Articles: Art Therapy with a Self-Mutilating Adolescent Girl
By Diana Milia
Page Number: 98-106
Author: Diana Milia
Self-mutilation is presented as a self destructive act with positive intentions toward self-healing and symptom relief, in such areas as sexual anxiety, aggression and hostility, purification of guilt and the preservation of order, boundary diffusion and separation anxiety, and trauma. This article presents the case of an adolescent girl in art therapy whose self-mutilative behavior and related problems are reflected in the content and process of her artwork. The advantages of art therapy treatment for self-mutilating clients are discussed. Not only is visual art a suitable alternative language for nonverbal acting-out self-mutilators, it also provides opportunities to exercise the same destructive and integrative urges that underlie their self-abuse. The art surface may metaphorically provide a healing function similar to that provided by self-mutilation in that it creates a protective layer--a skin--for the self, as in the formation of scar tissue.
Self-mutilation is generally viewed as a form of self-destructive behavior in which aggressive urges are acted out upon one's own body. Common forms of self-mutilation are biting, cutting, burning and hitting oneself, or banging parts of the body against walls or other objects. Other self-mutilating behaviors include abrasion of the skin, severing body parts, inserting sharp objects into body orifices, swallowing or inhaling noxious substances, and constriction of body parts (such as self-strangulation).
Although self-mutilation is particularly prevalent among adolescents, it occurs in a broad range of people of various ages. In many cultures, self-mutilation is incorporated into religious practices and social rituals. When thus culturally sanctioned, self-mutilation generally serves to purify, heal, or restore social and cosmological order. Shamanic sacrificial rituals, for example, may involve self-wounding followed by self-healing which is believed to magically purify or heal the community. Self-mutilation is considered pathological when it is idiosyncratic, or lacks esthetic value or ritual significance to the society at large. Favazza (1989) describes self-mutilation as a morbid attempt at self-healing that is not alien to humanity, but deeply rooted in our cultures and psyches through religious and social beliefs and practices.
Therapists working with people who self-mutilate need to recognize that this behavior is not purely destructive. The case study of Mary demonstrates the use of art therapy with a self-mutilating, emotionally disturbed adolescent. Parallels of self-mutilative behaviors appeared in the process and content of Mary's artwork. The plastic symbolic process of artmaking allowed her to experiment with expressing self-destructive urges in ways that could permit healing. In addition, the metaphorical content of her artwork revealed underlying psychic pressures that may have contributed to her self-mutilation. The art therapist's function was to acknowledge and witness the entire creative process of disintegration and reintegration, intervening when necessary to model integration with technical assistance and suggestions. A detailed account of Mary's progress in art therapy is provided because it was often in the subtle details of the process that her self-destructive urges were played out. Preceding the case study is a brief discussion of five inter-related areas of psychic pressure commonly associated with self-mutilation and, in particular, to this case: anxieties related to sexuality, guilt feelings, aggressive and hostile urges, separation, and trauma.
Sexual Anxiety
Sexual ambivalence, involving either the rejection of or confusion about one's sexual identity, may lead to self-castration through actual genital mutilation. Likewise, other forms of self-mutilation such as skin cutting may serve as a symbolic substitute for self-castration for those who perceive their sexuality as dangerous. For example, one effect of anorexia nervosa, an indirect form of self-mutilation through starvation, is to delay or prevent the onset of physical sexual maturation, which may involve an attempt to resolve oedipal conflicts that resurface in early adolescence (Haeseler, 1991). In cases where sexual arousal is felt to be wrong or threatening, self-mutilation may function defensively, halting such feelings through the administration of pain. The pain in itself may serve as a substitute for sexual stimulation, as in the case of repressed masturbatory urges and denied gratification. Siamopoulos (1974) views self-cutting as an autoerotic activity that symbolically opens up small female genitals in the skin which become erogenous zones available for self-manipulation. Supporting the theory of self-mutilation as an autoerotic behavior is the Freudian notion that stimulus to any part of the skin or mucous membrane can be sexually exciting (Freud, 1905).
Aggression and Hostility
Self-mutilation helps to control aggression in patients who believe there is no other form of communication available to express aggressive feelings, and who lack ability to delay gratification of hostile urges. Self-mutilation may be a last resort to protect others from harm, or to defend oneself against the consequences of attacking others. The aggressor's own body becomes a substitute target for aggression. Bradford (1990) describes self-mutilation among early Christian martyrs as passive aggressive behavior in which anger toward another is projected onto God, who punishes the offender while the martyr atones for his negative feelings through self-inflicted suffering. Simultaneously, the martyr gets revenge by exhibiting his or her suffering in such a manner as to make others feel responsible and guilt-ridden. As an acted-out form of communication, self-mutilation may also function as a means to gain attention, or as a form of manipulation. By stopping short of suicide, self-mutilation helps to prevent complete self-destruction by sounding an alarm.
Purification of Guilt, Preservation of Order
As in the case of martyrdom, self-mutilation may operate as a self-purification ritual. Purification carries the hope of restoring the individual to good standing with a figure of authority and protection, such as God or mother. A child, for example, may perceive himself or herself as bad and mother as good. Self-mutilation splits the self into good and bad parts so that the good self may side with mother to punish the bad self. Self-mutilation may be an attempt to prevent rejection by others by anticipating and carrying out voluntary punishment. This may be conditioned by early childhood experiences of severe punishment as a requirement for reinstatement in the family's affections.
In tribal customs and in many religions, purification serves to restore order within the community. This may involve identification and punishment of the "evil" element, as in scapegoating, or the sacrifice of a member or animal to make amends for sinful living. In either case, violence, bloodshed, and pain are usually involved. Such rituals provide controlled outlets for communal aggression, so that social structures and orders remain intact. Among the mentally ill, self-mutilation may function similarly to release aggression and restore internal order and harmony. Self-cutting may be a purification ritual to drain away "bad blood," similar to the medical practice of bloodletting. Favazza (1987) describes the elaborate prepations of a self-cutter who mutilated when feeling guilty, anxious, or depersonalized. The ritual involved a darkened room, and a set of special containers to gather and store the
collected blood.
Boundary Diffusion and Separation Anxiety
Self-mutilation can help to restore a sense of reality. The sensation of pain may be useful in drawing the individual's awareness back into the body during depersonalized states, much as we might pinch ourselves to see if we are awake. However, some self-mutilators such as skin cutters seem to feel little or no pain and are probably soothed by the appearance of blood because the wound and blood are clear evidence that the skin boundary is intact.
Self-mutilation may be associated with a chronic lack of sensory stimulation that is in some cases thought to be due to a lack of maternal handling in infancy. The quality of touching and holding in infancy may determine whether the skin boundary is experienced as pleasurable and whether the self--what is contained inside the skin--is valued (Deri, 1984). The establishment of basic trust may depend on loving and secure holding, while, conversely, distrust and the terrifying sensation of "falling into the abyss" may result from the lack of such holding.
