When does a breakdown in family communication lead a child to self-sabotage? When does family discord manifest itself in one or more of the children, in forms ranging from underachievement to lethal self-harming behavior? In this chapter, I want to establish a causal relationship between the degree of provocative behavior on the part of parents—or siblings and other powerful figures—and the resulting self-harming behavior in a child. The parental relationship proves to be a major influence in fostering such harmful behavior. A second major element is the deficit, or shortage, of genuine communication between other family members and the self-harming child.
We are all aware that there is no such thing as the perfect family. What we are concerned with here is that gray area where the imperfection becomes dangerous to the mental and emotional development of a family member. It is at that point, when psychopathological symptoms begin to appear in one member, that we want to evaluate and adjust the ways in which all the family members relate to each other. Then the newly appearing symptoms will lose the fuel that drives them.
Pitfalls in Family Life
In most reasonably healthy families, parents are the prime influences on the family structure. If, on the contrary, a child is directing the family system, parents need to reorganize the situation immediately.
When we talk about revising the family system, we are not talking about blame. The assumption here is that everyone is doing the best they can. Parenting style is not the measure of one’s soul, nor of the depth of one’s love for one’s child.
Parenting style can be affected, or impaired, by a number of vulnerabilities, of which the following are most common:
• Financial stress
• Employment or unemployment stress
• Chronic illness or disability
• Emotional disorders, most commonly depression
• Alcoholism
• Drug abuse
• Marital incompatibility
• Divorce
• Death of a spouse
Each of these situations (possibly others) usually has an adverse effect on the development of at least one child in the family.
FINANCIAL AND EMPLOYMENT STRESS
When parents have to choose financial priorities that may deprive one member of the family in favor of another (e.g., one child gets to go to college and one doesn’t), guilt and stress infiltrate almost every communication between the two children. This may cause strife between the parents as well. When a parent feels guilty toward a child, after a period of time, the child is perceived as the source of the parent’s guilt and becomes someone to be angry at.
The child who is sensitive to this anger may internalize it and blame herself for her parent’s unhappiness, even though she is the one who lost out in preferential treatment. The child who has benefitted from the decision, in turn, will be acutely aware of any punishing behavior the other child is receiving, and blame herself for having “caused” the situation. This acceptance of blame could lay the groundwork for either child to begin to inflict harm on herself.
Employment or unemployment stress can create numerous money-based problems. These are not the only ramifications of a precarious financial situation, however. Feeling insecure about one’s ability to support a family is a demoralizing experience for a parent. Fear of his or her potential incompetence severely undermines a parent’s confidence. The parent will resent being made to feel so devalued, and at the same time feel both angry at and intimidated by his or her own children. If this intimidation is communicated to a child, it can prematurely empower her, or even push her into the role of parent.
Parents under such stress may look to their own child for reassurance, emotional support, even validation. Those who are especially vulnerable to this parent-child role reversal are people whose own parents were harsh or critical. Seeking the unconditional love they lacked in childhood, these parents unwittingly place their child in a position of emotional authority: she becomes the family decision maker.
When the child in turn experiences herself as more powerful than her parents, she has no source of security. The child with no authority figures to lean on may invent behaviors that become very important to her, since she desperately needs something to depend on. She invents a system of ideas and behaviors that are immature and simplistic, reflecting the lack of guidance from a mature adult. In order to sustain herself emotionally, she makes self-inflicted pain a dependable and necessary part of her life.
We call such pervasive and needfully executed behaviors rituals. They range from obsessive-compulsive rituals to the ritualized regime of eating disorders to ritualized self-harming behaviors.
CHRONIC ILLNESS OR DISABILITY
Chronically ill or depressed parents can also leave an authority, or security, vacuum, which is difficult to fill. If we are talking about a married couple, the nondisabled parent may be overwhelmed with the burden of caring for the disabled parent at the same time he or she is earning a living to support the family. This is another type of situation that invites quick loss of temper, or emotional withdrawal, on the part of the overburdened parent. Either parent in such a situation may become frustrated and abusive toward a particular child. Such abusive behavior can intensify until it becomes a regularly occurring, severe event.
It is then only a short step for the child to take over the punishment she is receiving and become her own punisher. This may be done out of guilt or actually out of a need for the “soothing pain” originally created by the parent and then recreated by the child when she is lonely, because “pain” has begun to mean “home”—a recurring equation among self-mutilators. As we have seen, some children who are the victims of parental abuse (whether emotional or physical) learn to embrace pain because it is intermingled with whatever bits of love, nurturance, or attention they have ever received.
