Why Non-Cutters Should Worry Less: In Defense of Self-Mutilation, part four
How Much Should Cutting Worry Non-Cutters, as Opposed to, Say …
I don’t know. What are they worried about?
Cutting or any other act of self-mutilation is worrisome, of course, because it means that the person in question is not at peace with his/her world, that his/her emotional and psychological turmoil is not relieved by any socially acceptable means, and that s/he does not feel s/he can trust the coping skills endorsed by his/her parents, healthcare providers, teachers, etc., to take the place of self-harm. It means that the person probably feels a degree of lostness, loneliness, emptiness, sadness, anxiety, hatred, self-loathing, confusion, anger, and lots of other difficult emotions that may far surpass any negative emotion you have felt in your own life. It means that this person, in some sense, is exploring his/her own mortality and is, statistically, more likely to attempt suicide than a random person from the general population. If it were my friend of sibling or child, I would worry too, about the overall condition. (You should realize, of course, that freaking out, yelling at the person, imposing a Nazi-like set of rules, demanding sweeping changes right away, and/or inviting the person into a sweetly sanitized version of your world where everything will just be all right … These interventions are more likely to make things worse than better.)
But the cutting itself … What are you worried about?
Infection? That is a real concern, but it can be minimized with clean razors or knives, some rubbing alcohol or another antiseptic, and some gauze pads. When a cutter accepts the impulse to self-injure as a way of coping without burdening it with moral labels, the cutter will be more likely to do it safely.
Suicide? Cutting is not suicidal behavior, and does not necessarily indicate suicidal ideation. I sincerely doubt cutters are any more at risk for suicide than other depressed people with other less-than-ideal coping mechanisms like excessive drinking. Worry about the depression
Cutting as the New Teen Craze? No. There is a study published in summer 2007 claiming that 46% of teens have deliberately injured themselves (as opposed to 4% of the general population) and a 2008 Canadian study claiming 17.6% (or “one of six”) young people age 14 to 21 has done so. I suspect these studies are flawed and their numbers inflated, however. There is an enormous difference between generations in terms of what behavior would be reported in a psychological survey and how.
Teens today live in a more open culture in terms of psychological and psychiatric issues, and an arts and entertainment culture that often wears its pain on its sleeve (see emo). My guess is they are much more likely to report (and possibly more likely to overreport or falsely report) self-injury. Older cohorts, on the other hand, are less likely to admit to self-injury even on an anonymous survey—and this is increasingly true as we go back to older and older generations.
Categories of self-injury in these studies may be troublesome also. The articles linked above do not give sufficient detail to seriously examine this issue, but the numbers seem ridiculously high to me, so I find it suspicious. Behaviors listed in the articles include “cutting or burning skin, … biting or hitting oneself,” “scratching, … and minor overdoses of drugs (… prescription drugs [or] street drugs) and alcohol.” So every kid who pukes or passes out on drugs or booze is a self-injurer? Does hitting oneself include slapping oneself to stay awake? Does hitting or banging one’s head against a wall count (even though that probably would have been an expression of rage in older generations, not a deliberate self-injury)? Do injuries from Jackass-style pranks, backyard wrestling, or extreme sports count?
Don’t worry about the “fad”—the real fad is emo, which is essentially the same as that folk-singer-songwriter-confessional-poet-david-bowie-joy- division-robert-smith-morrissey-sad-grunge thing we all grew up on. It is no more dangerous now than it was then.
Cutting itself is not as dangerous as the hype suggests. I’d place it above habitual overeating, but below thrill-seeking extreme sports-type stuff on the danger scale. The risk is manageable. Like most addictions or habitual maladaptions, it will at some point cease to give the cutter what s/he wants, at which point a decision must be made, help must be sought (in my opinion), and recovery must begin.
Until then, friends and family of cutters, especially if you are non-cutters, need to focus on harm reduction and the underlying depression, anxiety, frustration, and/or stress lying under the self-injury. If you fuck this up by freaking out, moralizing, pontificating, accusing, etc., you will be much worse for the kid than the razor itself.
Related Posts on Other Blogs
Sittin’ & Thinkin’
Sitting this morning on the psych ward. My patient is a cutter, and her roommate is an addict, so I feel completely at home. We talked a little, my patient and I, about her admission and how she thinks it’s ridiculous that she was hospitalized for having some paperclips jabbed into her arm. I understand the hospital’s position, from a liability standpoint–overkill is better than letting someone slip through the cracks to death or serious injury. The stakes are high. Still, I don’t believe the psychiatric mainstream really understands self-mutilation.