Bick (1986) uses the term "adhesive identification" to describe the desperate clinging behavior of some children and adults who lack a sense of self-containment. The adhesive relationship is described as two dimensional--on the surface of the object--and separation from the object is experienced as a fall into the abyss. Stimulating behaviors such as rocking, humming, and scratching or tearing at the skin may be attempts to form a "second skin" to help contain the self, and to patch over the abyss that occurs during periods of separation.
For self-mutilators, the formation of scar tissue from wounds is literally a "second skin," and the wounds and scars, as well as the collected blood, may function as transitional objects to maintain a steady connection to mother or caretaker. The wound may be cared for, nurtured and healed like a baby. Kafka (1969) gives examples of the use of the body as a transitional object. In one case, a self-cutter experienced the blood flowing from her wounds as a warm, comforting security blanket. Another self-mutilator who interfered with the healing of her wounds and dreamed of shedding her skin, is described as "preoccupied with the...unfinished business of establishing her body scheme" (p.211). Kwawer (1980) also mentions separation anxiety in connection with self-mutilating young women patients, asserting that most of them have in common "early developmental difficulties in
differentiating from a disturbed or withdrawn mother" (p. 203).
Trauma
There may be a connection between early childhood trauma and self-mutilation, based on the theory that some trauma victims compulsively seek painful or abusive experiences in an attempt to master the trauma. For example, the self-mutilator may use his or her own body as a theater to reenact the trauma of abuse, simultaneously identifying with the abuser and the victim. Disfiguring marks and scars upon the skin may serve as reminders of painful experiences, as well as records of healing and survival.
Self-mutilation may also involve amnesia and denial, symptoms which are commonly associated with Posttraumatic Stress Disorder. Pao (1969) relates self-cutting to the "cutting off" of thoughts from feelings, adding that most such patients have no memory of their early developmental histories (p. 204). The dissociated state that precedes cutting serves to distract the patient from problems, while the cutting and wounding may function to somatize a painful memory which thus remains repressed.
Culturally based initiation rites usually provide challenges for the mastery of trauma through tests of pain endurance, often involving self-mutilation and healing. These rituals prepare a young person for adulthood and sometimes for lives as warriors or sorcerers. Some of what our culture views as pathological self-mutilating behavior, particularly among adolescents, may also be viewed as attempts to seek social acceptance and initiation into adulthood through an unconscious mirroring of culturally sanctioned forms of self-mutilation.
Mary: A Case Study
Clinical History
Mary's father and mother separated when she was about 4 years old, and she claimed to have no memory of her father. Although Mary was her parents' only child, her mother had had a son with a previous partner 15 years before her birth. Mary had mostly lived alone with her mother and this half-brother lived nearby.
Mary had suffered from anxiety attacks since the fourth grade. At 11 years old, she reportedly slashed her face with a razor. Depression and somatic complaints prompted many visits to medical doctors. At 15 years old, Mary reportedly took pills on eight occasions, cut herself with razors, and burned herself. During that year, Mary also began to date a 22-year-old man. When her mother asked that she stop seeing him because he was too old for her, Mary agreed. However, when Mary admitted to having had sexual relations with the man, her mother reacted by taking an overdose of pills. It was subsequently revealed that Mary's mother had herself become sexually involved with the same man.
Distressed by the ridicule she suffered from her school peers because of her mother's behavior, Mary moved in with her half-brother, and soon after attempted suicide by cutting and burning herself. She was hospitalized for about 2 months, during which time she continued to cut and bum her arms. Mary entered day treatment for depression following her release from the hospital and was recommended for individual art therapy as an adjunct to primary therapy.
Art Productions
Drawing
Before beginning regular art therapy sessions, Mary came to the art therapy studio for a Kramer Art Evaluation (Kramer & Schehr, 1983). Tall and obese, she appeared exceptionally large for her age, with dark, shoulder-length hair that fell in a protective curtain that partially obscured her face. She shyly returned my initial greeting in a barely audible voice and then lapsed into silence for the remainder of the session. Without hesitation, she rapidly sketched a feathery outline of a cat (Figure 1). After drawing its facial features, she covered the entire body with diagonal slash marks.
Mary's drawing suggested that she may have been ambivalent about her aggressive and erotic feelings, and defended herself against those feelings with self-directed hostility. The slashmarks give the cat in Mary's drawing a scarred appearance, and its isolation in the picture space suggests that it may have turned upon itself. Its raised tail is curved toward its body, adding to the effect of self-directed aggression. The paws are missing or cut off, perhaps in a self-injurious attempt either to control or to deny the possibility of aggressive behavior. They may also have been removed to defend against, or punish, erotic urges, because the frenetic line quality of the drawing suggests masturbatory anxiety. The cat's unfocused expression betrays anxiety,
while its smile seems to express a hopeful desire to please.
Clay Sculpture, First Phase: Beginning the Figure
After Mary finished her drawing she chose to work with clay (Figure 2). She patted out a pancake, attacked and destroyed its smooth surface with her fingers, and then smashed the clay back into a ball. Next she rolled out a coil, twisted it into a pretzel shape, and then quickly crashed it with her hand. Eventually, in a deliberate manner, she began to form the separate parts of a figure, short coils for legs and arms, and balls for the head and torso. She painstakingly formed two hands shaped like bear claws with each finger attached separately. One of the hands seemed to displease her, as she mercilessly crushed it in her palm. Working patiently and methodically, she made another hand much like the one she had destroyed. When she eventually formed the figure by connecting the separate body parts, the arms were placed in a defiant position with elbows extended and hands resting on the hips. However, Mary was still dissatisfied with the hands and destroyed them, fusing the wrists onto the sides of the body. With hands removed and arms immobilized, the figure appeared more defenseless and thus less threatening.
Mary shaped the torso of the figure by layering several thin slabs of clay one over the other, as though she were adding layers of flesh. She added round balls for breasts, explaining, "It's a girl," in a quiet, embarrassed voice. She glanced at me nervously as she tentatively touched the figure's genitals and breasts, and then tenderly stroked those areas of the figure. She added a thick belt of clay on the abdomen and then repeatedly cut into it, creating a long, deep gash. She placed a similar belt around the neck and slashed it similarly. The head was adorned with shoulder length curls.
Mary reached this point in her sculpture after 2 hours of uninterrupted concentration. In a standard Kramer Art Evaluation, she would have been instructed to proceed to a painting after completing her sculpture. However, it was apparent by Mary's deep absorption in the work that she had spontaneously entered into therapy, so the remainder of the evaluation was suspended to allow her to continue with her sculpture during the next session.
