Iwas doing a call-in radio show when someone called to find out if she was a self-mutilator. She explained that when she was about seven years old, she did many things in order to get her parents’ attention and what she wanted from them. One day, all else having failed, she decided to cut herself with a kitchen knife. Her motivation, she said, was to frighten her parents, and she thought the sight of her bleeding would do that.
“I started to cut my arm and then I just yelled, ‘Ouch!’ because it hurt too much. I never even cut deep enough to draw blood,” she said.
Clearly, this person is no self-mutilator.
How much resolution does it take to break the skin and draw blood? The nerves of the skin send pain signals to the brain to warn us of the danger from an impending injury. In the case of self-inflicted wounding, this pain acts as the body’s own defense mechanism to stop one from proceeding in the effort at physical injury. If a person proceeds despite this pain, that means that he or she is motivated by something stronger than the pain, something that makes him or her capable of ignoring or enduring it.
It takes intense feelings to ignore pain. Think of the times you have put your foot in cold water as you entered a swimming pool, or the ocean. When you felt the cold, you may have backed out altogether, or found some easier way of getting yourself in, whether by jumping and experiencing the shock all at once, or proceeding slowly, shivering your way in. On the other hand, what if you saw a child thrashing around, perhaps about to drown? You would immediately block out, not even noticing the water temperature as you raced to save the child.
Something allows us to ignore discomfort and danger when a higher priority arises. Saving a child’s life proves to be such a priority.
What priority exists for the self-mutilator, or cutter, which allows her to bypass her body’s own defenses and ignore the pain? What throws this switch in the brain, and, in the absence of any necessary or noble priority, allows her to cut herself with a kitchen knife?
For the cutter, the act of creating pain (if pain is in fact experienced), or of drawing blood, is in itself the goal. The cutter must have experienced her own necessities, urgencies, and dangers, on an inner emotional level, that were as intense and real to her as the sight of a drowning child was to the person entering the water.
The swimmer is reacting to a real event, occurring outside him- or herself. The person in the second example is reacting to internal feelings—perhaps an event from the past or a collection of events, a buildup of angry or hurt feelings, or any combination of the above.
The swimmer may be saving the life of a child. He or she has a clear goal that dictates the reason for ignoring the cold water. The self-injurer may not even be aware of what she is doing to herself; and as for reasons, these most likely elude her as well. However, she does have her own goal—an urgent and immediate one.
So, what is this goal? Her act solves no tactical problem for herself or for others, therefore we understand that she must be reacting to feelings within herself. By physically injuring herself, she is redressing existing grievances or pain symptomatically. This concept might strike us as ludicrous, treating one type of pain with another, but that is exactly what she is doing; that is her goal.
The option that she is not embracing—the one that is much more familiar to most of us—would be to take real verbal action and begin to bring her pain outside herself, where it could be diffused, shared, examined. Confronting an injustice usually relieves the tension that has built up inside. It is the way to achieve understanding. In the symptomatic or “substitute” method, the cutting never really puts the feelings of being hurt to rest, but rather provides only short-term relief. Thus, taking this route leads not only to a buildup of bad feelings, but also to an addiction to the method itself for the short-term relief it provides.
The self-injurer turns increasingly inward, away from others, abandoning any real emotional connection. This “inward turning” is bound to reduce the sense of relating to others, or interpersonal reality, and eventually reduces the accurate sense of reality in general. This we call psychopathology or mental illness. Which brings us to the question, “Why does this happen to some people and not to others?”
The Nature-Nurture Debate
Whenever mental or emotional illness is discussed, the issue of nature versus nurture comes up. Is a child born with the predisposition to any particular form of mental illness, or is that illness developed by members of the family, the community, or society? With most disorders, we can agree that the answer involves a combination of both genetic and environmental factors. (The most significant exception to this very basic statement would be the diseases that stem from organic neurological pathology, such as schizophrenia, Tourette’s Syndrome, autism, and others.) Both a family’s history and a patient’s individual history can give us clues as to how much of a part genetics and chemistry play in the patient’s disorder.
To begin with, the self-injurer is someone in whom a combination of depressive disorder and anxiety disorder are chemically present to varying degrees that are hereditary. It is important to emphasize that the levels at which these components are present in the self-mutilator range from “near normal” (very mild) all the way to “malignant” (incurable).