Cutting is almost never suicidal behavior. In most cases, self-harm is the best tool the patient trusts and know how to use to manage overwhelming mental and emotional stress, often the torment of a bleak major depression mixed with useless, chaotic, agitated energy. (This is not to say for sure that my patient has no suicidal impulses or plans–the other event that brought her here this time was a gross overdose on Tylenol. Was that another coping mechanism gone out of control, an accident, or a deliberate attempt? I don’t know.) Is there a better way for physicians, nurses, therapists to conceive of and treat self-mutilation?
When my mother was teaching young children, there came into fashion a method of literacy instruction in which a child’s own interpretation of spelling and pronunciation were given credibility and praise, and no immediate correction. The theory was that the best developmental foundations for the child are self-esteem and a sense of accomplishment rather than knowledge of a somewhat rigid, culturally codified linguistic system. There is something to this; there is also something in critics’ objection that the children were being coddled and “dumbed down.”
When my daughter was very young, I instituted (but not necessarily as a conscious decision) an approach involving acknowledgment of her way of doing things, and education in alternate ways for different contexts. Honor expression, but teach communication at the same time. I attempted to use the same model in teaching Freshman Composition at a state university years later, though that would have been much easier had I been at least functional in my students’ 10 or so collective non-English first languages. The model worked more successfully for teaching larger structures, translating the architecture of a VH1 Behind the Music script into narrative flow and paragraph transitions (“She was at the height of her career. Then, some awful event sent her plummeting back to the depths.” Cue commercial.)
Cutters have spent time–often years, often under constrictive and bewildering circumstances–developing the coping skills that have served them better than any others they know. The self-mutilation will not stop overnight because a couple doctors and a handful of counselors briefly introduce you to a few new (or familiar but discarded) ideas that will (A) require a lot of work, (B) offer no guarantee, and (C)–unlike cutting–have little or no immediate effect. Nor are repetitions of the potential harms of self-harm–infection, blood-borne disease, accidental death–likely to have any real effect. Cutters are used to others failing to understand. They have long since given up trying to get their points across, if they ever tried at all. To label them “suicidal” is to persuade them conclusively that you don’t have a clue. So what should healthcare and mental health professional so with self-mutilators?
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Recognize self-mutilation for what it is: a coping mechanism that has been effective where others have failed or been absent; an immediate gratifier with addictive potential; a dangerous behavior (but–jesus!–not that dangerous, in the scheme of things); the patient’s best friend, without whom she can’t imagine life, although she’ll tell you it’s not that important, just like she won’t tell you she has a sneaking suspicion that her best friend is really stabbing her in the back (no pun intended).
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Don’t just pay this lip service–really, truly, deeply understand this.
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Moderate your impulse to make a big deal out of the self-harm. Unless there are other signs to the contrary, don’t tell the patient she’s a suicide because she has cut herself (but keep an eye on her without arousing her fear or contempt). The most effective message, I believe, begins with a well-communicated understanding of the patient’s point of view. From there, you only have to more or less convince her that the old best coping mechanism is failing her. Years of avoiding long-term psychiatric treatment and substituting short-term pain relieving acts for more integrated and responsive (rather than reactive) patterns often lead to worsening depression (and/or other psychiatric problems), progressively dysfunctional relationships, and increasing isolation. The patient will likely believe that life will always be this way … but that is fairly characteristic of depressives in general, for whom mental health professionals are better prepared.
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Bridge the old coping mechanism to the new, make analogies, draw connections. Exercise releases endorphins, as does self-mutilation. Creativity can externalize pain, much like cutting. Be creative, but try to stay grounded in the patient’s reality as well as the healthier reality you are attempting to help her see.
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Be prepared to stay in this for the long haul, or to make sure that the patient has someone else for long-term monitoring and therapy. Emphasize the importance of and facilitate the implementation of a support network, a solid structure to ease the transition from the psych hospital, psych ward, or day program to the outside world and increase the likelihood that more positive coping skills will win out over old mechanisms when the patient once again faces the tumultuous, howling darkness of the barren inner landscape. Self-harm is a failing survival mechanism and an addiction as drinking booze is for alcoholics, and many will not succeed without cutting the first time around. Resilience and support are the keys. Without a radical revision in the understanding and treatment of the self-harming patient, the work of the mental health professional with these patients in institutional settings will almost always come to nothing.
