THE PHENOMENON OF A SELF-DESTRUCTIVE ACT
What does it feel like to cut yourself, deliberately, until you feel pain and start to bleed? Why would you do this? What does the experience of pain do to you, or for you? These are the questions that all self-mutilators ask themselves amid their desperation and shame. The answers come from many directions and have many meanings.
“Thanks, I really needed that”—we have all heard that sentence in movies and on television. Sometimes it’s in a serious context, sometimes funny. It refers to when a person gets “carried away” in a particular situation, overreacting, becoming frantic and hysterical, and ultimately losing control. There is always a second person in the formula who slaps the out-of-control person quite hard in the face. The first person regains his composure and expresses his gratitude for the painful, distracting slap with this cliché.
Most of us find the example of the slap in the face both familiar and understandable; yet the concept of cutting into our own skin, of feeling relief at both the pain and the sight of blood, seems totally alien to us. Relieving ourselves of pain is usually done with the help of something tranquilizing or anesthetic, not more painful. It seems paradoxical to utilize a greater pain for relief from pain, paradoxical to use the sight of one’s own blood for relief. Yet that is precisely the mechanism of relief for those whose world is one of choices between one kind of pain or another.
There are many explanations for how an individual develops such peculiar and limited choices. But all consist of scenarios that are radically different from most healthy childhood experiences, feelings, and development.
As I’ve already stressed, we all seek the familiar. If we are lucky, the familiar experiences of our past are pleasant, supportive, kind, and caring. If we are unlucky, they are neglectful, insensitive, punishing, and abusive. As children, we are incapable of making judgments about the adults in our lives and how they treat us. We never decide that our parents or primary caretakers are wrong. If they are wrong, then we have no competent parents and are in effect abandoned. Fear of abandonment is the greatest fear a child has. It far supersedes the fear of death, which, to a child, is an abstraction at best.
If a child could designate a parent’s act as “wrong,” then the child would have to accept that he or she has an incompetent parent. This is the emotional equivalent to having no parent at all. And because parents are a child’s only protection, having no parent means losing that protection and its sense of safety.
If a child’s experience with her parents is uncomfortable, neglectful, or painful, the child accepts the pain and assumes that her parents’ behavior is justified because they must be “right.” She has only herself to blame for the fault of failing to adjust to the pain, because the pain must be right. Think, for example, of the verbally abused child who is told that she’s stupid and worthless. The painful verbal abuse becomes familiar, reliable, part of home. As the small child develops into an older child, an adolescent, and then a young adult, she needs her parents’ protection from the world less and less. It is then her job to recreate the pain that guided her through her early life, the pain that means home, safety, comfort.
This is an example of a pathological distortion of the superego, or conscience. The child has grown into a young person whose associations and meanings for everything in her world have been malformed by her earliest experiences. Although most of us can only comprehend her mode of thinking as backwards, or messed up, it is in fact, tragically, the most logical result of her childhood.
The best way of understanding why a person would want to harm herself is by listening to the voices of those suffering from this disorder.
Jessica: Incest and Cutting
Jessica explained that she had a problem with “losing time,” a temporary amnesia that would last two to three hours. This was especially dangerous because she was a nanny who took care of a three-year-old girl in an affluent suburb and had the responsibilities of driving the child to various activities. She was afraid that she would forget where she had left the little girl last, or not pick her up on time, thereby endangering both her own job and the child’s safety.
Sometimes Jessica would “wake up” sitting behind the wheel of the car, parked on a country road, only to discover that she had “lost” two hours. She would have no idea what she had done for those two hours. She might have been acting responsibly, carrying out her caretaking duties, or sleeping, or involved in any sort of activity. She said that sometimes she “woke up”bleeding, not knowing how she had become injured.
During the course of treatment, Jessica revealed that her father had raped her from the age of five to the age of twelve. When she got her first period, he began to sodomize her so she couldn’t get pregnant. This all ended when she was fourteen and threatened to tell school authorities about his behavior. Because Jessica’s mother was severely alcoholic, she had never been a source of protection to her child.
In therapy, Jessica would occasionally make mention of “strange” and lengthy showers she was taking. Each time she alluded to this puzzling activity, she would promptly change the subject. At one point, after a year of therapy, she volunteered that she took these extended showers when she felt lonely or abandoned.
