Articles: A World of Hurt: Healing the Wounds of Self-Injury
By Sam Boykin
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While Joan Jordan opened the door to her apartment off Monroe Road, I noticed a nasty-looking gash at the base of her thumb being held together by six freshly sewn stitches.
"I did it this morning when I was washing dishes," Jordan quickly offered when she saw the surprised look on my face.
Ordinarily this kind of incident wouldn't elicit much speculation, but I was visiting Jordan in order to interview her about Borderline Personality Disorder (BPD), a condition she was diagnosed with in 1984 but has been struggling with for most of her life. It's a disorder that manifests itself in several different ways, including self-mutilation.
Jordan is a short, stout woman in her mid 50s. Her voice is a lilting pattern of highs and lows that she correlates with the rise and fall of her head, emphasizing strongly held beliefs with an emphatic nod. Engaging in a one-on-one conversation with Jordan can be a bit disconcerting as she zeroes in on her audience with a direct gaze that radiates an intense passion, an emotional storm boiling just under the surface.
"If I was a cutter I would never have been able to convince the doctor or my friends that I did this by accident," Jordan continued.
A "cutter" is a term that has been ascribed to BPD patients who mutilate or injure themselves. BPD is a complex and multi-dimensional disorder marked by a host of symptoms ranging from impulsiveness and identity disturbances to intense and uncontrollable anger, but the symptom that receives the most attention is self-injury or self-mutilation. Using knives, razor blades, or whatever sharp object is available, including their own fingernails, "borderliners" who display this particular behavior will cut themselves repeatedly -- usually on parts of the body easily hidden such as the arms, legs or abdomen -- sometimes severely enough to require stitches. They explain that it's a way to deal with feelings of stress, rage and abandonment. Patients say they feel no pain when they cut themselves, just a tremendous emotional and physical release.
Although the exact motivations behind the behavior are debated, most professionals agree that the act of self-mutilation is done for two reasons: as a way to deal with intense feelings, and as a way to attract attention. Other forms of self-injury include burning your own skin with cigarettes; banging your head against the wall; and in some extreme cases, pouring acid on yourself.
Jordan's chosen method of self-mutilation wasn't as overt. Her self-abuse was internal -- she's attempted suicide six times by overdosing on prescription drugs.
Jordan said she hasn't tried to harm herself since 1992, the year she was released from the BPD unit at Asheville's Highland Hospital. Yet everyday is still a battle for her as she continues to struggle with the "stack-ups" and the "killing pain." These are two of the phrases she's developed over the years in trying to vocalize the turmoil and pressure that dominate a borderliner's world.
To Jordan and millions like her, stack-ups are the daily pressures of life that can be overwhelming and cause for extreme distress. What would appear as seemingly minor instances such as a disagreement with a friend, car trouble, or a bad day at work are often enough to send borderliners into a tailspin of depression and turmoil. This inner conflict, coupled with the already existing pressures of the disorder, will build and fester until it ultimately results in the "killing pain," which can only be alleviated with self-destructive behavior.
"There's a limited amount of stack-ups that you can take before you get to the killing pain," Jordan said. "Eventually it will drive you to do whatever it takes to make the killing pain go away."
During one of Jordan's BPD therapy sessions, when a psychiatrist compared borderliners' pain to what third-degree burn victims feel, Jordan had an epiphany.
"Lights, bells and whistles went off in my head," she said. "It was the first time in my life anybody had put into words how I hurt. And on our worst days we hurt the same way a third-degree burn victim does when a brush is taken to the body to take off old skin so new can grow."
Typically, borderliners' lives are marked by volatile and unstable relationships, particularly their romantic relationships, which are characterized by extremes of idealization and devaluation. They're often needy and require constant reaffirmation and nurturing, and usually it's this neediness that makes their relationships turbulent and unsuccessful. Once a relationship deteriorates it usually ends badly, often marked by fits of disruptive emotion and behavior. Although not all cases involve incidences of self-mutilation, other BPD symptoms cause the person to act out in additional destructive ways. Many of these symptoms may have the uncomfortable ring of familiarity to them as an estimated 2 to 4 million Americans suffer from BPD, the majority of them young women. The following scenario is typical of BPD behavior:
After a few months of dating an attractive girl he had met at a neighborhood bar, "Bob" had grown alarmed by his new girlfriend's increasingly erratic and jealous behavior. She would often show up when he went out with his male friends demanding to know what he was up to, accusing him and being combative one minute, then contrite and remorseful the next. She made constant phone calls and continuously demanded more of his time. When Bob finally tried to end the relationship she made enraged threats of violence and suicide. She came by his job several times and demanded that he talk to her. She would show up at his apartment late at night and when he wouldn't see her she would vandalize his car.
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