EMOTIONAL DISORDERS
When a parent suffers from an emotional disorder—the statistically most common being depression—that person usually stops functioning as an active parent, often becoming withdrawn and passive about child care and supervision. This rarely leads to the kind of aggressive behavior mentioned earlier. It does lead to anger on the child’s part, against the depressed parent for failing that child.
Such anger is usually suppressed by the child, however, since she is also aware that the parent she is angry at is deemed helpless to overcome his or her depression. If this suppressed anger becomes too much for her to cope with, and she lacks a sympathetic and understanding audience, the child may begin to hurt herself out of the intensity of her frustrations, which have no other outlet.
ALCOHOLISM
Alcoholism poses an additional threat to the children of its sufferers beyond that of chronic mental illness. The alcoholic parent, while drinking, is more likely to commit physical abuse and even sexual abuse against one or more children than a parent who is not an alcoholic. This creates the dual problem for the child of, first, seeing her family in chaos and danger, and second, fearing for her own safety.
If the drinking and violence persist over years, the child may fight off feelings of helplessness by accepting the abuse and adjusting to it as if it were normal. She may become grandiose and believe that it is up to her to stop or limit the violence of the drinker. At this point, she may have become so inured to the abuse that she sees it as part of her relationship with the alcoholic parent. When this occurs, she simply expects the abuse, and it is fused with her general relationship with the parent. For her to abuse herself then is merely to do what she has been taught to think of as a normal experience.
The child has enough perspective, however, to know that this kind of behavior is something that cannot be shared with others. She is ashamed at being hurt by her alcoholic parent, and just as ashamed at her need to hurt herself, even if she doesn’t understand why she is doing it.
DRUG ABUSE
When a parent suffers from drug addiction—cocaine, for example—he or she experiences the angry edginess that most cocaine addicts endure, in addition to the distancing and numbing effects of the drug. This combination makes a parent short-tempered, even violent, as well as emotionally unavailable to the child. But no matter what the drug is, if the parent is truly an addict, the mood swings that the child is exposed to are so severe that she will soon become aware that her parent is under the influence of a drug and see that parent as a person of no resource for her.
Again, as with the child of an alcoholic, she might see herself as the only one who can minimize the parent’s drug usage. If a child sets these types of expectations for herself, they can only lead to disappointment and, sometimes, a reversal of the parent-child authority-dependence relationship, as we saw with the case of parents with financial or employment problems.
At times the child will be aware of the parent’s extreme edginess, restlessness, agitation, and hostility—when the parent is “strung out,” or going through withdrawal and in need of the drug. During these periods, the child may be victimized and harmed in a variety of ways by the parent. Like the child of the alcoholic parent, the child of the drug-addicted parent finds such abuse “normal” within the context of this sick relationship, and, again, she could very well “apply” the parental abuse to herself without the parent being there. This behavior could be termed role-modeled behavior. While it may be hard to see self-mutilation as role-modeled behavior, the self-mutilator who is receiving such pain can, in some cases, unconsciously reconnect with her parent.
MARITAL INCOMPATIBILITY: CAUGHT IN THE MIDDLE
When parents are strongly incompatible with each other, this incompatibility, which is characterized by a lack of communication between the couple, can also spread to the children, and usually does. Or the incompatibility may take the form of aggression between the parents, and the child is caught in the middle. The child may also become triangulated, or mistargeted, by one of the parents, receiving the aggression meant for the other parent. Again, if the pattern repeats itself, the child who is the recipient of the aggression sees her own absorption of the abusive behavior as helping to hold the family together.
In her reframing of the meaning of her being abused, the child sees acceptance of the abuse as noble and constructive. In later years she may even perpetuate the abuse with the unconscious intention of “creating harmony.”
DIVORCE
Children of divorced parents are often faced with needy, angry, and jealous parents, who rival one another over their child’s affection. As young children recover from the marital disintegration, they may take advantage of this to get their way by playing one parent’s needs against the other. Parents are vulnerable to the child’s manipulation because of their insecurity, and their anxiety. They may transfer their anger toward the ex-spouse to the child, accusing the child of possessing character traits of the disliked former spouse.
That child will believe the parent’s accusations. It is too difficult for children to disbelieve a parent, which is the emotional equivalent of losing the parent entirely.
DEATH
The child of a widowed parent may be the child of a needy parent. The child of one parent rarely argues with her only parent because she does not have an alternate parent to move toward. If there is a relationship problem, the precious sole parent must not be damaged or alienated.