The presence of these genetic or chemical disorders may become apparent at significant developmental junctures, such as birth, puberty, adolescence, or departure from the family household, although the manifestation can also occur at any time in between or after these particular crossroads. The fact that a child possesses a genetic predisposition toward certain types of behavior, however, does not sentence him or her to any particular psychological or psychiatric disorder.
The form that such a chemical or otherwise genetically inherited trait ultimately takes is in large part dependent upon the child’s upbringing—how he or she is nurtured. Troubled childhood or adolescent behavior can be dealt with in a variety of ways. The result can either be mild problems relating to depression and/or anxiety, or full-blown, complex disorders such as phobias, eating disorders, obsessive-compulsive disorders, borderline personality disorders, and self-mutilation.
The child who is dealt with skillfully and lovingly will not end up with one or more of the above disorders, but will have to cope with bouts of anxiety and/or depression to varying degrees. These disorders can be worked through with such solutions as psychotherapy, therapeutic support for family change, and medications. The severity as well as the type of the disorder decides which options are most helpful and appropriate.
On the other hand, if the behaviors or moods caused by these hereditary/chemical disorders are condemned, blamed on the child, or cause the parents to dislike, fear, alienate, or detach emotionally from that child, then the child is left alone. A child who has to cope with inexplicable and difficult feelings on his or her own turns inward. He or she invents safety mechanisms to escape the pain not only of the hereditary/chemical disorder itself but of being alone in this battle against the unexplained and the very scary feelings it causes. The longer this isolation of the child continues, the less likely it becomes that he or she will be treatable. The safety mechanisms that the child creates become stronger and more deeply ingrained with time, and eventually they will become a necessary part of the person. This is one way in which a full-blown personality disorder can develop.
Why Self-Mutilating?
Self-mutilators have many different reasons for their actions and are tormented by a spectrum of different feelings. Yet I consistently encounter two characteristics in all self-mutilators:
1. A feeling of mental disintegration, of inability to think.
2. A rage that can’t be expressed, or even consciously perceived, toward a powerful figure (or figures) in their life, usually a parent.
For the self-mutilator, the experience of one or both of these feelings is unbearable and must therefore be “drowned out,” as they report, by some immediate method. Physical pain and the sight of oneself bleeding become solutions because of their ability to overpower the strength of these feelings.
An Attempted Solution to Emotional Pain
Usually, the first incident begins with strong feelings of anger, anxiety, or panic. If the feeling is not too intense, throwing an object, or breaking or knocking something over, may settle the person down. It’s when the person becomes so overwhelmed that none of these “remedies” help that we may see them plunge a fist into a wall or through a window, bang their head against a wall, or finally take a weapon to use against themselves.
Someone who stumbles upon self-injury in this manner and discovers that it relieves one of the painful states listed above will be inclined to use this discovery again in the future. The individual who needs this kind of solution is a person who cannot redress the grievances she has with others, who is afraid to argue, to articulate what she is so angry about. The self-mutilator is ashamed of the mental pain that she experiences and has no language with which to describe it to others.
However they came to it, the self-mutilator is someone who has found that physical pain can be a cure for emotional pain. It is someone who, for one reason for another, has absolutely no outlet for her emotional pain, and therefore no relief from it. All she has is that short period of time when it is temporarily overpowered, “drowned out,” by physical pain.
When a person attacks his or her own body with an instrument that will wound the skin, and often worse, it means that the person feels helpless to use any other means to manage the mental anguish and chaos that is borne out of unmanageable feelings. This goes far beyond frustration. Self-mutilating behavior means the mind has slipped away from its ordinary context or perspective, losing sight of the impracticality of pain and danger in order to commit an act that will bring an immediate solution (however unrealistic or temporary in nature) to emotional pain.
Characteristics of the Self-Injurer
The person who chooses this action is someone who experiences herself as powerless. She may not be docile, timid, or shy in public; she may even be quite outgoing. But no matter how outgoing or confident she seems, she feels alone wherever she is, different from everyone around her, an outsider. She is often plagued by a fear of punishment—usually from a parent—for being deficient, inadequate, a disappointment in a way that was either specifically defined for her, or one that is unspoken but understood.
Like the anorexic, she may feel that she has no one to depend upon or to trust with her emotions. That feeling alone will produce fearfulness most of the time, even when there is no immediate cause to fear. So, what we know about this person is that she is afraid, and she may hide behind obsessional thinking or eating disorders as well as self-mutilation to gain relief from her constant state of fear. She is seeking all the relief she can find from her fearfulness. Often, she is a high achiever in some area, whether it is academics, the arts, or athletics. At the same time, she may ignore (and usually does) subjects that don’t interest her. Her school record may fluctuate drastically from A’s to F’s.