The last cut was not the deepest
Dear Reader in search of insight about cutting and self-mutilation,
It had been more than 5 years since I cut myself last, but a few weeks ago after a fight with the wife in which I found myself unable to control my anger, my feelings of hopelessness and essential isolation, even more so after she left to flee to a seedy hotel for the night seeking a relative sense of safety, adding shame and increased self-loathing and loathing of random strangers who blocked my view of the blood moon jockeying for position with their cameras as I sat seeking solace in the exchange between the water and sky, I decided that, even though I could make it through the night on the residuals of therapy and 12-stepping, I would rather feel better in the short term, something with the least long-term impact both on myself, my body and my psyche, and on my relationships—I mean primarily with my wife, but also with so many others, which tended to exclude breaking my 5½ year sobriety to go on a whiskey bender, I returned home to gather a collection of my favorite most visceral and self-hating music, a kitchen knife, paper towels, and rubbing alcohol, and cut into my chest and abdomen (balancing the most satisfying flesh to cut with the easiest to hide).
Here is what I learned:
- Cutting still works, in the short term, externalizing the pain and releasing the body’s little opioids. Not as well as booze, but it works.
- Despite my intentions, I was more of a pussy about it than I used to be. Of course, cutting in the past was mainly for the overflow pain that the alcohol could not resolve. So, as with so many things about which I am a pussy (i.e., about which I am ambivalent, hesitant, anxious, e.g., sex, socializing), it seems much easier to cut effectively when I am drunk (which I won’t be for the foreseeable future). Basically, the knife was fairly dull, and it was difficult for me to force myself to press hard enough to compensate for that, though I did make myself bleed.
- In the days that followed, when the worst of the fight’s aftermath had passed, I continued to feel a pull toward cutting and other instantly gratifying, short-term fixes, in the face of smaller stresses. I was reminded that cutting is addictive, chemically and psychologically, and that used on a regular basis cuts us off from healthier methods of dealing with life, from ultimately more fulfilling paths.
- It was interesting. I don’t regret it. I still believe it is as viable and valid a coping mechanism as many other unhealthy acts that are more widely accepted. I don’t want to do it again.
Cultural/Evolutionary Basis of Cutting: In Defense of Self-Mutilation, part three
Cultural/Evolutionary Basis of Cutting
Human beings have been cutting themselves for thousands of years. Way back when, however, it wasn’t a solitary activity in response to overwhelming psychological stress. It was integrated into the community as a rite of passage, a ceremonial scarring to mark one’s acceptance into the adult community. Highly ritualized events like this not only provided a sense of direction and belonging, but they acknowledged the human need for intense physical experiences (pain in this case, but other ancient rituals emphasized sex, drugs, starvation, etc.) and gave those experiences boundaries of time, place, and community.
Of course, we have disposed of those barbaric traditions, because we are now too civilized and too rational to do such things to ourselves or our children. Of course, drugs (including but not limited to booze) and addictive behavior; illicit and compulsive sex, prostitution, infidelity; violence and S&M dynamics of all sorts still flourish somewhere in the shadows (and often in the broad daylight) of the adult world. But at least the children are safe. (OK, I’m being obviously sarcastic here. I won’t insult your intelligence by drawing that out.)
My own opinion is that there is nothing inherently bad about sex, drugs, or violence. (There is, of course, something inherently dangerous about them, but it’s not a moral issue.) Nor are they demons from our distant past that we can stamp out through some sort of political, psychological, or social progressivism or reactionism. In fact, we run into virtually identical problems whether we liberate these forces from the prison of moral interpretation (replacing it by either excusing excess with novel designations of victimhood or celebrating excess with a blind eye toward its dangers) or beat them repeatedly with moral baseball bats. They have always been an integral part of the human experience and they always will be. The only choice we have to make is how to work with them, direct them into channels less likely to kill us and our loved ones. As long as we refuse to make that decision, old human patterns will persist in their more destructive forms.
As long as kids have little or no sense of purpose or meaning, no sense of personal identity (you can’t tell just by the hair or the music or whether they get along with their parents), no sense that their actions can affect the world around them, sex, drugs, and violence will flourish in their world, too. Pain will be a solution to pain. Cutting will not stop. But in some distant memory, in the chemicals that flow from our glands and swim through the primordial waters of our bloodstream, all of this connects us to an age when everything made a hell of a lot more sense.
