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This is where the cutting started. I was desperate for the release, the rush of adrenaline, the distraction, the sense of justified punishment, that I knew would come with more serious self-injury. I was about 15 when I pried apart a disposable razor and removed the blade. I had no real understanding of what it would take to kill myself, so my cuts were very tentative at first, and in a hidden spot: my upper arms and shoulders. As I began to realize that a lot of blood didn't mean bleeding to death, I got more and more daring, commensurate with my need for increasingly severe injury to achieve the same result. While I was doing more and more damage to my body all the time, my parents never mentioned my wounds, which had now started appearing on my forearms and legs, and so I never received stitches. Knowing what I know now, there were at least a dozen occasions on which I needed them.

In order to understand self-injury, you must understand that it is wholly separate from suicidal ideation. A person who self-injures is not trying to kill herself, though she may also be suicidal. The driving force behind each is very different, as I see it: Self-injury is an attempt to soothe oneself, so that one can survive, while suicide is a complete surrender to pain. Speaking from my own experience, I can say that when I have been suicidal, I have had no hope whatsoever. When I have had impulses to self-injure or do in fact injure myself, however, I do have hope and realize I need only to get through this particularly awful moment, or hour, or day, and things will get better.

Most people who have never deliberately hurt themselves are generally pretty confused and often horrified that anybody could consider such a thing, much less get relief and comfort from it. While it is different from drug abuse in many ways, it is in others quite similar. A person uses a drug, such as alcohol, to escape a bad day, a troubled relationship, painful memories, or any number of negative emotions. Drinking numbs the person's emotions to a point where they are either bearable or not felt at all. Self-injury works similarly. An emotion, any emotion (anger, sadness, loneliness, fear, self-loathing), begins and then escalates to an unmanageable level. A healthy person with normal coping mechanisms might at this point call a friend, or cry, or take a hot bath. Someone who hasn't learned how to soothe herself in a healthy way but still needs a release from the pent-up emotion and pain may turn to self-injury as a means to do so.

Here's how my ritual goes: I feel particularly bad for whatever reason, and my first thought is to hurt myself. I have to weigh the advantages and disadvantages of doing so, because fresh wounds will probably catch someone's attention and put me (and them) in an uncomfortable situation. But if I do decide to cut myself, I start with a box of razor blades, a bathtub of hot water, and some dark-colored towels to catch the blood. I set the razor blades and towels, along with bandages and gauze and tape, near the bathtub. I think for quite some time about where I should cut: Where will they be least likely to be seen? Where will they be least dangerous? Where will I be able to do it deeply enough to satisfy myself yet still be able to perform my daily activities while the wounds heal? Once I have picked a spot, I decide on the number of cuts I will make. It must always be an even number, which speaks to my obsessive tendencies. The number of cuts decided upon, I remove a blade from the box and set one corner against my skin, applying pressure. Once the skin has been punctured, I drag the edge of the blade to the length I want the cut to be. I do this as many times as I've decided I need cuts, and I make sure the cuts are evenly spaced and exactly the same length and depth.

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