She is often apologetic even when she has done nothing to apologize for. She is fearful of what she sees as the imminent danger or resentment others will feel toward her. Sometimes, her frequent gratuitous apologies stemming from this fear will annoy and alienate those friends closest to her. She may interpret their withdrawal as an indication that she has been offensive or not apologetic enough and increase the very behavior that repels those around her. Still, she is a person generally liked by her peer group, who may identify on a very small scale with her vulnerability, a vulnerability that most of them are also experiencing to a lesser degree.
The self-mutilator is therefore a likable, sometimes high-achieving person with a myriad of problems.
The feelings of fear and loneliness from having no one to depend upon or trust are not formed in the imagination of the self-mutilator, but usually in actual childhood or early adolescent experience. They are realistic fears, based on real experiences. There is an impressive correlation between traumatic experiences and the severity of the resulting self-mutilating behavior. Some of the trauma is subtle and may include having a parent with a mental or physical illness; being overlooked and neglected; having the family broken up or separated for a period of time. Some of the trauma is very unsubtle: physical abuse, sexual molestation, and incest rape.
Parental Behaviors That Influence Self-Mutilation
Parental aggression toward the “troubled”child will cause the child to be simultaneously protective of and afraid of displeasing her parents. This is a form of child abuse that can range from moderate to severe—one that leaves a child first with no one to blame, and then with no one to retaliate against, except herself. Usually, the self-blame builds up for years before the self-retaliation (in this case, self-mutilation) begins.
Healthy parenting does not produce a self-mutilating child. Parenting has its greatest effect on a child during the formative years of her personality development (birth to six years of age). Although these are the years when a child needs the most from her parents, it may also be a very strenuous time with regards to finances, marital relations, and the experience of each parent as he or she establishes parental identity. Establishing our identity as a parent changes the way we feel about ourselves, and is an often underestimated factor that affects the parenting process profoundly.
Two key features of a healthy parent’s identity are
1. Confidence/Authoritativeness: Gives the child a sense of being protected from his or her own impulses as well as from the dangers of the outside world.
2. Nurturance/Warmth: Creates a sense of value and self-esteem in the child.
If parents themselves require support from the child, or the parents have an inadequate amount of warmth and attentiveness to offer the child, the child does not enjoy the security to express the natural negative feelings that all children occasionally experience toward their parents. The child believes that such feelings would harm her parents and leave her parentless.
If a child experiences this reversal of dependence during her formative years, she can only dare to feel anger toward herself, never toward others. She is the child who may become one form of self-mutilator, known as nondissociative, who suffers from intolerable rage with which she is only capable of attacking herself.
The child who, during her formative years, experiences a lack of warmth and nurturance, or who is the object of her parents’ cruelty, will be the second kind of self-mutilator, the dissociative, who feels disconnected from her parents, from others, and ultimately from herself.* When she experiences an “attack” of this sense of disconnection, she feels mental disintegration developing. At this point she needs a powerful distraction around which to organize and stop the mental disintegration. Pain, and her own blood, provides a sufficient distraction, and works as a tool to help the cutter center herself.
During the first six years of life, the blueprint is forming. The design usually won’t make itself apparent until just prior to puberty, about ten or eleven years of age. What we see by then in a self-mutilator is a girl whose relationships have failed. Because she has not had successful emotional relationships, she has not had the opportunity to acquire the language of emotional expression we learn when we have to relate to other people. Lacking the words with which to express her emotional pain, she resorts to a destructive physical dialogue with herself.
Feelings—The Danger Zone
The self-mutilator is not someone who is articulate about her feelings. I find that many of these girls are awkward when it comes to explaining their thoughts and feelings about themselves and the relationships they have with others. They are usually unable to estimate the reactions that others will have to their words and deeds. They are, in fact, puzzled by past reactions others have had to them, and repeat their misinterpretations in everyday relations.
In other words, most self-mutilators suffer from a lack of emotional perceptiveness toward other people. In some cases, the girl is altogether unaware of the existence of the emotional life of an important other. In other cases, she has her own ideas about the feelings of those around her, but they are highly distorted ideas that do not at all resemble the emotional reality of the situation. This sometimes lacking and sometimes distorted perception of others’ emotions comes from an insecurity within the self. The self-mutilator has very little physical and emotional security about herself. She lacks a foundation of understanding about herself and therefore has no consistent vantage point from which to step back and evaluate the feelings of those around her.