Themes that were alluded to in her cat drawing were visibly acted out in the process of making the clay figure. Anxiety about hostile and aggressive urges reappeared. The claw-shaped hands that Mary destroyed paralleled the missing paws on the cat. As though the act of destroying the hands and fusing the wrists to the body did not sufficiently remove the threat of aggression, Mary directed further hostility toward the figure by wounding it in the abdomen and neck. Masturbation anxiety was again suggested by the manner in which she stroked the figure's genitals and breasts while glancing nervously at me. Though anxiety associated with erotic urges and sensations cannot be viewed as extraordinary in a girl of Mary's age, the juxtaposition of erotic urges, anxiety, bondage, and self-directed aggression did raise questions about her concept of female sexuality, and alluded to possible traumatic and/or abusive
experiences.
Clay Sculpture, Second Phase: Completing the Figure
Mary continued to work on her clay figure during the next two sessions. She smoothed the clay around the waist area, nearly obliterating the deep cut that she had made there during the first session. She cut away the collar around the neck with a knife-shaped clay tool, and without warning decapitated the figure in a single smooth stroke. Mary set the head aside, then calmly picked it up and crashed it in the palm of her hand. She then attached a second head to the body, forming a thick neck without a collar. She placed a short, boyish hair style on this head by draping thin slabs of clay over it and chopping off the ends. Holding the figure in her hands as though it were a doll, she brushed its hair with a toothbrush in slow and deliberate, yet tender movements.
She then turned her attention to forming a spherically shaped slab, with a crease down the center, which she attached to the figure's back to form protruding buttocks. She tenderly traced over and over the center crease. At this stage, the figure was complete except for the face, which was difficult for Mary to form. She several times placed features on it and then wiped them off, ultimately forming only the nose and eyebrows (Figures 2, 3).
Symbolically, the figure had so far been mutilated, decapitated, and resurrected in an altered form which exuded a more masculine quality. Viewed as a conscious or unconscious self-portrait of Mary, the figure's ambiguous identifying sexual characteristics suggest that her own sexual identity was unclear. Her mutilation of the figure's body parts might have represented symbolic self-castration as a defense against erotic feelings and/or sexual maturation. Given her mother's suicidal gesture in response to Mary's revelation of sexual activity, Mary may have feared that her sexual maturation might destroy her mother. In order to avoid further competition with her mother, Mary may have sought safety in a regression to a pre-adolescent boyish identity--a theory supported by her childlike demeanor. The figure's lack of a mouth for speech reflected the custom of nonverbal communication between Mary and her mother, who instead communicated through impulsive self-destructive acts. The lack of eyes may have alluded to Mary's reluctance to view the reality of her situation. The anger and rage toward her mother which Mary could not articulate may have been redirected upon herself in mutilating acts that indirectly communicated her pain in the form of scars. The clay figure with more masculine features may simultaneously have represented an image of her mother that included aspects of dominance and control.
Painting
Mary missed 3 art therapy sessions due to an "accident" in which a dog was reported to have bitten her right wrist. The wound required surgery. Wielding a plaster cast that extended to the middle of her fingers, she decided to begin a painting using her non-dominant left hand. She mixed colors with her left hand, holding the containers awkwardly against her body with the cast, and refusing any assistance. She was soon deeply absorbed in the painting, an activity which occupied two sessions. Her final act before declaring the painting finished was to cover the upper area of the painting with black marks (Figure 4). Mary did not say whether these marks were intended to represent birds, but they were clearly drawn in the form of check-marks. Even as the paint ran dry on the brush, Mary continued to "mark" the paper with invisible black checks. She disparaged the picture, adding that she had no idea what it was about.
Mary's painting is a dynamic composition of uncanny shapes and swirling motion. A dark ghostlike figure hovers ominously on the left. Lavender blobs appear on either side of an opening at the center of the page. The lower right-hand corner of the picture is unclear, although a brown oblong object hugs the right edge of the page. A sun cut off by the top right comer spreads yellow light across the picture, while black checks crowd the top of the page. The sharp points reminded me of the self-inflicted scars on Mary's arms. She continued to express her dislike of this painting, saying that it was an "ugly blob." It is likely that the image reflected an unpleasant state, and her repeated rejections of it constituted an attempt to defend herself from the resurgence of those conscious or unconscious feelings. The intensity of her reaction also attested to the power of the image to express and evoke feelings.
Clay Sculpture, Third Phase: Creating an Environment for the Figure
Mary returned to her sculpture, silently making a long coil which she attempted to stand upright. I intervened to secure this structure on an armature, whereupon she added layer upon layer to it, echoing the manner in which she had added bulk to the human figure. After stroking each layer smooth, she eventually crafted a tree from the coil by adding a rounded mass of clay to the top. She then made a base for the tree by pounding out a slab with a large mallet. Mary seemed soothed by this activity, which she continued for some time. She cut the clay slab into a square and settled the tree into one comer of it, adding more layers to the base of the trunk and then placing the figure next to it. She trimmed the edges of the slab until the space for the tree and figure began to appear cramped. Mary then carved on the tree trunk a heart containing her initials next to a modified peace symbol. This carving on the tree trunk was similar to her earlier cutting of gashes into the torso of the clay figure, and may have symbolically reenacted the self-inflicted cuts on her arms. Mary's final task was to complete the facial features of the clay figure. After attaching large eyeballs, she added clay to the chin area to form a jutting jawline. With considerable difficulty, she completed the mouth by cutting out lips and pasting them on. She stated that the sculpture was finished, adding emphatically that the figure "has no clothes on" (Figure 5).
Her pointed announcement that the figure was unclothed, and its placement next to the overpowering phallus-like tree suggest that Mary felt vulnerable and exposed. Her painting also seemed to include sexualized imagery. The black check-marks reminded me of the wedge shapes sometimes seen in artwork by victims of sexual abuse which have been described as "cutting points" or "something that is painful and capable of inflicting harm" (Malchiodi, 1990, p. 164).
Considering her completed sculpture, it seemed to me that Mary's placement of the clay figure within an environment indicated that she was actively attempting to create an appropriate space, however constricted, for the figure. Her extended use of the clay mallet and her addition of a protruding chin to the original figure seemed to indicate that Mary had developed more direct means of expressing aggressive feelings. The dramatic impact of the scene in Mary's sculpture suggested that she was discovering a way to "talk" through visual metaphors and perhaps was beginning to isolate and clarify aspects of the chaos pictured in her "ugly blob" painting.
In the art therapy sessions, Mary continued to accept only minimal assistance. I remained quiet and unintrusive in an attempt to create a safe place in which she could explore painful feelings related to her sexuality and individuality through the metaphorical use of imagery.
