As a modern society, we have become inured to watching open-heart surgery and emergency-room procedures on television. With the help of our own experiences and the information provided by modern media, we now casually discuss gynecological problems, childbirth, cancer, organ transplants, and so on.
Yet we still shrink from acknowledging the signs of emotional and mental pain. This book takes a look at the difficult subject of self-mutilation: how it relates to our society, and our fear of the dark impulses that lurk within us all.
Until 1996, the public had little familiarity with self-mutilation. Then Princess Diana volunteered that she had been a cutter, and articles on the topic began to appear in popular magazines.
Often I meet new patients who say that they already have tried several therapists before coming to me. As soon as they indicate that they are self-mutilators, the therapists respond that they have no experience and decline to treat them. Why hasn’t this disorder been looked at more carefully in the past? Perhaps because such pathological behavior is as repellent to the psychological community as it is to the general public.
Back in 1974, when I first treated anorexics, my colleagues, most of them psychiatrists, tried to dissuade me. “Steve,” they would say, “specializing in treating anorexics would be like having an entire practice of suicidal patients.” Coping with anorexics was considered foolish and frightening at a time when a therapist could seek out a patient population who simply wanted to be analyzed—to lie on a couch and free-associate about their childhoods. Over the past twenty-four years, an entire subdivision of the profession has sprung up to research and treat eating disorders.
Yet, aside from the current publicity, most of which is sensational, unhealthily explicit, and serves only to frighten and disgust people, we are still largely in the dark about the phenomenon of self-mutilation. Much research remains to be done. Our primary source of information will be those people who have engaged in this behavior in the past and those that are doing it in the present: the patients themselves.
The mental health profession (whether its members have medical or nonmedical backgrounds) will have to get comfortable talking with patients, in detail, about cutting and burning oneself. They will have to get used to demanding that their patients show them the damage done, inspect this damage, and determine whether or not a physician needs to treat them. All of this must become a natural and comfortable part of the therapist’s treatment repertoire. It requires, in most cases, knowledge equivalent to the medical information found in the Boy Scout Manual.
When therapists first began to treat eating disorders, they had to learn about electrolytic imbalance, heart rate, blood pressure, body temperature, blood values, and organ function, as well as estrogen levels and their relationship to menstruation, and weight-to-height ratios. Suddenly, therapists were talking with their patients about intimate details of bodily function. This was something that had rarely occurred in previous therapies. These are patients who are mystified by their bodies and who deliberately distort their physical appearance. They need therapists who, as their teachers, will feel as comfortable and knowledgeable about their patients’ bodies as their minds.
The therapist who chooses to work with self-mutilators will have to become desensitized not only to the results of the physical acts committed against the body but to the fact that this damage is self-inflicted. I suspect it is this aspect that is the hardest for us all to deal with.