Any child of a single parent lacks the luxury of acting out, or expressing anger, where it could damage the sole parent or the relationship with that only parent. If that parent is abusive and needy at the same time, and child will be trapped between her role as the receiver of abusive behavior and abandonment by weakening the only parental tie she has.
Each of these situations saps parental energy, patience, the ability to make clear decisions, and the ability to offer nurturing in the form of affection, listening time, and reassurance to an anxious, angry, or confused child.
In addition, each of these situations may cause parents to be neglectful, irritable, impatient, angry, rageful, and verbally or physically abusive, as a reaction to their own depletion and stress.
You Can’t Choose Your Parents
A child who experiences any manifestation of parental stress, stemming from any of the situations just described, may choose self-harming or self-mutilating behavior as the expression of her overwhelming need to release negative feelings without hurting anyone else. The reason for choosing oneself as the target is the fear that one’s parents cannot tolerate the anger without being damaged further. In addition, the child fears a loss of love for verbally expressing her anger.
A second, even less healthy reason for self-mutilating behavior is that the chronic infliction of any of the above aggressive parental behaviors against a child will cause the child to fuse love-attachment-abuse into a single complex cluster of feelings. If a parent physically abuses the child while verbally declaring love or care, the child’s desire for attachment becomes the glue that fuses these two contradictory messages. This will result in the self-infliction of pain as a way of dealing with loneliness and the need for parental companionship.
The most common dynamic of self-mutilation occurs in the first example: that of an adolescent acting out against herself as a compensatory or substitute release against the parent. Ironically, these acts are most frequently committed by the more nurturing, understanding children, who can’t bring themselves to risk hurting or harming their parents.
Let’s see how this operated for Juanita, the youngest child and scapegoat of the family who emigrated from Mexico (chapter 2). When Juanita was abused or disapproved of by her family, she could act out against herself with a vengeance, using a knife or scissors. Even her cutting had an intense energy to it and often produced deep cuts and broad scars. The timing of her cutting was a clue to its unconscious motivation. It would take place either after a dispute with her parents—whether in person or on the telephone—or after a long period of no contact with them, which she inferred was their excluding her from the family.
Annika, whom we met in chapter 1, discovered that physical pain was an antidote for generalized anxiety. “It wasn’t pain I was feeling, it was like an injection of Novocaine that the dentist uses; it makes pain go away even though the needle ‘pricks’ as the dentist puts it in. And because I controlled the pain, there was no fear with it.”
For Annika, her cutting was a calming remedy for her feelings of emotional discomfort. She turned the disturbing behavior into something soothing for herself. To understand her reasons for doing this, we must backtrack and take a look at her history.
The Nurturance Vacuum
Annika’s mother was left by her father for another woman when Annika was eight years old. Her father, a moderate alcoholic, remarried a recovered alcoholic. Annika’s father would often call her late at night to talk to her. He asked about her in an obligatory style: “Are you okay? Is everything all right?” She sensed that she was supposed to answer, “Yes.”
He promptly went on to tell Annika how her mother was asking for too much money from him for child support and what a tough time he was having getting his life started with his new wife. He always sounded so wretched that Annika didn’t consider the possibility of confronting him about how inappropriate it was for him to complain to her about her mother. In this way the father was unconsciously making Annika responsible for her own child support, especially when he voiced complaints about her mother, who was hassling him for more money.
While all this was going on at least twice a week, Annika watched her mother become increasingly depressed over being abandoned by her husband for another woman. The mother complained repeatedly about the financial difficulties they were having because Annika’s father would not give them enough money.
Annika saw a needy parent no matter which way she thought of turning for support. On some level she understood that her welfare was not uppermost in either of her parent’s minds. Yet her anger toward them for trapping her in the middle was repressed and hard for her to identify.
“I think that they’re both doing the best they can, but they just can’t offer me any support because they’re both drowning.”
“Is there anyone you can turn to for support?” I asked.
“No. They are both only children and their parents are all dead. So I have no other family. I often wish that I had never been born. I miss the way it was before they started arguing, or at least before I knew they were unhappy with each other. I miss feeling like they were my mommy and daddy. I guess that’s gone forever. Now I feel like I’m an orphan with two children—them.”