Pastel Drawings
While her clay sculpture was drying, Mary made two pastel drawings in one session. The first was a picture of a rainbow against a blue sky with a large sun in the upper right. She merged the bright colors together and then covered the sky with large black check-marks identical to those in her painting, adding a triangular-shaped group of smaller check-marks that covered a portion of the rainbow (Figure 6). Immediately, she asked to begin a second drawing. In a flurry of activity, as opposed to her usually slow working pace, she completed Figure 7.
The expansive, buoyant image of the rainbow seems to be "held in check" by the punitive check-marks which seem to add a malign element to the picture. Just as self inflicted wounds may provide relief by restoring order and cleansing the body of "bad blood," Mary's second drawing (Figure 7) seems to release a flood of dark images and negative feelings in a well-controlled manner. The sunny day of the first drawing has turned to night, and familiar figures appear: a girl, a tree, and ghoulish figures. The large ghost with its open mouth is reminiscent of the dark shape on the left side of Mary's painting (Figure 4). The little girl on the other side of the tree has freely swinging arms with clenched fists and a wide open mouth that seems to suggest direct expression of feelings. The crescent moon may have unconsciously referred to the knife that she used to cut herself.
In the fast pastel drawing (Figure 6), the parallel bands of the rainbow suggest layering, bringing to mind Mary's somewhat compulsive thickening of her clay figure and tree trunk by the addition of multiple layers of clay. The tree in the second pastel drawing is also expanded, its transparent color extending beyond the drawn outline, reminiscent of Mary's obesity, where layers of flesh may have served to protect her. Mary seemed to reenact self-mutilation while making her clay figure through the process of layering, cutting, smoothing over, and relayering the clay.
By this point in therapy, the end of the school year was approaching, and Mary knew that I would be leaving. Her final artwork was a card commemorating a deceased cat. Mary explained that this cat was special because it was her first pet, and "he let me do anything to him." With this last artwork, Mary poetically terminated art therapy by revisiting her original image of a cat, which she resurrected, commemorated, and then put back to rest.
Conclusion
This case illustrates the complexity of self-mutilation as a violent form of self-preservation. Its facets may be seen as overlapping and multi-layered, as illustrated by Mary's layered clay work. Her suicidal depression was in part related to her inability to establish her own identity in the presence of a disturbed and intrusive mother. By self-mutilating, Mary disguised her rage, substituting her body as the target, and by expressing her feelings in nonverbal symbols of pain and suffering. Mary's self-mutilation may also have helped her to recover a sense of individuality and control through the "marking" of her own skin boundary. The need for differentiation from her mother may have been a factor in Mary's apparent ambivalence about her sexuality, and self-mutilation could have been intended to damage her attractiveness and femininity. It helped her to survive and cope with the trauma associated with growing up in a deprived and disorganized environment and was also instrumental in gaining Mary access to treatment. When Mary began therapy, she seemed unable to articulate feelings of anger and aggression. Throughout the course of art therapy, these feelings found expression in her imagery and treatment of the art materials.
Implications for the use of art therapy in the treatment of patients who self-mutilate extend beyond the simple substitution of self-representations for the physical body. When Mary mutilated symbolic self-representations, her tension seemed relieved. It is inherent in the projective quality of artmaking that unconscious memories or sensations of trauma may be released, and in some cases symbolic attacks on imagery may serve to check the flooding of traumatic memories, which may consist only of isolated visual, tactile, or other sensory impressions. The nonverbal, visual, tactile, and sensory experience of working with art materials to create spontaneous images makes this medium ideal for the gradual processing of memories necessary to master trauma. Mary's continuous reworking of related themes in her artwork indicated that she was engaged in a process of recovering and integrating intense feelings. The imagination was an intermediate area where the mastery of trauma could be practiced in the relative safety of metaphor.
In the 1700s, physicians began to depict and describe skin conditions in the attempt to understand disease processes within the body (Stafford, 1991). The skin was viewed as reflecting the inner self---a smooth, unblemished skin surface, for example, was equated with inner purity and goodness while spots, discolorations, or other surface blemishes were believed to emanate from an impure soul. This concept endured and spread to esthetics, as well. For example, impressionist painters were considered artistically vulgar for breaking up the painting surface into patches of color.
I believe the surface of an artwork may at times be associated with skin in the artist's unconscious. Mary's scratching, slicing, layering, and smoothing of the surface of her artwork reflected feelings about her own body and metaphorically served as acts of healing.
The unusual manner in which Mary formed her clay figure, through the assemblage of separate body parts, and the severing and sacrificing of other parts, resonates with a common theme among creation myths--that the world was created as a result of the sacrifice and mutilation of a primordial hermaphroditic being (Favazza, 1987). The various separated body parts such as blood, bones, and flesh became water, mountains, and earth, and so on. Just as creation was envisioned as being born of violence through sacrifice and mutilation, self-mutilation itself may be viewed as a violent creative process. Art therapists are in an excellent position to nurture the creative energies that drive self-mutilating clients and to assist them in focusing their energies on metaphors and symbols of integration and individuation.
References
Bick, E. (1986). Further considerations on the function of the skin in early object relations. British Journal of Psychotherapy, 2(4), 292-299.
Bradford, D.T. (1990). Early Christian martyrdom and the psychology of depression, suicide and body mutilation. Psychotherapy, 27(1), 30-41.
Deri, S.K. (1984). Symbolization and creativity. Madison, CT: International Universities Press.
Favazza, A.R. (1987). Bodies under siege: Self-mutilation in culture and psychiatry. Baltimore: Johns Hopkins University Press.
Favazza, A.R. (1989). Normal and deviant self-mutilation. Transcultural-Psychiatric Research Review, 26(2), 113-127.
Freud, S. (1905). Three essays on the theory of sexuality. New York: Basic Books.
Haeseler, M.P. (1991,April). Finding a voice: Art therapy with eating disordered clients. Paper presented at the University of Bridgeport Art Therapy Lecture Series, Bridgeport, CN.
Kafka, J.S. (1969). The body as transitional object: A psychoanalytic study of a self-mutilating patient. British Journal of Medical Psychology, 42, 207-212.
Kramer, E. & Schehr, J. (1983). An art therapy evaluation session for children. American Journal of Art Therapy, 23, 3-12.
Kwawer, J.S. (1980). Some interpersonal aspects of self-mutilation in a borderline patient. Journal of the American Academy of Psychoanalysis, 8(2), 203-216.
Malchiodi, C. (1990). Breaking the silence: Art therapy with children from violent homes. New York: Brunner/Mazel.
Pao, P. (1969). The syndrome of delicate self-cutting. British Journal of Medical Psychology, 42, 195-206.
Siamopoulos, V. (1974). Repeated self-cutting: An impulse neurosis. American Journal of Psychotherapy, 28(1), 85-95.