To sum up, in the population of self-mutilators we see a group of mostly young people who are often emotionally inarticulate and emotionally imperceptive. The lack of emotional security, as well as a real inability to express themselves emotionally with the use of language (rather than by acting out), leaves them in an emotional isolation, where life is lived at the defensive, survival level. Sonia, whose case begins below, is an example of a young woman who turned to self-mutilating to “solve” her emotional dilemma. Her case is also an example of underparenting: parents who did not exhibit the two features necessary to positive parenting—confidence/authority and nurturance/warmth—predisposed Sonia to self-harming behaviors.
Sonia: Coping by Cutting
Seventeen-year-old Sonia is the daughter of Cuban immigrants. She came to the United States with her family sixteen years ago, when she was one year old. The family moved to a college town in the Midwest where her father had accepted a job as an acting teacher after a long and prominent career in Cuban theater.
Sonia spoke very little Spanish, although she understood it. The midwestern community they moved to had almost no Spanishspeaking population. A major fear of Sonia’s parents was that she would become Americanized. They came from an old, wealthy, conservative Cuban family, and were determined that Sonia would be a classical musician and not an actress because, in their opinion, Americans in the theater were too liberal sexually.
Sonia sat down in the overstuffed chair in my office, smiled, and maintained her smile, but said nothing. I broke the silence by asking, “Do you know why your mother made an appointment for you to see me?”
“Because I cut myself.”
“Did you cut yourself once, or have you cut yourself often?”
She giggled at my question, but then seemed to fade away from the office into a daydream.
“Sonia?” I called out to get her attention.
She shook her head as if trying to dispel the trance. Her eyes darted around the room, rarely meeting mine.
“Sonia,” I repeated, “what do you do to hurt yourself?”
“I don’t know—it’s different all the time.”
I was jumping the gun. I realized that cataloguing her symptomatic behaviors was premature and useless to treatment and recovery until this very isolated girl formed a connection with me. At this point I couldn’t even stay in her focus for more than seconds at a time, much less begin to form a relationship we could use to rid her of her symptoms.
I moved my chair a bit closer, in hopes that it would make it more difficult for her to “drift” or go into a dissociative state. She looked rather surprised, almost frightened at the shift.
“You look worried or frightened that I moved my chair closer to you. Are you afraid that I will harm you?”
“Well,” she said, and paused to think before continuing, “I guess—not you.”
“You mean others have hurt you?”
“Sure. Doesn’t that happen to everyone?”
“It depends on what kind of hurting we are talking about, and who is doing it and how often. Do your parents hurt you?”
“Sure. Don’t everybody’s?”
“I think that most children have experienced their parents’ being angry at them, losing their temper at them, even spanking them. However, it’s usually rare and does not cause damage to the child in the form of scratches, bruises, cuts, burns, or broken bones. When these kinds of injuries result, we call it child abuse.”
She stared at me, almost in disbelief. I had put her own experiences, that she had never described to anyone, into words. She did not “slip away” while I had been speaking. I continued:
“In the first example I gave you, which is not child abuse, the relationship between parent and child is, for the most part, kind, loving, caring, and protective on the parent’s part, and there is a bond between parent and child which includes talk and communication.”
I still hadn’t lost her, but after the second explanation, she was beginning to slip away again. I had put her in conflict with what was possibly a young lifetime of accepting abuse. It was becoming clear that she handled conflict by “zoning out” or cutting herself when she was unable to tune out her painful experiences. For Sonia, avoiding conflict was her top emotional priority. Conflict could cause her to act out toward her parents in a way she feared, because as she told me in a later session, it would cause them to hurt her, stop loving her, or protest to her that she was “killing them.”
These protests by her parents about how they suffered at the hands of her “misbehavior” (normal teenage behavior that included coming home from school a little late or failing to practice her cello enough) had at least as powerful an effect on her as their beatings. This emotional abuse rivaled the physical abuse Sonia endured, such as her mother scratching her bow arm, or slapping her in the face as hard as she could.
Sonia internalized all of her punishments and experienced them as feelings of abandonment and rejection, which made her believe that she was alone and uncared for in this world. Since she couldn’t depend on her parents (or anyone else), she was left feeling that the only thing she could do was try to “control” her painful feelings of abandonment.
