Sometimes threatening our own lives or wellbeing is the only power we have left to exercise. As a psychiatric nurse, in medium-secure services, A&E Liason, a Crisis Team, and, more recently, a Single Point of Entry service, I've assessed hundreds of people who harm themselves or attempt suicide when it all gets too much. How do I avoid cynicism? It's dead easy (only cynicism is the coward's way out): I imagine a conversation between the adult I'm assessing and my idealised view of the kind of child he or she might have been, during which they "catch up" and gossip. Then I ask myself: what kind of life so damages a person to the extent that serial presentations to A&E, psychiatric services, and, indeed, the ambulance service, with self-inflicted injury, appears to be a way to achieve a better life? And could this be a way of life that anybody would wish for themselves?