Stafford, B. M. (1991). Body criticism. Cambridge, MA: Massachusetts Institute of Technology.
Author: Diana Milia
Self-mutilation is presented as a self destructive act with positive intentions toward self-healing and symptom relief, in such areas as sexual anxiety, aggression and hostility, purification of guilt and the preservation of order, boundary diffusion and separation anxiety, and trauma. This article presents the case of an adolescent girl in art therapy whose self-mutilative behavior and related problems are reflected in the content and process of her artwork. The advantages of art therapy treatment for self-mutilating clients are discussed. Not only is visual art a suitable alternative language for nonverbal acting-out self-mutilators, it also provides opportunities to exercise the same destructive and integrative urges that underlie their self-abuse. The art surface may metaphorically provide a healing function similar to that provided by self-mutilation in that it creates a protective layer--a skin--for the self, as in the formation of scar tissue.
Self-mutilation is generally viewed as a form of self-destructive behavior in which aggressive urges are acted out upon one's own body. Common forms of self-mutilation are biting, cutting, burning and hitting oneself, or banging parts of the body against walls or other objects. Other self-mutilating behaviors include abrasion of the skin, severing body parts, inserting sharp objects into body orifices, swallowing or inhaling noxious substances, and constriction of body parts (such as self-strangulation).
Although self-mutilation is particularly prevalent among adolescents, it occurs in a broad range of people of various ages. In many cultures, self-mutilation is incorporated into religious practices and social rituals. When thus culturally sanctioned, self-mutilation generally serves to purify, heal, or restore social and cosmological order. Shamanic sacrificial rituals, for example, may involve self-wounding followed by self-healing which is believed to magically purify or heal the community. Self-mutilation is considered pathological when it is idiosyncratic, or lacks esthetic value or ritual significance to the society at large. Favazza (1989) describes self-mutilation as a morbid attempt at self-healing that is not alien to humanity, but deeply rooted in our cultures and psyches through religious and social beliefs and practices.
Therapists working with people who self-mutilate need to recognize that this behavior is not purely destructive. The case study of Mary demonstrates the use of art therapy with a self-mutilating, emotionally disturbed adolescent. Parallels of self-mutilative behaviors appeared in the process and content of Mary's artwork. The plastic symbolic process of artmaking allowed her to experiment with expressing self-destructive urges in ways that could permit healing. In addition, the metaphorical content of her artwork revealed underlying psychic pressures that may have contributed to her self-mutilation. The art therapist's function was to acknowledge and witness the entire creative process of disintegration and reintegration, intervening when necessary to model integration with technical assistance and suggestions. A detailed account of Mary's progress in art therapy is provided because it was often in the subtle details of the process that her self-destructive urges were played out. Preceding the case study is a brief discussion of five inter-related areas of psychic pressure commonly associated with self-mutilation and, in particular, to this case: anxieties related to sexuality, guilt feelings, aggressive and hostile urges, separation, and trauma.
Sexual Anxiety
Sexual ambivalence, involving either the rejection of or confusion about one's sexual identity, may lead to self-castration through actual genital mutilation. Likewise, other forms of self-mutilation such as skin cutting may serve as a symbolic substitute for self-castration for those who perceive their sexuality as dangerous. For example, one effect of anorexia nervosa, an indirect form of self-mutilation through starvation, is to delay or prevent the onset of physical sexual maturation, which may involve an attempt to resolve oedipal conflicts that resurface in early adolescence (Haeseler, 1991). In cases where sexual arousal is felt to be wrong or threatening, self-mutilation may function defensively, halting such feelings through the administration of pain. The pain in itself may serve as a substitute for sexual stimulation, as in the case of repressed masturbatory urges and denied gratification. Siamopoulos (1974) views self-cutting as an autoerotic activity that symbolically opens up small female genitals in the skin which become erogenous zones available for self-manipulation. Supporting the theory of self-mutilation as an autoerotic behavior is the Freudian notion that stimulus to any part of the skin or mucous membrane can be sexually exciting (Freud, 1905).
Aggression and Hostility
Self-mutilation helps to control aggression in patients who believe there is no other form of communication available to express aggressive feelings, and who lack ability to delay gratification of hostile urges. Self-mutilation may be a last resort to protect others from harm, or to defend oneself against the consequences of attacking others. The aggressor's own body becomes a substitute target for aggression. Bradford (1990) describes self-mutilation among early Christian martyrs as passive aggressive behavior in which anger toward another is projected onto God, who punishes the offender while the martyr atones for his negative feelings through self-inflicted suffering. Simultaneously, the martyr gets revenge by exhibiting his or her suffering in such a manner as to make others feel responsible and guilt-ridden. As an acted-out form of communication, self-mutilation may also function as a means to gain attention, or as a form of manipulation. By stopping short of suicide, self-mutilation helps to prevent complete self-destruction by sounding an alarm.
Purification of Guilt, Preservation of Order
As in the case of martyrdom, self-mutilation may operate as a self-purification ritual. Purification carries the hope of restoring the individual to good standing with a figure of authority and protection, such as God or mother. A child, for example, may perceive himself or herself as bad and mother as good. Self-mutilation splits the self into good and bad parts so that the good self may side with mother to punish the bad self. Self-mutilation may be an attempt to prevent rejection by others by anticipating and carrying out voluntary punishment. This may be conditioned by early childhood experiences of severe punishment as a requirement for reinstatement in the family's affections.
In tribal customs and in many religions, purification serves to restore order within the community. This may involve identification and punishment of the "evil" element, as in scapegoating, or the sacrifice of a member or animal to make amends for sinful living. In either case, violence, bloodshed, and pain are usually involved. Such rituals provide controlled outlets for communal aggression, so that social structures and orders remain intact. Among the mentally ill, self-mutilation may function similarly to release aggression and restore internal order and harmony. Self-cutting may be a purification ritual to drain away "bad blood," similar to the medical practice of bloodletting. Favazza (1987) describes the elaborate prepations of a self-cutter who mutilated when feeling guilty, anxious, or depersonalized. The ritual involved a darkened room, and a set of special containers to gather and store the
collected blood.
Boundary Diffusion and Separation Anxiety
Self-mutilation can help to restore a sense of reality. The sensation of pain may be useful in drawing the individual's awareness back into the body during depersonalized states, much as we might pinch ourselves to see if we are awake. However, some self-mutilators such as skin cutters seem to feel little or no pain and are probably soothed by the appearance of blood because the wound and blood are clear evidence that the skin boundary is intact.
Self-mutilation may be associated with a chronic lack of sensory stimulation that is in some cases thought to be due to a lack of maternal handling in infancy. The quality of touching and holding in infancy may determine whether the skin boundary is experienced as pleasurable and whether the self--what is contained inside the skin--is valued (Deri, 1984). The establishment of basic trust may depend on loving and secure holding, while, conversely, distrust and the terrifying sensation of "falling into the abyss" may result from the lack of such holding.