I believed that she was ready to go into more detail, so I asked her what was so “strange” about these showers. I had assumed that she was being compulsive about cleaning herself, perhaps to cleanse herself of feelings of contamination from her father’s violation of her body. Her answer surprised me and led me to a different interpretation.
“I, um, use a lot of soap, liquid soap, all over my body, but not just on the outside. I use it on the inside, too. I rub the concentrated soap on the inside until it burns, and I keep rubbing until I’ve had enough burning and pain.”
I responded, “It seems that you’re not after the cleaning abilities of the soap but the pain-causing aspects of it.”
She nodded in agreement.
“You describe the pain as burning?”
She nodded again.
“Does the burning inside you resemble the burning feeling that accompanied the stretching feeling you experienced as a little girl being raped by an adult man?”
She began to cry. “It’s crazy! It’s crazy! Yes, it does! Why would I want to make myself feel the feelings I hated the most when I was little?”
After handing her a box of tissues, I started slowly, “Who else was important to you, were you attached to when you were little?”
She blew her nose loudly. “No one! She was always drowsy-drunk on wine! There was no one else, just him!”
“Was he ever nice to you?”
She blew her nose loudly again. “Yes,” she said grudgingly, “he took me to the park, he bought me candy. Once in a while he would take me to school. She never did.”
“Is it possible that when you feel lonely, you recreate the feelings, pain and all, that remind you of him to relieve your loneliness?”
“That’s so sick!”
“But it’s home, or at least the only home you knew.”
“That’s not only sick, it’s pathetic . . . I’m worthless. If he had been just my stepfather, it might mean I had some value. But I was flesh and blood and he trashed me. He hurt me. So all I have left for memories is pain in my body’s openings.” She sobbed for the rest of the session.
Jessica is an extreme example of how people are capable of revising the meaning of pain—from something to be avoided to something that is pursued and embraced. She anticipated her paininducing experiences with excitement because she knew that she would soon be escaping from her feelings of loneliness and abandonment. The pain she inflicted upon herself came as a welcome trade-off from the terrible feelings, and transported her away from her loneliness into a trance state where she was oblivious to her painful emotions. She had no conscious thoughts or feelings while she was hurting herself. Unconsciously, the pain connected her to her sole attachment, her father. Escaping her feelings of loneliness and abandonment while connecting herself with her only caregiver, no matter how sick and cruel he was, were the goals of Jessica’s self-harm.
During her showers, Jessica would evoke states in herself that lasted for an hour or more. Other times she would have no memory of how the trancelike state had developed. She would simply experience a “waking-up” feeling and notice that she had new cuts and bruises on her body. She did not remember how they got there. It would seem that sometimes Jessica needed to deepen her trance state by causing herself physical pain.
Juanita’s Story: “Bitter Medicine”
Juanita was a twenty-year-old student whose family moved from Mexico when she was five. Her father was an engineer who made a good income working for a chemical company. They lived in an affluent community in which her father was very sensitive to the anti-Hispanic feeling. Most Hispanic men there were day laborers, gardeners, and caretakers; he always dressed well, to avoid being confused with them. Juanita’s mother was depressed. When she took her children (Juanita’s three older brothers and two older sisters) to school, the other mothers initially assumed she was their nanny. If they spoke to her, it was to patronize her. She had to continually explain that she was a resident of the community, not an imported maid.
Juanita was born seven years after the last of the five children—an accidental pregnancy. She was given over to the care of the maid the family had brought with them from Mexico when they immigrated to the United States. Juanita was a cheery, outgoing child, spontaneous and noisy. Her father was often embarrassed by her behavior in public places, especially in restaurants. He would demand that she quiet down, then hit her in public.
He continuously told her that she was a disgrace to the family. As time went on, her brothers and sisters began to treat her with the same contempt. Only the maid remained on her side; the rest of the family called Juanita disloyal. They said she made the family look bad in public and chided her for preferring the maid over them. As a result, Juanita felt emotionally exiled from her family. She hated herself, believing her accusers.
