windows that were open and letting in the soft sounds of birds. In this room, the early morning sun was shining through the open windows and the lace curtains were gently blowing in the breeze. The plaster walls were plain and white, their expanse interrupted only by an occasional ladder back chair standing nearby. The floors were rustic with wide, planked wood. There was only one door leading into the room and it was closed. In the center of the room, bathed in sunlight, was a simple, small wood table with only one object on its surface, a beautiful, cut crystal bud vase holding a single rose. The rose was just beginning to open.
As I followed Nadia’s description, the sunlit, serene feel of the room turned suddenly grey and foreboding when she told me that the entire scene was in black and white, like an old movie. She said that the rose was the only color present and it was strikingly red. “The rose is so red, that when I see it in my mind, I can feel my heart beat, like a passion simmering underneath my skin,” she said. Nadia continued the narrative, noting that as she looked at the rose more closely, she noticed beads of moisture on its delicate petals. She touched these drops of moisture, and they felt unexpectedly warm. When she looked down at her fingertips, she saw blood. “My blood is the tiny droplets on that rose and it is just as crimson as the flower,” she says.
Nadia wanted to feel the warmth of her blood in the midst of her cold, grey world. She wanted to see color again. She wanted to feel again. She says, “I want my passion for life to return. I want it to flow out of me, instead of being buried so deep inside that I am beginning to wonder if it is there anymore. I want to feel warm and red, not cold and grey.”
Nadia eloquently illustrates one of the most frequently cited reasons for self-injurious behavior. She self-mutilates to feel alive and to escape the emptiness she experiences in her daily life. It is common for individuals to comment that they do not “feel real or human,” and that the pain they elicit along with the sight of blood flowing from their body creates a sense of “being alive.” If this seems confusing, think about all the people you know who go to great lengths to “feel alive” or “feel young and energetic.”
In trying to describe this concept to others, I often share an example from the movie, Titanic. Envision the scene where Leonardo DiCaprio climbs up on the ship’s most forward railing. With the wind blowing in his face and only water beneath him, he stands up with his hands raised high up into the air and yells “I’m the King of the World!” This is a wonderful depiction of an individual who is experiencing a sense of “feeling and being alive.” Self-injurers strive to create this experience through their acts of bodily harm. Because they often do not believe that they can achieve this feeling without self-injury, they develop a pattern of its use.
2. As Punishment
A second common reason why individuals self-injure is for punishment. Self-injurers seek to punish themselves, either for what they perceive as their own failings (internal reasons), or because of external events. Internal reasons for punishment include things like failing a test, missing the winning goal or saying something that you later regret. As a result, the person feels angry, frustrated and disappointed in themselves. For example, Brian states, “When I mess up in a game or on a test, I look for a way to punish myself. Self-injury provides me with that way.”
External reasons for punishment might include a friend being rude, a fight with parents, a flight being cancelled, a car breaking down, or the weather ruining plans. As a result, the person feels angry, frustrated, and disappointed with something or someone in the outside world. Elaine explains, “A client changes his mind about a deal due to financial constraints, or it rains during my only vacation of the year, and I cannot help but turn to my trusted friend, my piece of glass. Using it during those times is a way to purge myself of all my anger and disappointment.” Or, according to Sara, “When a friend at school gives me a dirty look, or talks about me behind my back, or when I get into a fight with my parents, the anger and sadness I feel is so big that I cut to deal with it.”
3. To Numb Feelings
A third common reason that people self-injure is to numb uncomfortable feelings. In this case, one of two things happens. Either emotional pain is turned into physical pain because it is easier to deal with, or the person masters numbing the physical pain which in turn helps them to achieve their ultimate goal of relieving their emotional pain. In either case, however, the same goal is achieved. The emotional pain is managed by finding a way to numb it or avoid it completely.
Joey exemplifies this point. He expresses his pain physically by burning. He comments, “I do not like the sight of blood or the way it feels to slice my skin. Cutting causes me too much pain, so I burn instead.” Joey does not self-injure to feel pain. He self-injures to numb pain. He states, “I can numb the burning sensation on my arms or legs whenever I put a lighter or cigarette to my skin. I like the power and control I feel when I make the pain go away.” For Joey, mastery over physical pain is followed by mastery over emotional pain.
4. To Decrease Tension
The last common reason that people self-injure is to decrease tension and stress. This is one of the most prevalent indicators for self-injurious behavior and the one cited most often when patients first come into my office. Many of my patients are struggling with intense pressure and stress in their lives. During the initial intake interview, these patients often admit to utilizing self-injury as a way to relieve those feelings. I hear statements like “It calms me down,” “It relieves tension,” or “I feel at peace with myself when I do it.”
This calming technique, although very unhealthy, seems to work in the short term. The problem is that it does not work in the long term and can lead to very dangerous consequences. Aside from the reasons behind self-injurious behavior, the behavior itself can be highly detrimental both physically and psychologically. However, when used to relieve tension and stress, there is an added component which makes it more dangerous and potentially lethal.
In my professional experience, I have found that there is a significant correlation between increasing tension and increasing severity of the self-injurious behavior. In other words, the more stress and tension that the individual feels, the greater the severity of the self-injurious act. As discussed above, it is not uncommon for these patients to end up in the hospital because their behavior becomes so dangerous and out of control.
For example, Kathy was admitted to the hospital following an incident of self-injurious behavior where she cut so deep that she stated, “I even scared myself.” She explained, “I needed to cut more deeply to get the same effect. The tension I was feeling was so powerful that superficial cutting did not seem to get rid of all my stress. I needed something more.” Nadia found herself in a similar situation. She was hospitalized right before a family reunion. She cut so deep, she could see bone. She did not want to go to the hospital, but knew that it was what she needed. She was afraid that she would take things too far as a way to try to get the relief she was looking for. She stated, “The cuts I made on a daily basis were not enough. I needed something more. It was like I built up a tolerance to the pain and couldn’t get the same feeling unless I dug deeper into my skin.”
5. A Coping Mechanism
In summary, self-injurious behavior is a coping mechanism. As defined, it is a way for individuals to manage overwhelming feelings that are too painful or difficult to verbalize. The first step in helping a loved one who is self-injuring is understanding her pain and recognizing that she is attempting to manage it. The remainder of this book will focus on identification of self-injury as well as prevention and intervention. Specific guidelines and techniques that can help self-injurers learn to manage painful emotions in a way that is safer, healthier, and more productive will be addressed.
Identifying