Bick (1986) uses the term "adhesive identification" to describe the desperate clinging behavior of some children and adults who lack a sense of self-containment. The adhesive relationship is described as two dimensional--on the surface of the object--and separation from the object is experienced as a fall into the abyss. Stimulating behaviors such as rocking, humming, and scratching or tearing at the skin may be attempts to form a "second skin" to help contain the self, and to patch over the abyss that occurs during periods of separation.
For self-mutilators, the formation of scar tissue from wounds is literally a "second skin," and the wounds and scars, as well as the collected blood, may function as transitional objects to maintain a steady connection to mother or caretaker. The wound may be cared for, nurtured and healed like a baby. Kafka (1969) gives examples of the use of the body as a transitional object. In one case, a self-cutter experienced the blood flowing from her wounds as a warm, comforting security blanket. Another self-mutilator who interfered with the healing of her wounds and dreamed of shedding her skin, is described as "preoccupied with the...unfinished business of establishing her body scheme" (p.211). Kwawer (1980) also mentions separation anxiety in connection with self-mutilating young women patients, asserting that most of them have in common "early developmental difficulties in
differentiating from a disturbed or withdrawn mother" (p. 203).
Trauma
There may be a connection between early childhood trauma and self-mutilation, based on the theory that some trauma victims compulsively seek painful or abusive experiences in an attempt to master the trauma. For example, the self-mutilator may use his or her own body as a theater to reenact the trauma of abuse, simultaneously identifying with the abuser and the victim. Disfiguring marks and scars upon the skin may serve as reminders of painful experiences, as well as records of healing and survival.
Self-mutilation may also involve amnesia and denial, symptoms which are commonly associated with Posttraumatic Stress Disorder. Pao (1969) relates self-cutting to the "cutting off" of thoughts from feelings, adding that most such patients have no memory of their early developmental histories (p. 204). The dissociated state that precedes cutting serves to distract the patient from problems, while the cutting and wounding may function to somatize a painful memory which thus remains repressed.
Culturally based initiation rites usually provide challenges for the mastery of trauma through tests of pain endurance, often involving self-mutilation and healing. These rituals prepare a young person for adulthood and sometimes for lives as warriors or sorcerers. Some of what our culture views as pathological self-mutilating behavior, particularly among adolescents, may also be viewed as attempts to seek social acceptance and initiation into adulthood through an unconscious mirroring of culturally sanctioned forms of self-mutilation.
Mary: A Case Study
Clinical History
Mary's father and mother separated when she was about 4 years old, and she claimed to have no memory of her father. Although Mary was her parents' only child, her mother had had a son with a previous partner 15 years before her birth. Mary had mostly lived alone with her mother and this half-brother lived nearby.
Mary had suffered from anxiety attacks since the fourth grade. At 11 years old, she reportedly slashed her face with a razor. Depression and somatic complaints prompted many visits to medical doctors. At 15 years old, Mary reportedly took pills on eight occasions, cut herself with razors, and burned herself. During that year, Mary also began to date a 22-year-old man. When her mother asked that she stop seeing him because he was too old for her, Mary agreed. However, when Mary admitted to having had sexual relations with the man, her mother reacted by taking an overdose of pills. It was subsequently revealed that Mary's mother had herself become sexually involved with the same man.
Distressed by the ridicule she suffered from her school peers because of her mother's behavior, Mary moved in with her half-brother, and soon after attempted suicide by cutting and burning herself. She was hospitalized for about 2 months, during which time she continued to cut and bum her arms. Mary entered day treatment for depression following her release from the hospital and was recommended for individual art therapy as an adjunct to primary therapy.
Art Productions
Drawing
Before beginning regular art therapy sessions, Mary came to the art therapy studio for a Kramer Art Evaluation (Kramer & Schehr, 1983). Tall and obese, she appeared exceptionally large for her age, with dark, shoulder-length hair that fell in a protective curtain that partially obscured her face. She shyly returned my initial greeting in a barely audible voice and then lapsed into silence for the remainder of the session. Without hesitation, she rapidly sketched a feathery outline of a cat (Figure 1). After drawing its facial features, she covered the entire body with diagonal slash marks.
Mary's drawing suggested that she may have been ambivalent about her aggressive and erotic feelings, and defended herself against those feelings with self-directed hostility. The slashmarks give the cat in Mary's drawing a scarred appearance, and its isolation in the picture space suggests that it may have turned upon itself. Its raised tail is curved toward its body, adding to the effect of self-directed aggression. The paws are missing or cut off, perhaps in a self-injurious attempt either to control or to deny the possibility of aggressive behavior. They may also have been removed to defend against, or punish, erotic urges, because the frenetic line quality of the drawing suggests masturbatory anxiety. The cat's unfocused expression betrays anxiety,
while its smile seems to express a hopeful desire to please.
Clay Sculpture, First Phase: Beginning the Figure
After Mary finished her drawing she chose to work with clay (Figure 2). She patted out a pancake, attacked and destroyed its smooth surface with her fingers, and then smashed the clay back into a ball. Next she rolled out a coil, twisted it into a pretzel shape, and then quickly crashed it with her hand. Eventually, in a deliberate manner, she began to form the separate parts of a figure, short coils for legs and arms, and balls for the head and torso. She painstakingly formed two hands shaped like bear claws with each finger attached separately. One of the hands seemed to displease her, as she mercilessly crushed it in her palm. Working patiently and methodically, she made another hand much like the one she had destroyed. When she eventually formed the figure by connecting the separate body parts, the arms were placed in a defiant position with elbows extended and hands resting on the hips. However, Mary was still dissatisfied with the hands and destroyed them, fusing the wrists onto the sides of the body. With hands removed and arms immobilized, the figure appeared more defenseless and thus less threatening.
Mary shaped the torso of the figure by layering several thin slabs of clay one over the other, as though she were adding layers of flesh. She added round balls for breasts, explaining, "It's a girl," in a quiet, embarrassed voice. She glanced at me nervously as she tentatively touched the figure's genitals and breasts, and then tenderly stroked those areas of the figure. She added a thick belt of clay on the abdomen and then repeatedly cut into it, creating a long, deep gash. She placed a similar belt around the neck and slashed it similarly. The head was adorned with shoulder length curls.
Mary reached this point in her sculpture after 2 hours of uninterrupted concentration. In a standard Kramer Art Evaluation, she would have been instructed to proceed to a painting after completing her sculpture. However, it was apparent by Mary's deep absorption in the work that she had spontaneously entered into therapy, so the remainder of the evaluation was suspended to allow her to continue with her sculpture during the next session.