In her junior year of high school, she cut her left wrist. She was hospitalized at a nearby psychiatric hospital for attempting suicide. While in the hospital, she developed a pattern of head-banging in fits of anger. She would also smack the backs of her arms against the corners where two walls met—until she was given powerful tranquilizers. Juanita was on tranquilizers when she was discharged from the hospital; she stayed on them for a year.
After that year, her therapist thought it was time to taper off her medication. But within two months she began to cut herself, mostly on the wrists. She was hospitalized repeatedly for a week at a time for these so-called suicide attempts.
When Juanita entered college, she developed a pattern of excelling academically for the first three-quarters of each semester, then withdrawing to her room and not attending her final exams. She had been expelled from two colleges when she came into treatment with me.
She was likable, dressed in bright colors, and quick to explain to me that deep down she understood she was smart and a good person. She spent her first several months of therapy describing her past. When she was upset by something she had just said, she would immediately change the subject. If I asked her to return to the subject, she would tell me that it was too overwhelming for her, but that she would come back to it at a later time.
During one session, Juanita reached into her pocketbook and took out a small object. She had been speaking about one of the occasions when her father had hit her and humiliated her in a restaurant. Her mood became subdued and trancelike.
That’s when she took out the pair of children’s scissors, looking like a toy, with its bright green plastic handles. As she absentmindedly placed the open scissors on her forearm, I realized she intended to cut herself. I pulled her hand away and wrestled the scissors from her, flinging them on the desk behind me at the other end of the office. Juanita grabbed my arms. She was fighting me, though still in a trance state, repeating, “I need my scissors.” When she finally realized that I did not have her scissors in my hands, she scanned the room and spotted them on my desk. She spent the next hour trying to get past me to the desk. It was clear that getting to cut herself was her only way of stopping the pain and anguish she was feeling. No amount of talking on my part helped. Exhausted by her efforts, she finally fell asleep in her chair.
Juanita attempted to do what most cutters avoid: she tried to cut herself in front of someone else. This was an ability she had developed during her stays at psychiatric hospitals where there is no privacy. There were other ways in which she was different from most cutters. She made very broad scars, longer than normal, and placed her cuts as high as the shoulders and chest. She detested these scars and asked a plastic surgeon to remove them. He refused after the appearance of new scars, telling her he would only deal with them once she had been cured of damaging her skin.
Juanita hated the results of her self-mutilating behavior, but she was inevitably drawn to it for the relief it brought. She would talk about her cutting episodes, but when I asked to see the scars, she was suddenly shy. She selected the largest and told me how disgusting she thought it looked. I asked to see the most recent. She rolled up her sleeve just past the elbow, and showed me the gauze pad held on with adhesive tape. She removed the tape with a sudden jerk as people do, to minimize the pain, grimacing at the pull of the material.
I commented, “You don’t like all pain, then?”
She shot me a critical look. “It’s never about liking pain. If I liked pain, then it wouldn’t help. I hate it. That’s why it helps.”
“What does it feel like, then?”
“I feel terrible. I have to make my feelings go away. I use very bitter medicine to make them go away. If I’m lucky, I go away, too. When I do it, there’s only the place on my skin that I’m looking at. There’s nothing—no thoughts. I start to cut. It hurts. I cut a little deeper. It hurts a lot. I move the blade. It hurts much more. I start to bleed. The blood means I hurt enough to chase away all other pain. It’s over. I can take a nap after I finish looking at it and cover it with a bandage.”
_______
Juanita’s solution, or “bitter medicine” for her pain was indicative of her despair about the possibility that other people could be a source of support or safety for her. As the family scapegoat, she had learned to hate herself. She didn’t feel entitled to succeed in school or to seek comfort from others when she was sad or upset. Like other disorders that result from failed trust relationships and attachments—eating disorders, obsessive-compulsive disorders, alcoholism, drug dependence—a behavior or a substance is used as a coping mechanism for the pain of the original wound. Self-mutilation is just the most bizarre and paradoxical example, in which pain and self-damage are used to bring about relief, safety, and security.
The self-mutilator is very sensitive to her emotional pain, but even more than that, she is despairing of the trustworthiness of others. She prefers to be the one in charge of the pain she experiences and the feeling of numbness it leaves her with.