Over the weekend the media carried stories that Oscar Pistorius had been rushed to hospital from jail following an “incident”. Early reports quoted anonymous prison employee as saying that razor blades had been found during a search of his cell, and that staff had been observed bandaging his wrists as he was moved.
Slipped in his cell
This sounded suspiciously like an incident of wrist-cutting, quite common among distressed people, and widely misunderstood. A. family spokesperson initially said that they would not respond to these rumours, but later his brother Carl did respond, denying any deliberate self-harm, saying Oscar had injured himself by slipping in his cell, which seemed credible enough.
But the matter remained a bit ambiguous. Later a prison spokesman said Oscar had injured his wrists, but emphasised that he (Oscar) had denied attempting suicide. Two security guards at the hospital were however quoted as saying he had bad cuts to his wrists, and “the doctors kept wrapping bandages around them”. They also said he was guarded in the hospital by more than 10 warders which, under normal circumstances, would be excessive.
Read: Attempted suicide: risk life-long
A British newspaper mistakenly said Oscar had been rushed to “a private hospital”, whereas Kalafong is definitely a public hospital.
Apart from issues of medical confidentiality, more often used by prison and other authorities to protect themselves than the individual, there is a real issue of public interest, regarding how a prisoner was able to harm himself by obtaining and hiding blades in his cell – suggesting a deplorable level of carelessness.
'Slipped on a wet floor'
Suicide attempts and self-harm are fairly common among the population at large, and even more so among prisoners, especially during their first months of imprisonment. Prison authorities ought to be very aware of this, and remain vigilant to prevent such events.
Although aspects of this incident don’t quite make sense, it is quite possible that someone could slip and fall in their cell. It appears not to have a non-slip floor, seems crowded, and pictures show a bedside table with sharp edges against which he could indeed have hurt himself. It was later reported that he slipped on a wet floor on his stumps, and was injured by the shards of a broken coffee mug, which sounds feasible.
But how could this kind of injury require the attention of more than one doctor and require urgent transport to a hospital? A possible bone fracture would need to be X-rayed, but even that wouldn’t be so desperately urgent.
If Oscar said there was no intention of deliberate self-harm, perhaps we should believe him. But it could have been a dramatic attempt to gain sympathy from the judges and public, as such tactics are not infrequently used by people in similar circumstances. However, as Oscar and his defence team have until now used every opportunity to exaggerate and emphasise any hint of vulnerability, it would be most unusual for him or his team to deny suicidal motivation if it could garner sympathy.
Read: Self-mutilation increase in SA teens
Wrist-cutting and self-mutilation
Over the years I’ve done a lot of research on self-mutilation, usually in the form of wrist-cutting, mainly because I could find little useful guidance in standard textbooks. The problem is common, troubling and difficult to understand and deal with, and useful advice is sadly lacking.
One important point became clear to me early quite soon. Assuming that everyone who cuts themselves is trying to end up dead is a mistake. I discovered a whole, neglected and ignored world where people who are desperate and very upset cut themselves – and find it produces a degree of relief. Indeed, some describe lyrically how, after a period of increasing tension, and dissociating into a state of feeling nothing, they came alive again when seeing their own blood – minus the tension.
Self-cutting is also a remarkably effective way of signalling and transmitting your distress to others as people tend to find it extremely disturbing. The snag is that because they don’t know how to respond to the situation, their reactions may actually make the situation worse and thus unwittingly encouraging further similar events.
Read: Relief from emotional distress
For a surprisingly large number of people self-cutting is a private ceremony, where they produce a network of overlapping, feathery cuts and, eventually, scars. These may become almost a diary etched into their skin, allowing them to read the delicate lines of their scars, and describe each episode thus commemorated.
To me Oscar’s injuries do not fit this typical pattern. Even if he did cut himself, it would probably have been a sign of continuing distress, rather than of suicidality. The story seems to have disappeared from the media rather quickly, but one hopes that behind the scenes there will be a careful review of the circumstances, and attention given to issues like reducing floor slipperiness and safer mugs.
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M. A. Simpson. 1976. Suicide and self-mutilation. In: Suicidology: Contemporary Developments. Ed. E.S. Shneidman. Grune & Stratton, New York.
M. A. Simpson. 1980. Self-Mutilation as Indirect Self-Destructive behavior. "Nothing to get so cut up about..." pp. 257- 283, In: The Many Faces of Suicide: Indirect Self-Destructive Behavior, N.L. Farberow. (Ed). McGraw-Hill, New York.
M. A. Simpson. 1975. The phenomenology of self-mutilation in a general hospital setting. Canadian Psychiatric Association Journal, 1975, 20, 6, 429-434.
Professor MA Simpson is Health24's CyberShrink. A South African psychiatrist, he qualified in medicine and in psychiatry in Britain. He has been a senior academic, researcher, and Professor in several countries. Read more of his columns.