, examines the characteristics of those that present to adult mental health services, and the possible underlying background and trigger factors that lead to these anxiety-raising events. Suggestions are made on preventive and assessment procedures, staff reactions and management strategies aimed at helping patients deal with the overwhelming feelings that underlie self-injury.

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References
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Repeated self-injury: perspectives from general psychiatry

  • Leonard Fagin
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eLetters

On being non-judgemental

Ovais Wadoo, SHO
17 October 2006

I read the article “Repeated Self Injury” by Dr Leonard Fagin. It wasinteresting to read the response by Dr Md Ali Jaha wh argued whether we are really non-judgemental when dealing with certain patients who present repeatedly (for example people with borderline personality disorder or alcohol misuse).

The response of staff dealing with self harm depends as much on theirexperience as any other factors. A junior psychiatrist answering a desperate call on a Friday evening about a young man threatening to cut his wrist may give different advice than a senior clinician who knows this patient well (as stated in the article). So to know a patient well, especially when the patient has difficult and complex problems becomes all the more important. We know that information gathering is key to making any diagnosis or management plans. So the information passed by our colleagues proves to bevery important as it gives us the background of the patient, his past riskissues and previous interventions.

As doctors we must use our skills and competencies to make judgements(clinical not moral) to ensure that patient receives best possible care and that is not being judgemental. Being non-judgemental means "relating to or having an open attitude without implicit moral judgement".
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Adopting a non-judgemental attitude

Dr Md Ali Jahan, SHO, Psychiatry
23 June 2006

My thanks must go to Dr Leonard Fagin for his excellent article on "Repeated self-injury".

I have read many timesin relation to managing a self harming patient who is presenting very frequently to the ward or A&E - please be non-judgemental. But, are we really non-judgemental when seeing people who self harm especially with borderlinepersonality or alcohol misue problems? How can we be non-judgemtnal when dealing with such complex and difficult patients?

In many junior doctors' rooms, I have seen advanced notices regarding patients who present themselves very often to services, giving instructions from community mental health or crisis teams saying - do..do not..do..do not..contact..etc. In this situation, how can I be non-judgemental about the patient who is going to be seen by me? Is it not the case that we are blocking the emergence of new ways of dealing with apparently the same situation in future?

I understand that we should not have any set ideas about any person before seeing him or her, but if we deal with same patients over and over again with the same pattern of behaviour, then, what are the ways that can help us become non-judgmental? Is it a basic instinct that at the end of the day we really cannot be non-judgemental?
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