Themes that were alluded to in her cat drawing were visibly acted out in the process of making the clay figure. Anxiety about hostile and aggressive urges reappeared. The claw-shaped hands that Mary destroyed paralleled the missing paws on the cat. As though the act of destroying the hands and fusing the wrists to the body did not sufficiently remove the threat of aggression, Mary directed further hostility toward the figure by wounding it in the abdomen and neck. Masturbation anxiety was again suggested by the manner in which she stroked the figure's genitals and breasts while glancing nervously at me. Though anxiety associated with erotic urges and sensations cannot be viewed as extraordinary in a girl of Mary's age, the juxtaposition of erotic urges, anxiety, bondage, and self-directed aggression did raise questions about her concept of female sexuality, and alluded to possible traumatic and/or abusive
experiences.
Clay Sculpture, Second Phase: Completing the Figure
Mary continued to work on her clay figure during the next two sessions. She smoothed the clay around the waist area, nearly obliterating the deep cut that she had made there during the first session. She cut away the collar around the neck with a knife-shaped clay tool, and without warning decapitated the figure in a single smooth stroke. Mary set the head aside, then calmly picked it up and crashed it in the palm of her hand. She then attached a second head to the body, forming a thick neck without a collar. She placed a short, boyish hair style on this head by draping thin slabs of clay over it and chopping off the ends. Holding the figure in her hands as though it were a doll, she brushed its hair with a toothbrush in slow and deliberate, yet tender movements.
She then turned her attention to forming a spherically shaped slab, with a crease down the center, which she attached to the figure's back to form protruding buttocks. She tenderly traced over and over the center crease. At this stage, the figure was complete except for the face, which was difficult for Mary to form. She several times placed features on it and then wiped them off, ultimately forming only the nose and eyebrows (Figures 2, 3).
Symbolically, the figure had so far been mutilated, decapitated, and resurrected in an altered form which exuded a more masculine quality. Viewed as a conscious or unconscious self-portrait of Mary, the figure's ambiguous identifying sexual characteristics suggest that her own sexual identity was unclear. Her mutilation of the figure's body parts might have represented symbolic self-castration as a defense against erotic feelings and/or sexual maturation. Given her mother's suicidal gesture in response to Mary's revelation of sexual activity, Mary may have feared that her sexual maturation might destroy her mother. In order to avoid further competition with her mother, Mary may have sought safety in a regression to a pre-adolescent boyish identity--a theory supported by her childlike demeanor. The figure's lack of a mouth for speech reflected the custom of nonverbal communication between Mary and her mother, who instead communicated through impulsive self-destructive acts. The lack of eyes may have alluded to Mary's reluctance to view the reality of her situation. The anger and rage toward her mother which Mary could not articulate may have been redirected upon herself in mutilating acts that indirectly communicated her pain in the form of scars. The clay figure with more masculine features may simultaneously have represented an image of her mother that included aspects of dominance and control.
Painting
Mary missed 3 art therapy sessions due to an "accident" in which a dog was reported to have bitten her right wrist. The wound required surgery. Wielding a plaster cast that extended to the middle of her fingers, she decided to begin a painting using her non-dominant left hand. She mixed colors with her left hand, holding the containers awkwardly against her body with the cast, and refusing any assistance. She was soon deeply absorbed in the painting, an activity which occupied two sessions. Her final act before declaring the painting finished was to cover the upper area of the painting with black marks (Figure 4). Mary did not say whether these marks were intended to represent birds, but they were clearly drawn in the form of check-marks. Even as the paint ran dry on the brush, Mary continued to "mark" the paper with invisible black checks. She disparaged the picture, adding that she had no idea what it was about.
Mary's painting is a dynamic composition of uncanny shapes and swirling motion. A dark ghostlike figure hovers ominously on the left. Lavender blobs appear on either side of an opening at the center of the page. The lower right-hand corner of the picture is unclear, although a brown oblong object hugs the right edge of the page. A sun cut off by the top right comer spreads yellow light across the picture, while black checks crowd the top of the page. The sharp points reminded me of the self-inflicted scars on Mary's arms. She continued to express her dislike of this painting, saying that it was an "ugly blob." It is likely that the image reflected an unpleasant state, and her repeated rejections of it constituted an attempt to defend herself from the resurgence of those conscious or unconscious feelings. The intensity of her reaction also attested to the power of the image to express and evoke feelings.
Clay Sculpture, Third Phase: Creating an Environment for the Figure
Mary returned to her sculpture, silently making a long coil which she attempted to stand upright. I intervened to secure this structure on an armature, whereupon she added layer upon layer to it, echoing the manner in which she had added bulk to the human figure. After stroking each layer smooth, she eventually crafted a tree from the coil by adding a rounded mass of clay to the top. She then made a base for the tree by pounding out a slab with a large mallet. Mary seemed soothed by this activity, which she continued for some time. She cut the clay slab into a square and settled the tree into one comer of it, adding more layers to the base of the trunk and then placing the figure next to it. She trimmed the edges of the slab until the space for the tree and figure began to appear cramped. Mary then carved on the tree trunk a heart containing her initials next to a modified peace symbol. This carving on the tree trunk was similar to her earlier cutting of gashes into the torso of the clay figure, and may have symbolically reenacted the self-inflicted cuts on her arms. Mary's final task was to complete the facial features of the clay figure. After attaching large eyeballs, she added clay to the chin area to form a jutting jawline. With considerable difficulty, she completed the mouth by cutting out lips and pasting them on. She stated that the sculpture was finished, adding emphatically that the figure "has no clothes on" (Figure 5).
Her pointed announcement that the figure was unclothed, and its placement next to the overpowering phallus-like tree suggest that Mary felt vulnerable and exposed. Her painting also seemed to include sexualized imagery. The black check-marks reminded me of the wedge shapes sometimes seen in artwork by victims of sexual abuse which have been described as "cutting points" or "something that is painful and capable of inflicting harm" (Malchiodi, 1990, p. 164).
Considering her completed sculpture, it seemed to me that Mary's placement of the clay figure within an environment indicated that she was actively attempting to create an appropriate space, however constricted, for the figure. Her extended use of the clay mallet and her addition of a protruding chin to the original figure seemed to indicate that Mary had developed more direct means of expressing aggressive feelings. The dramatic impact of the scene in Mary's sculpture suggested that she was discovering a way to "talk" through visual metaphors and perhaps was beginning to isolate and clarify aspects of the chaos pictured in her "ugly blob" painting.
In the art therapy sessions, Mary continued to accept only minimal assistance. I remained quiet and unintrusive in an attempt to create a safe place in which she could explore painful feelings related to her sexuality and individuality through the metaphorical use of imagery.
