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Steven Levenkron "Cutting: Understanding and Overcoming Self-Mutilation" D R A M A++Q U E E N
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LIVING UNDER THE KNIFE | PAGE 1, 2
Most of my friends and I were on the mild end of the spectrum. "Cutting" tells many stories of extreme cases -- where victims of incest and other physical abuse attempt to use self-mutilation as a means of treating their problems. Over time, this strategy only makes things worse. The behavior collapses into a full-blown dissociative disorder and the victims lose contact with reality. They fall into trances or periods of amnesia in which they inflict physical harm on themselves without consciously knowing what they're doing. Over time, these flights of amnesia can evolve into permanent psychosis. Levenkron explains that for kids who have suffered mental or physical abuse by parents and caretakers, pain is fused with their sense of security. Children are unable to judge their parents, he says, and even an abusive parent is better in a child's mind than none. To decide that mom or dad is a bad mom or dad would cause a separation anxiety much more unbearable than any harm that parent might inflict. So to cope with what feels like inexpressible "crazy" pain, they invite physical pain. They take out on themselves the anger they are afraid to take out on other people. (This introversion of anger probably accounts for the fact that the overwhelming majority of cutters are female; male depression usually expresses itself as outward rage.) It falls along the same logic as chopping off your arm to take your mind off your headache. Cutters respond to the visual stimulus of seeing their own blood flow. They describe a sense of calm and of being grounded back to reality, since the physical pain is finite and reminds them of their physical reality. Pain is often a kind of self-medication because of the endorphins released in the brain. In essence, it's a quick fix that does mental and physical harm and not much good. Self-mutilation ultimately causes shame, which further hinders girls from expressing their feelings. Levenkron's conclusion is obvious enough: Self-mutilators need to go into therapy ("twice a week, outpatient"). They need to develop trusting relationships with people who can handle their problems. In many of the cases he discusses, therapy is that much more vital because abuse by the parents is the origin of the children's problems. Once we accept this solution, the fact that the book doesn't specifically target an audience of parents seems less troubling. Perhaps psychotherapists need to be reached before the parents of self-mutilators can be. My mother caught a glimpse of the gruesome red patch on my arm one day. When she asked me what it was, I nervously made up a story about a freak curling iron accident. Nearly sick, she nodded and let the issue drop. Later, she gathered up her strength to tell me I could either go to a hospital or private school, but that we couldn't afford both. This was exactly the jolt of reality I needed. I never discussed the burning with my therapists except briefly, in the past tense, mainly because it felt like a symptom rather than a central problem. Also, I was embarrassed about it, and I didn't think even a therapist could have understood. To protect herself from liability, she probably would have tried to send me to a hospital, which I didn't need. According to Levenkron, I was probably right. In case history after case history in "Cutting," his patients tell him they have been "too much" for their previous therapists. Even within the psychological community, self-mutilators are considered "sick cookies." A therapist needs a small amount of medical knowledge (about as much as is contained in the Boy Scout manual) to inspect the wounds for severity and medical attention. Most shrinks, Levenkron says, would rather have patients who "free-associate about their childhoods." If this is the case, "Cutting" is an important pop textbook written for an audience of professionals with a lot left to learn.
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