Annika was not feeling the thwarted rage that Juanita experienced. She was not looking for a way to vent anger and settle for using her own body for that purpose. But she ended up using the same behavior as Juanita because the experience of cutting herself took her away from the inescapable trap of her neediness, ignored by her parents since they were both “drowning” in their own problems. Annika described her feelings before cutting herself as “lonely, nostalgic, sad.” Then she would nearly “disappear” into a semi-trancelike state, and begin the cutting.
“It just takes me away from my life.” She shrugged her shoulders sadly.
Annika’s cutting had not become more severe, more endangering, but it did become more frequent, as did her trancelike states. These trance states were seen by her friends, though somehow she kept the actual cutting unobserved by anyone.
Then one day she was helping her mother in the kitchen and in the blink of an eye she cut quickly and deeply into her wrist while her mother had her back to her, scrubbing vegetables in the sink. The running water and the humming microwave concealed the sounds of Annika slipping to the floor. It was probably a minute or two before her mother turned around to see her daughter lying on the floor in an expanding puddle of blood.
Annika was rushed by ambulance to a nearby hospital. She had lost nearly two units of blood and was in danger of going into shock. In addition to severing the veins in her wrist, she had cut several nerves and tendons. She would need emergency microsurgery in order to allow her eventually to use her hand again. Doctors and psychiatrists interviewed her to determine if she was attempting to kill herself.
Annika was surprised at the commotion that she had created. “Do you know that you almost died?” one nurse said. Annika told the doctors that she had no intention of jeopardizing her life, or her hand, for that matter. She explained that the reason the cut was so deep was because she made it in a hurry. She hadn’t wanted her mother to see her doing it. She planned to tell her mother that it was an accident that happened while she was quartering the chicken. She then showed the hospital staff all the other smaller cuts on her forearm and explained that she did this frequently when she got upset.
For the first time she was eager to show her handiwork to others, as testimony that she wasn’t trying to kill herself. She had a routine behavior that never in the past produced harm, other than small scars.
The hospital staff was in a quandary. Annika’s action fulfilled all the criteria for a serious suicide attempt, but her explanations and her manner were not those of a suicide attempter who had been thwarted. The staff kept her in the hospital for nearly a week until the surgery had healed enough for her to go home. But they insisted that as part of her discharge plan she must enter regular psychotherapy because of her “routine,” as she called it, of cutting herself.
Earlier, I stated that Annika’s cutting had become more frequent. This was not due to an increase of stress from intensified parental pressure, but rather to her anticipating the next demanding conversation with either of her parents. Individuals who encounter periodic stress or difficulties of the same sort learn to anticipate them. Since these experiences were usually accompanied by anxiety, we refer to this as anticipatory anxiety. In the case of the cutter, she will often react to anticipatory anxiety with anticipatory cutting. Hence, Annika increased the frequency of her cutting to a point where if she thought that she might have to have a “heart-to-heart” talk with either parent, she would cut herself before and after the talk.
During Annika’s third therapy session in the hospital, she gazed at her bandaged hand, resting in its supportive sling, then looked up at me and said wearily, “It will be a year before they even know if the nerves in my hand will ever work again. The stuff I did to protect me from my life may make me a cripple for life. Will it ever stop getting worse?”
Annika’s original provocation for cutting herself was unfortunately commonplace: Her parents got divorced. After they divorced, they fell into the patterns that so many divorced parents do. Fearing the loss of love from their child, they compete for the child in a dependent style. To make matters worse, there were the elements of alcoholism. Nevertheless, this is a typical situation except that it contributed to a very serious, even life-endangering psychological disorder. In Annika’s case, I am sure that the hereditary link to her father’s alcoholism also tipped the scales toward this disorder.
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In examining the backgrounds of cutters and other self-mutilators, we see a range of family situations and changes that runs from relatively benign to insensitive, abusive, and cruel. In juxtaposition, we see self-mutilating behaviors that range from repetitive—often at a minor level—to uneven in their endangering ability to lethal. In most cases, with the exception of incest (which causes the most catastrophic consequences), there is little relationship between the level of family dysfunction and provocation and the dangerousness of the self-mutilator’s behavior.
Obviously, other elements are at work beyond the family structure. These include chemical hereditary factors, the presence of other disorders, and social components.
Parents who are concerned that a child may be at risk for self-mutilation can take the following precautions:
—develop their ability to be patient with the child’s feelings;
—provide time for the child to discuss problems or worries;
—be consistent in providing verbal reassurance and security;
—practice communication between the couple about their child;
—avoid role reversal (letting the child become the parent) by being calmly authoritative; and
—offer positive models of self-worth, conflict resolution, and flexibility.