Articles: Self-Injury Gaining Public, Scientific Notice
By Ann Japenga
Self-injury is a taboo coping behavior, like bulimia and anorexia.
A Canadian convent school in the 1960s. Mary Graham is sitting on the tile floor of the girls' bathroom, her regulation navy blue skirt fanned out around her knees. The room is quiet; everyone else is in class.
A troubled, lonely teen-ager, Mary has recently found an ally in her English teacher. But now Mary has learned that she is to be transferred from the English class. She feels exiled by the one person who seemed to care about her.
Before reading what Mary does next, remember that all of us have do-it-yourself approaches to regulating our emotions. When frightened, hurt or enraged, we consume chocolate or self-help books; we exercise obsessively, binge, purge, pray, scream. Some of our methods are more socially acceptable than others.
Mary removes the blade from the razor she uses to Shave her legs. She rolls up the sleeve of her white blouse and makes two quick cuts on her inner forearm. This is not a suicide attempt. Mary does not want to die. By inflicting pain on herself, she wants to stop hurting.
Later, there will be a trip to the emergency room, a stint at a psychiatric hospital, expulsion from school. For the moment, however, Mary is relieved. For much of her adult life, whenever she feels afraid or anxious, she will turn to this same rash cure and feel the same momentary relief.
Mary Graham is 45 now, a big-boned, healthy-looking woman with an open face and frank manner. The mother of two teen-agers, she has not cut herself for four years, thanks to a special treatment program. But she still spends a lot of time talking to people about self-injury, trying to make them comprehend what seems incomprehensible.
When a horrified talk show host questioned the sanity of anyone who would willfully hurt herself, Graham pinned him with her level gaze. "Oh, we're very sane," she assured him.
Then why did Graham do it? "It calmed me down. It made me feel better," she said. "It was almost like taking tranquilizers. I'd injure myself, get tired, and fall asleep. And when I woke up things seemed to be better."
Like bulimia and anorexia, behaviors that once seemed unthinkable, self-injury is a taboo coping behavior that is starting to emerge in the public spotlight. Studies say an estimated 1,400 out of 100,000 people will at some time seek solace in self-directed acts of violence such as cutting (the most common) or burning themselves or even breaking bones. That makes the activity about half as common as eating disorders. One Ann Landers column on the subject inspired more than 15,000 replies from self-injurers.
The practice is starting to get scientific attention as well. In the past decade, several hundred studies on the topic have been published. According to Armando Favazza, a psychiatrist who has studied the phenomenon, the typical self-injurer is a woman in her late 20s who began harming herself as a teen-ager to cope with overwhelming psychic pain.
The ranks of cutters and slashers, as they are sometimes called, are disproportionately female, perhaps because the majority of people who harm themselves were abused as children, and girls are more likely to be victims. Self-injurers may also be anorexic or bulimic or have other impulse disorders such as kleptomania.
No one knows why someone chooses cutting over other stress-relieving activities. Some scientists theorize that self-mutilation prompts the release of endorphins -- the feel-good brain chemicals associated with runner's high -- but no one has been able to prove a link.
Psychological explanations are more plausible, said Favazza, author of "Bodies Under Siege: Self-Mutilation in Culture and Psychiatry." For some people, the behavior might be a manipulative way of getting attention. Others find release in punishing themselves.
Whatever the origins of the behavior, one thing is clear: Once someone discovers that self-injury makes her feel better, the act can become habitual. Mary Graham's early experience on the bathroom floor conditioned her to rely on bloodletting whenever she was feeling emotionally overloaded.
She eventually married, had children, and stopped injuring herself for a time. But the slashing resumed about six years ago, when her marriage began to deteriorate.
Graham was then working as a delivery person for a drugstore. She kept a first-aid kit in the delivery car and five or six razor blades hidden in her purse. In the emotional aftermath of an argument at home, she might park the car in a secluded spot or take a walk into the woods. Then she would again resort to her favorite pacifier.
"I was running away from things I couldn't handle," she said. "It was like an addiction."
It's not that Graham wanted to keep scarring herself. She had gone to a psychiatrist for help, but his verdict was that she was hopeless.
Such harsh judgment is not unusual. Medical personnel have been known to withhold anesthetic while suturing a self-injurer. And emergency room staff often relegate the woman who repeatedly slashes her arms or legs to less urgent status than the "real" emergency cases.
"You know, I didn't go to medical school so I could spend my time stitching up self-mutilators," one doctor told a patient, according to a newsletter for people who injure themselves.
Yet self-injurers can be helped.
Graham sought aid a second time four years ago when she heard about the nation's only inpatient treatment program for self-injurers, at Hartgrove Hospital in Chicago.
The program, which started in 1986, focuses not on the practice of self-injury but on the psychological problems that underlie it. "I treat self-injury as a response to whatever the individual is feeling or doesn't want to feel," said director Karen Conterio.