Related Posts on Other Blogs
The RecoverYourLife.com Forums discuss whether seeking help is just “being selfish?”
ModBlog shows us a journey from “Self-Harm to Self-Love” using conscious and deliberate self-branding over cutting scars, and and another “Self-Injury Scar Cover-Up Procedure” using artistic scarification.
ModBlog also has some incredibly interesting posts on ritual and/or performance cutting (Caution: Graphic, bloody pictures).
Physiological Basis of Cutting: In Defense of Self-Mutilation, part two
Physiological Basis of Cutting
The easiest place to start is with the biochemical stuff. People understand that because it seems remote enough from the conscious choices we make. To the extent they have no choice, we don’t need to ask “Why do they do that?” Except, it’s not all that clear cut in this case. But it does provide a somewhat satisfying answer to the question, “What do they get out of it?”
They get endorphins coursing through their body, the body’s own natural opioid (kind of like heroin), which does a tremendous job (usually) alleviating pain and stress, lifting mood. Same stuff released during strenuous exercise and sex. It can help manage frustration, anxiety, depression, agitation, even some psychotic symptoms.
Like any short-circuit of the problem-resolution process coupled with an intense behavior-reward complex, cutting runs into the twin problems of limiting access to other coping skills and increasing dependence on (and addiction to) the rewarded behavior. Why spend months in intense therapy and struggling to change your behavior and interactions with the world so you can “feel better” when all you have to do is cut, and you know you’ll feel better immediately? And it does. It would not be this addictive if it were that effective in the first place.
… Next installment: Cultural/Evolutionary Basis of Cutting
In Defense of Self-Mutilation, part one
I hurt myself today
to see if I still feel
I focus on the pain
the only thing that’s real.
–Nine Inch Nails, “Hurt”
I wouldn’t say I’m pro-cutting, but neither am I anti-cutting. It is a coping mechanism with a significant short-term positive effect and fewer risks than some other coping mechanisms popular among people who don’t know how to cope. The Internet has a healthy population of sites and articles and posts that say much the same. My disagreement with these sites and articles and posts is that they usually lead and/or finish with “Stop Cutting!”
“Stop Cutting!” is as short-sighted a slogan, in its well-intentioned way, as “Just Say No!” was for drugs in the ’80s. (Reminds me of NWA, We don’t just say no, we’re too busy sayin’ yeah.) As a recovering alcoholic, I refuse to tell anyone else to “Stop Drinking!” regardless of quantities or destructive behaviors or deteriorating health. It wouldn’t do any good, and may backfire. After all, what the fuck do I know about someone else’s life? What makes me so much better than someone else that I can presume to tell him/her what to do? Defensiveness spikes and anger increases the urgency to get fucked up. Or, Increase the Stress >> Increase the Likelihood of the Maladaptive Coping Behavior. The truth is, an alcoholic generally is not going to stop drinking until s/he feels like it, “hits bottom,” makes a decision, etc. Even then, it’s far from easy. And, in my experience, cutting is very similar.
The biggest problem for the Anti-Cutting movement (and for anyone who deals with the issue in any way) is the biggest obstacle in the way of cutters who otherwise might be ready to put down the knives and razors. When cutting comes into a conversation, the response I hear most often from noncutters is “You know, I just don’t get the whole cutting thing, never have.” It aggravates me a little every time, probably just because it makes such sense to me, and there was always something very satisfying about cutting. It worked. For a while. But it’s difficult to explain to people who haven’t experienced it, haven’t needed it. Below is my attempt.
(First, let me kick my credentials: I first cut myself at age 18 with a big serated knife in my parents’ kitchen. I don’t recall hearing about people doing that sort of thing back then, except maybe once or twice among more sophisticated city folk, and then in the context of art or performance. It was years before the current cutting “epidemic.” I continued cutting, though not as frequently as some other cutters, until I stopped drinking and drugs about 5 years ago. The last time I obsessed about cutting and nearly picked up the knife again was about 2 months ago. Now, I’m on track to become a nurse practitioner working with children and adolescents with psych issues.)
… Next installment: Physiological Basis of Cutting
Related Posts on Other Blogs
pulling out hair gives tips to cutters and friends in “Self Injury Support”
Sun & Shield says Thou Shalt Not Cut in “A Biblical view on self-mutilation, or “cutting””
Teen Issues says, patronizingly, “Wanna join the new fad? Don’t.”
the kids speak in “Multigenre Fun” on writing lives/teaching lives