When I spoke of abuse, it dredged up Sonia’s most terrible and terrifying feelings of loneliness and abandonment, her memories of physical and emotional pain. In order to control the impact these feelings had on her in her young lifetime, Sonia had learned how to escape—by zoning out. It was apparent that this trance state Sonia went into, when first I asked her about the frequency of her self-injury and then again when I spoke of child abuse, was neither a new nor a rare experience for her. It was a defense she had created and used (often enough for it to be brought to the attention of her parents) in order to protect herself from painful and confusing feelings. She was now enlisting her number one defense against my attempts to get her to talk about the feelings from which that defense had always shielded her.
I watched her fade out in front of me and decided not to interfere. I was hoping that somewhere in her awareness, she would realize that I was not going to be angry, or punish her for “misbehaving” toward me by zoning out during our session.
I allowed three minutes of silence and then said, “I think you needed to leave me for a while because what I said to you was too hard to hear.”She kept spacing out. I realized that since she had put herself into a sort of trance, I had forgotten my hypnosis training and hadn’t addressed her by name, requesting that she come out of the trance.
“Sonia,” I requested firmly, “I would like you to come out of your trance.”
She focused her eyes, shook her head a bit, and smiled in appeasement at me.
I repeated what I had said to her before, and added almost apologetically, “I guess by saying that when your parents hurt you it is not an okay thing but rather child abuse, I said some welcome but very scary things to you.” I kept up a strong but sympathetic eye contact with her.
“Once, my father smashed my cello to bits when I put it down after I had stopped practicing five minutes early.” Her appeasing smile had disappeared.
I was pleased at having bridged the emotional chasm between Sonia and the rest of her world, but I realized that this bridge was fragile and would have to be rebuilt many times. I sat silently as she continued:
“If I made too many mistakes, my mother would grab my bow arm and dig her nails into it. Sometimes my arm bled.”
She spaced out again.
“Sonia? . . . Sonia, did that hurt?”
She shrugged her shoulders, still staring straight ahead. She wasn’t completely withdrawing into her trance state. “It would hurt most people. They might cry.”
One tear slid from her left eye. Her trance deepened. After three silent minutes had passed, I spoke in a loud, almost strident tone. “Sonia, we must make other appointments. Today we have to make our next appointment.”
She came halfway out. It seemed she knew that I was talking to her but wasn’t sure what I had said.
“Sonia. Appointment time.”
“Huh? What do you mean?”
“We have to make our next appointment.”
“Oh.” (Still dazed) “Okay.”
“What time do you finish school?”
“Two-thirty,” she responded promptly, sounding more alert. “But I have cello lessons after that.”
“What days do you have lessons?”
“Mondays and Thursdays.”
“Can you come on Tuesdays?”
“I think so.” She was completely alert now. “Yes, Tuesdays will be fine.”
“I would like to meet with your parents.”
She looked alarmed. “Why?”
“To see what they’re like.”
“They’ll be mad at me! And my father’s out of town. The theater group travels a lot.”
“Why would they be mad at you? They sent you here.”
“Because of what I told you.”
“I don’t tell your parents what you say here.”
She looked relieved but not completely comfortable.
“In the future you will probably say a lot of things you don’t want anyone ever to hear. You’ll be able to say those kinds of things because no one else will ever hear them. This is your private thinking and talking place . . . You’ll see.”
Sonia’s mother came in two days later. She wore a conservative suit with a small turquoise silk scarf, indicating a bit of discreet flair. She had dark hair pulled back in a bun, and gold hoop earrings. Her eyes were large and almost black, deepset, the eyebrows poised down toward the bridge of her nose. She could be imposing and intimidating at will. Today, she was a worried mother, but I had been subtly warned.
“I don’t understand why a person, no less my daughter, would want to hurt herself, cause herself pain, and scar her beautiful skin. Is she some kind of crazy?”
Somehow her Cuban accent helped her get to the point very quickly. I thought I would use her simplified idiom to my advantage.
“Yes. She is crazy when she does this behavior.”
“Is she crazy all the time? She goes to school, practices cello. I don’t get complaints from the school that she acts crazy there.”
“No. I don’t think she is crazy all the time, but the times she behaves this way could become more frequent, as well as cause damage to her physically.”
“You mean that she could become like a cripple? Then she wouldn’t be able to play the cello, or have a normal life.”