Pastel Drawings
While her clay sculpture was drying, Mary made two pastel drawings in one session. The first was a picture of a rainbow against a blue sky with a large sun in the upper right. She merged the bright colors together and then covered the sky with large black check-marks identical to those in her painting, adding a triangular-shaped group of smaller check-marks that covered a portion of the rainbow (Figure 6). Immediately, she asked to begin a second drawing. In a flurry of activity, as opposed to her usually slow working pace, she completed Figure 7.
The expansive, buoyant image of the rainbow seems to be "held in check" by the punitive check-marks which seem to add a malign element to the picture. Just as self inflicted wounds may provide relief by restoring order and cleansing the body of "bad blood," Mary's second drawing (Figure 7) seems to release a flood of dark images and negative feelings in a well-controlled manner. The sunny day of the first drawing has turned to night, and familiar figures appear: a girl, a tree, and ghoulish figures. The large ghost with its open mouth is reminiscent of the dark shape on the left side of Mary's painting (Figure 4). The little girl on the other side of the tree has freely swinging arms with clenched fists and a wide open mouth that seems to suggest direct expression of feelings. The crescent moon may have unconsciously referred to the knife that she used to cut herself.
In the fast pastel drawing (Figure 6), the parallel bands of the rainbow suggest layering, bringing to mind Mary's somewhat compulsive thickening of her clay figure and tree trunk by the addition of multiple layers of clay. The tree in the second pastel drawing is also expanded, its transparent color extending beyond the drawn outline, reminiscent of Mary's obesity, where layers of flesh may have served to protect her. Mary seemed to reenact self-mutilation while making her clay figure through the process of layering, cutting, smoothing over, and relayering the clay.
By this point in therapy, the end of the school year was approaching, and Mary knew that I would be leaving. Her final artwork was a card commemorating a deceased cat. Mary explained that this cat was special because it was her first pet, and "he let me do anything to him." With this last artwork, Mary poetically terminated art therapy by revisiting her original image of a cat, which she resurrected, commemorated, and then put back to rest.
Conclusion
This case illustrates the complexity of self-mutilation as a violent form of self-preservation. Its facets may be seen as overlapping and multi-layered, as illustrated by Mary's layered clay work. Her suicidal depression was in part related to her inability to establish her own identity in the presence of a disturbed and intrusive mother. By self-mutilating, Mary disguised her rage, substituting her body as the target, and by expressing her feelings in nonverbal symbols of pain and suffering. Mary's self-mutilation may also have helped her to recover a sense of individuality and control through the "marking" of her own skin boundary. The need for differentiation from her mother may have been a factor in Mary's apparent ambivalence about her sexuality, and self-mutilation could have been intended to damage her attractiveness and femininity. It helped her to survive and cope with the trauma associated with growing up in a deprived and disorganized environment and was also instrumental in gaining Mary access to treatment. When Mary began therapy, she seemed unable to articulate feelings of anger and aggression. Throughout the course of art therapy, these feelings found expression in her imagery and treatment of the art materials.
Implications for the use of art therapy in the treatment of patients who self-mutilate extend beyond the simple substitution of self-representations for the physical body. When Mary mutilated symbolic self-representations, her tension seemed relieved. It is inherent in the projective quality of artmaking that unconscious memories or sensations of trauma may be released, and in some cases symbolic attacks on imagery may serve to check the flooding of traumatic memories, which may consist only of isolated visual, tactile, or other sensory impressions. The nonverbal, visual, tactile, and sensory experience of working with art materials to create spontaneous images makes this medium ideal for the gradual processing of memories necessary to master trauma. Mary's continuous reworking of related themes in her artwork indicated that she was engaged in a process of recovering and integrating intense feelings. The imagination was an intermediate area where the mastery of trauma could be practiced in the relative safety of metaphor.
In the 1700s, physicians began to depict and describe skin conditions in the attempt to understand disease processes within the body (Stafford, 1991). The skin was viewed as reflecting the inner self---a smooth, unblemished skin surface, for example, was equated with inner purity and goodness while spots, discolorations, or other surface blemishes were believed to emanate from an impure soul. This concept endured and spread to esthetics, as well. For example, impressionist painters were considered artistically vulgar for breaking up the painting surface into patches of color.
I believe the surface of an artwork may at times be associated with skin in the artist's unconscious. Mary's scratching, slicing, layering, and smoothing of the surface of her artwork reflected feelings about her own body and metaphorically served as acts of healing.
The unusual manner in which Mary formed her clay figure, through the assemblage of separate body parts, and the severing and sacrificing of other parts, resonates with a common theme among creation myths--that the world was created as a result of the sacrifice and mutilation of a primordial hermaphroditic being (Favazza, 1987). The various separated body parts such as blood, bones, and flesh became water, mountains, and earth, and so on. Just as creation was envisioned as being born of violence through sacrifice and mutilation, self-mutilation itself may be viewed as a violent creative process. Art therapists are in an excellent position to nurture the creative energies that drive self-mutilating clients and to assist them in focusing their energies on metaphors and symbols of integration and individuation.
References
Bick, E. (1986). Further considerations on the function of the skin in early object relations. British Journal of Psychotherapy, 2(4), 292-299.
Bradford, D.T. (1990). Early Christian martyrdom and the psychology of depression, suicide and body mutilation. Psychotherapy, 27(1), 30-41.
Deri, S.K. (1984). Symbolization and creativity. Madison, CT: International Universities Press.
Favazza, A.R. (1987). Bodies under siege: Self-mutilation in culture and psychiatry. Baltimore: Johns Hopkins University Press.
Favazza, A.R. (1989). Normal and deviant self-mutilation. Transcultural-Psychiatric Research Review, 26(2), 113-127.
Freud, S. (1905). Three essays on the theory of sexuality. New York: Basic Books.
Haeseler, M.P. (1991,April). Finding a voice: Art therapy with eating disordered clients. Paper presented at the University of Bridgeport Art Therapy Lecture Series, Bridgeport, CN.
Kafka, J.S. (1969). The body as transitional object: A psychoanalytic study of a self-mutilating patient. British Journal of Medical Psychology, 42, 207-212.
Kramer, E. & Schehr, J. (1983). An art therapy evaluation session for children. American Journal of Art Therapy, 23, 3-12.
Kwawer, J.S. (1980). Some interpersonal aspects of self-mutilation in a borderline patient. Journal of the American Academy of Psychoanalysis, 8(2), 203-216.
Malchiodi, C. (1990). Breaking the silence: Art therapy with children from violent homes. New York: Brunner/Mazel.
Pao, P. (1969). The syndrome of delicate self-cutting. British Journal of Medical Psychology, 42, 195-206.
Siamopoulos, V. (1974). Repeated self-cutting: An impulse neurosis. American Journal of Psychotherapy, 28(1), 85-95.
Stafford, B. M. (1991). Body criticism. Cambridge, MA: Massachusetts Institute of Technology.
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