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What I Wish Health Care Professionals Would Consider Before Dressing My Self-Harm Wounds

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I’ve touched on this subject before but I feel the need to revisit it. “Noncompliance” is something that is so widely accepted as a viable piece of terminology when talking about people who have any kind of physical or mental health difficulty and it’s one I don’t feel is really questioned enough.

Inherent in noncompliance is the unspoken implication that the medical professional has the definitive truth of what is in another individual’s best interest. Now of course a doctor or psychiatrist can assert their medical knowledge as superior to the person whom they are treating and can say from this perspective alone, that yes, they know what is considered as providing the best medical outcome based on evidence based practice. But I believe this is not the same as understanding what is in the best interest of an individual.

This is where I think true occupational therapy comes into its own. Occupational therapy aims to look at the whole person, not just the medical outcome. You may assert that having my arms dressed by qualified nurses is more congruent with evidence that points to the reduced risk of infection associated with professional driven wound management. But beyond this, do you consider the impact the treatment intervention you are asserting will actually have on me as an individual? Have you considered how the treatment makes me feel? Have you thought about how the time it takes up in my daily life may disrupt my routine and make it difficult to plan other occupations I find meaningful? Did you consider the cultural implications of your suggested treatment? When independence in our society is prized as the goal, how may being dependent upon a service again affect my esteem? Have you thought about how my role as a patient may shape my self-concept when I’m working hard in therapy to construct an identity outside of my use of services?

The psychological impact of your suggested treatment is overlooked simply because generally wound management is considered medically, as better enacted by qualified practitioners. This however overlooks my personal narrative. I have been a self-harmer since before my teenage years and have amassed a great deal of knowledge on dressings and wound management in that time — after all I’ve had to in order to keep myself safe. I frequently find myself telling those who are qualified which dressings would work best and how better to apply them so they don’t fall down or come away from the skin. Most practice nurses are so used to doing dressings for a largely older age population that they often forget how much more movement a younger person’s dressings need to withstand. Sometimes they apply them so poorly I’m usually having to redo them as soon as I’ve walked back home from the surgery. In applying my own dressings and monitoring my own wounds, I am taking on responsibility for my own actions and demonstrating self-care. Why is this viewed as noncompliance?

The main point I want to make is I believe the physician puts himself or herself into a position of knowing what’s best for a person based on meeting a single set of criteria. There is no consideration as to whether having my dressings completed by the practice nurses is likely to trigger me into further self-harm because of the lack of dignity and control I feel in the situation. If I want to attend to my own wounds, I am labeled a “bad patient” because I’m not agreeing with what the doctor feels is the best course of action. I am seen as “noncompliant.” But how can I not be compliant with my own care. Can I not disagree with the recommended treatment regime and still be legitimate in knowing what’s best for me as a person? Do I not have the right to say I know myself better than a professional who has never met me before? Is it not in both our interests to work together as a partnership rather than in a futile power struggle where you must always be heralded as the superior and me as the psychiatric patient who needs others to make her decisions for her ?

I believe everyone has the fundamental right to be listened to when they tell you what’s best for them and not be labeled negatively because of it. I believe the word, “noncompliant,” is another way of a professional saying, “I didn’t try hard enough to understand what’s important to this individual.” I believe it’s a way of saying the problem is the patient and the only solution is the treatment they as the professional thought to administer. To me, “noncompliant” says, “I’m right and you’re wrong” and doesn’t stop to consider the notion that maybe patient and physician both have a valid point. Yes, outcomes in evidence-based practice may suggest I have less chance of infection and wound complications if I allow the nurses to do my dressings twice weekly at the GP surgery, but also this treatment may actually exasperate my feelings of powerlessness, low self-esteem through learned dependence and take a psychological tole on me when it leaves me cast into the role of psychiatric patient and service user. In this way I am not “noncompliant” with my care because I am trying to look out for my own best interest and get my needs met to the best of my ability.

The goal should be not to label people, but to engage people. If an individual isn’t taking a prescribed medication — why aren’t they taking it? If they aren’t using a piece of equipment you gave them — what is it that prevents them from doing so? What, why and how are words around enabling others rather than defending one’s clinical position.

My argument is that nobody is “noncompliant.” I believe it is a redundant, reductionist piece of language to use. People simply choose to act in ways you don’t think are helpful to them.

I think it’s time we binned the arbitrary labels that let the professional off the hook from finding another treatment or strategy to meet their patient’s needs. It’s time to take back our own power and say: “You don’t have the right to tell me what I need. It isn’t your job to tell me to sit down, shut up and do what I’m told.”

Psychiatric patients aren’t children, we don’t need disciplining into accepting your values and ideals as our own, we just need support from clinicians who will work to understand our perspective and work with us rather than against us in what should ultimately be the aim for us both: our overall well-being.

If you or someone you know needs help, visit our suicide prevention resources page.

If you struggle with self-harm and you need support right now, call the crisis hotline at 1-800-273-8255 or text “START” to 741-741. For a list of ways to cope with self-harm urges, click here.

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Thinkstock photo via utah778.

Originally published: July 19, 2017
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