“How does she behave at home? Is she moody, angry, sad, cheerful?”
“I don’t think she is moody most of the time. Sometimes she looks sad. When I ask her what’s wrong, she always says, ‘Nothing.’ Most of the time she has no expression on her face, except when she is playing the cello, then she has a look of fierce determination. When she puts it down, she becomes blank again.”
“How does she get along with you and your husband?”
She looked angry now. “My husband travels so much with the college acting group, when he’s not rehearsing until all hours. He hardly sees her. It’s like I’m bringing her up myself. I get along with her real well. We don’t fight or argue. Sometimes her room is messy.” She donned a charming, almost mischievous smile. “But maybe you have teenagers? That’s normal, not crazy. No?”
“No, messy is definitely not crazy. I do think that I will have to see her once a week to prevent this from getting worse, and hopefully make it go away.”
“Of course. I hear wonderful things about you. I’m sure you can do this job successfully. Would you like me to come back? Can I call you if I’m worried about her getting out of control with this? I don’t want her to cripple or kill herself.”
“Yes, of course. We just can’t discuss what she says here.”
She made a slight frown, followed by a knowing smile. “Of course not. I would not want to hear what she says or any of the terrible things you must hear from the other people you see.”
Sonia’s father came in the following week: a handsome man at forty-five (three years older than his wife), dressed in bluejeans and a black turtleneck.
“I’m glad and relieved to meet you,” he began. “I wanted Sonia to go into music almost for safety. A lot of the kids I work with have so many problems and so few plans for their futures. They don’t understand how competitive it is out there. They think Hollywood and Broadway are just waiting for them. Sonia causes me great pain. That she does these things to herself breaks my heart. I think maybe it hurts me even more than it does her. Sometimes I am in so much pain that when I’m home I pay little attention to her, to let her know I’m disappointed with this behavior. When she can tell me it’s over, I’ll be closer with her. I am a director; people listen to me all day long. In my own home I can’t even direct my daughter to stop damaging herself. I think a child is more draining than directing a whole troupe of actors—even under Castro.”
He did not ask any questions about his daughter, her pathological behavior, the prognosis, what he should do to help her.
“Well, I hope you can direct her out of this dangerous behavior.” He looked at his watch. “I’m sorry to cut this short but I have a rehearsal to go to.”
He shook my hand briefly and left.
Sonia came in for her second appointment. She looked suspicious and worried. “They liked you. Did you like them?”
“Do you want me to like them?”
She shrugged. “I don’t care. As long as they like you, they won’t be mad if I come here, although my father already made a remark about how expensive it is for me to see you and that I better stop this behavior because of the sacrifices he is making so I can see you.
“My mother liked you. I think she likes you better than she likes my father. Is that right?”
“I guess they don’t get along so well with each other.”
“I think that they hate each other, but I don’t care.”
“I don’t think that I need to meet with them again.”
Sonia seemed relieved. All the worries she had implied appeared to vanish. She looked at me directly. “You know she doesn’t hit me or scratch me anymore. He always is either cold to me or busy feeling sorry for himself. At least he can’t damage my cello again.” She smiled with satisfaction.
“Why not?”
“I’m not on scholarship at my fancy private school just because some foolish people think I’m good. The cello I play has been lent to me by a collector. It’s worth over a hundred thousand dollars. I’m not sure how much.”
Sonia, now reassured that I wasn’t an agent of her parents’ motives, was talking in slightly longer sentences with less difficulty. She had begun to enter into a treatment relationship with me.
_______
Sonia is an example of a victim of parental loss of temper, narcissistic self-pity, and cruelty. She is not at the extreme end of the spectrum, which includes girls who are the victims of sexual abuse and incest. Nevertheless, she shows many of the symptoms of those victims. She is conversationally shy, and avoids anything resembling closeness, or self-disclosure. She uses pain and blood to release her feelings of abandonment, anger, and despair. In this way she avoids a state of mental disintegration—the inner bombardment by chaotic thoughts that seem disconnected to each other.
The self-mutilator is typically a young woman who has not formed healthy attachments with parental figures. By physically injuring herself, she is making an attempt to redress the pain she was accustomed to as a young child. What she fails to realize is that by harming herself, she never really confronts the feelings of being hurt or neglected. Self-injury provides only short-term relief.
The account of Sonia’s treatment continues in Part Two, as we explore the complex processes of change and recovery.
*The distinctions between these two categories are explained further in chapter 8.