For most of her life Victoria Leatham, (now in her early thirties) has been plagued by thoughts of self harm. For a long period cut her wrists in response to stress. Leatham's memoir describes her responses to these experiences, and her attempts to find relief through changes of accommodation, by ending or beginning relationships, through new jobs and through various psychiatric interventions. By the end of the book Leatham seems to have found ways of living with persistent negative thoughts, and a sense of peace with herself. Two key decisions related in the final chapter are to decline the best job offer she's ever had, and to decline the advances of the persistent Alex, who always turns up when Leatham is at her most vulnerable, and who offers little more than an empty familiarity. With these decisions Leatham  asserts some control over her life, and the book finishes on an upbeat note as Leatham anticipates a future in the manner of many thirty somethings: older an wiser, and hopeful that the worst of the recurrent trauamas of her earlier life are now behind her.

The first chapter begins: "I had no idea how simple act of running a sharp razor blade cross my wrists would change everything so completely." Her initial episode of cutting proves to be a Faustian pact; the exhilaration produced by the pain and the sight of blood becomes a necessary way of relieving self doubt, dark moods, and the stresses of life. In the rest of the book Leatham shows just how true her initial statement is, as bloodletting works its addictive effects. Even in the periods where she is not cutting herself, the thought of it haunts her, and Leatham is never far away from another packet of razor blades. Finally though, there is hope, as in the six years prior to writing the book Leatham has remained free from self injury.

Along the way Leatham provides an absorbing narrative of a life unfolding in the face of the constant threat that self harm or depressed moods will return. She is evidently a capable and articulate woman. Leatham finds employment relatively easily, working in a number of editing and publishing positions. She is well thought of by numerous employers, several times having temporary contracts extended and being asked to take on additional responsibilities. Despite her self doubts, Leatham makes some adventurous decisions, such as the one to shift to the other side of the country to the isolated city of Perth to assume a position for which she is poorly qualified. Personal relationships are a rather different story. Although Leatham comes across as a personable woman who is well liked by others, her intimate relationships are frequently disastrous, precipitating moves interstate and periods of severe stress.

Throughout her memoir Leatham gives no more attention to her relationships with professionals than to other aspects of her life. She visits numerous psychiatrists, has several periods of hospitalization, and takes various medications. Her doctors are a mixed bunch, some relating with warmth and empathy, at least one barely interested enough to stay awake. Professional health care is sometimes helpful; other times you get the feeling that finding a helpful professional requires a large element of luck.

Self mutilation is one of those issues that have the power to polarize. One the one hand it intuitively seems to contradict any idea of a purpose for living; on the other hand there are those who find an outlet for stress, even comfort from inflicting pain and drawing their own blood. While obviously a potential indicator of suicidality, for many people there is no direct relationship between their self harm and an immediate intent to die. Throughout the book Leatham only occasionally talks of wanting to die, and even in these cases there is a high level of ambivalence. But there is no mistaking the struggle of dealing with repeated self harm, the constant vigilance for the responses of others, and the highly visible permanent reminders that make it difficult to leave the past behind.

Bloodletting is a highly readable account, told in a straightforward way with the author relating intimate and troubling life experiences in a disarmingly frank manner. The book is not confessional, in the sense that Leatham is using it as her only opportunity to reveal aspects of herself, or to tell all about conflicted relationships and bad behavior. The reader gets a sense that Leatham is well at ease with herself and her past. The many characters who populate this book, and the wide range of experiences Leatham encounters create the feel of a novel. From her involvement with the dangerous and charming psychopath Angus, the looming presence of her critical mother, to meeting a warm and supportive aunt on the other side of the country and learning of the death of a close confidante, the book is both moving and at times entertaining. The reader needs to remind themselves that this is a memoir of psychic and physical pain. 

  Bloodletting is a useful addition to the growing number of personal accounts of individuals finding ways of living with dark and despondent moods, teaching themselves to hope and finding what works in building a life worth living. It has close parallels to Suzy Johnston's The naked birdwatcher. It is recommended reading for individuals experiencing similar crises to those described by Victoria Leatham, and for the family members and friends who seek to understand them. Mental health professionals will find this book useful for its highly personal rendering of what in the professional literature is often too much analyzed and too little understood.

© 2007 Tony O'Brien

Tony O'Brien RN, M.Phil., Senior Lecturer, Mental Health Nursing, University of Auckland, a.obrien@auckland.ac.nz

Categories: Memoirs