Firstly, before I become all “left-brained” about this, imagine actually doing it.  Close your eyes if you need to.  Imagine the feel of an AA battery in your hand – the size, the weight.  Notice how solid it is.  Now imagine resting it between your lips – the feel of cold metal.  Picture yourself pushing the AA battery, with the tip of your finger, all the way into your mouth and towards the back of your tongue.  Now imagine swallowing.  Go on – really imagine it.

Seems like quite an undertaking doesn’t it?  Or is that just me?  Personally I struggle with large paracetamol.

But that is what Jane did.

She spent a few nights in hospital, while the medics hoped it would pass, before they realised it was leaking and removed it via an endoscopy.  Jane told me afterwards that her vomit was black.  So, in a way, it is quite surprising that a few days later – she swallowed another AA battery.

Why?

Self-harm?  For sure.  Attention seeking?  Well yes, it is hard to avoid the conclusion that is part of it.  Unlike other forms of self-harm, which can usually be dealt with fairly quickly, it guarantees the focused attention of carers and medical staff for several days.  Jane certainly seemed relatively content in her private ward – revealingly she referred to the bathroom as “my on-suite” and I noticed on several occasions she asked the nurses to bring her cups of juice which she never drank.

Do you think that could be the reason?

Then let me make you this offer:  I will pay for you to spend a weekend at a five star hotel, feel free to watch all the pay-per-view films and order all the room service you like.  What’s the catch?  Oh…it’s a trivial thing really…you just have to swallow this AA battery.

Still think it’s the reason?

Here is what some experts say:

As with other forms of self-injury, the patient presents for care having completed the deliberate act, but in the case of foreign-body ingestion, this act initiates an ongoing injurious sequence, since the risk of “passive injury” from the foreign body remains.  Thus, these patients actually present in the midst of their self-harming process.  This evokes more frustration from their treaters who, if the object is not retrievable, are effectively “held hostage” and made to sit through the anxiety-provoking period until the object is safely passed. (My Italics)

Foreign-Body Ingestion in Patients With Personality Disorders, Gitlin et al, 2007

I am not Michael Gove, I like experts – they help me understand complicated things.  And I definitely think the counter-transference (the emotions someone evokes in his/her carer/therapist/doctor etc) is an important way of understanding why Jane swallowed a battery.  Certainly, if she is looking to project feelings of frustration, anxiety and powerlessness into other people then she has stumbled on a very effective way of doing it.  A rich seam of acting-out gold.  But how strong must these feelings be in her that she must communicate them, or rid herself of them, in this way?

Another significant factor here is that the first time she did it she had just had contact with her mum and mum returned to spend time with her in hospital.  The second time?  Mum had just gone on holiday to Portugal.  How manipulative, you think?  Or how desperate?

I cannot see how someone could manage the physical act of swallowing an AA battery without, to some extent, being able to disassociate from their own body.  And what group of people are often very good at doing this?  Victims of sexual abuse.

This is pretty much all my thoughts on “why would a 14-year-old girl swallow a battery?” and the truth is, on a very profound level, I still do not really understand it.  But almost as disturbing for me as Jane swallowing a battery was an almost complete lack of curiosity from my colleagues, the medical team and the CAMHS worker at the hospital.   A total lack of compassion and even very basic awareness that, whatever else may be going on, Jane must be a very troubled girl.

Pointlessly, people resorted to asking Jane why she had done it.  They then chose to take her answers at face value and became annoyed when it transpired she was giving different explanations to different people: She had fallen out with the other girls in the home, she was worried about a new young person coming to live there, she was bored.

There is a really very obvious reason for this – Jane, quite clearly, does not know why she swallowed a battery.  The reasons will be buried in her unconscious.  So when she is asked she feels she has to say something – anything.  Anything which might offer a coherent answer both to the adult asking and herself.

I might not know why Jane swallowed an AA battery but I do know this – her placement with us has been closed.  We cannot manage the risk.  And I make this prediction: She will be bounced around various generic kids homes for a few years, none of which will be able to “manage” the risk.  “Manage” really means accept and tolerate the risk – it cannot be removed.  Jane will always be able to find something dangerous to swallow, and getting her to an emotional and psychologically healthy enough space, where she no longer behaves in this way, is long-term work.   Jane will not get the help she needs.

Now imagine something else.  Imagine how Jane felt when she swallowed an AA battery – how wretched, how lonely.