In the program, Graham was encouraged to explore the abuse, abandonment or other trauma that might be triggering her urge to cut. Some Hartgrove patients also are treated with Prozac and other medications that increase the amount of serotonin available to the central nervous system.
Several recent studies suggest these medications may reduce the incidence of self-injury because they decrease impulsive behavior, and they have become a standard course of treatment for active cutters, said Favazza. Beyond that, there is no single agreed-upon psycho-therapeutic approach.
The Hartgrove program teachers patients alternative ways of discharging the tension that drives their careening emotions, as well. Some former cutters now draw, write or talk when an urge to hurt themselves strikes. Graham takes fast walks in the woods when she feels inclined to reach for the razor.
But the most valuable part of the program for Graham was a "no harm" contract she was required to sign, promising that she would not injure herself for the 30 days she was in residence. Conterio believes people who hurt themselves can, in essence, "just say no." Living up-to the contract convinced Graham that she was in control of her actions and was not, in fact, hopeless.
Conterio has not formally followed up on the Hartgrove program graduates, who come from all over the country, but she believes the prognosis for self-injurers is good. "They can go on to enjoy their lives," she said.
Graham used to cover her scars with excuses: She'd had an operation; she'd gone through the windshield. "Now if someone asks, I just tell them, 'I did it myself,' "she said.
According to researchers and self-injurers alike, the most helpful thing you can do if you hear such an admission is to take it in stride.
"Try not to make it bigger than it is," said a 24-year-old social services worker who injures herself. "People get defined by this one behavior, but we are so much larger than that."
A Canadian convent school in the 1960s. Mary Graham is sitting on the tile floor of the girls' bathroom, her regulation navy blue skirt fanned out around her knees. The room is quiet; everyone else is in class.
A troubled, lonely teen-ager, Mary has recently found an ally in her English teacher. But now Mary has learned that she is to be transferred from the English class. She feels exiled by the one person who seemed to care about her.
Before reading what Mary does next, remember that all of us have do-it-yourself approaches to regulating our emotions. When frightened, hurt or enraged, we consume chocolate or self-help books; we exercise obsessively, binge, purge, pray, scream. Some of our methods are more socially acceptable than others.
Mary removes the blade from the razor she uses to Shave her legs. She rolls up the sleeve of her white blouse and makes two quick cuts on her inner forearm. This is not a suicide attempt. Mary does not want to die. By inflicting pain on herself, she wants to stop hurting.
Later, there will be a trip to the emergency room, a stint at a psychiatric hospital, expulsion from school. For the moment, however, Mary is relieved. For much of her adult life, whenever she feels afraid or anxious, she will turn to this same rash cure and feel the same momentary relief.
Mary Graham is 45 now, a big-boned, healthy-looking woman with an open face and frank manner. The mother of two teen-agers, she has not cut herself for four years, thanks to a special treatment program. But she still spends a lot of time talking to people about self-injury, trying to make them comprehend what seems incomprehensible.
When a horrified talk show host questioned the sanity of anyone who would willfully hurt herself, Graham pinned him with her level gaze. "Oh, we're very sane," she assured him.
Then why did Graham do it? "It calmed me down. It made me feel better," she said. "It was almost like taking tranquilizers. I'd injure myself, get tired, and fall asleep. And when I woke up things seemed to be better."
Like bulimia and anorexia, behaviors that once seemed unthinkable, self-injury is a taboo coping behavior that is starting to emerge in the public spotlight. Studies say an estimated 1,400 out of 100,000 people will at some time seek solace in self-directed acts of violence such as cutting (the most common) or burning themselves or even breaking bones. That makes the activity about half as common as eating disorders. One Ann Landers column on the subject inspired more than 15,000 replies from self-injurers.
The practice is starting to get scientific attention as well. In the past decade, several hundred studies on the topic have been published. According to Armando Favazza, a psychiatrist who has studied the phenomenon, the typical self-injurer is a woman in her late 20s who began harming herself as a teen-ager to cope with overwhelming psychic pain.
The ranks of cutters and slashers, as they are sometimes called, are disproportionately female, perhaps because the majority of people who harm themselves were abused as children, and girls are more likely to be victims. Self-injurers may also be anorexic or bulimic or have other impulse disorders such as kleptomania.
No one knows why someone chooses cutting over other stress-relieving activities. Some scientists theorize that self-mutilation prompts the release of endorphins -- the feel-good brain chemicals associated with runner's high -- but no one has been able to prove a link.
Psychological explanations are more plausible, said Favazza, author of "Bodies Under Siege: Self-Mutilation in Culture and Psychiatry." For some people, the behavior might be a manipulative way of getting attention. Others find release in punishing themselves.
Whatever the origins of the behavior, one thing is clear: Once someone discovers that self-injury makes her feel better, the act can become habitual. Mary Graham's early experience on the bathroom floor conditioned her to rely on bloodletting whenever she was feeling emotionally overloaded.
She eventually married, had children, and stopped injuring herself for a time. But the slashing resumed about six years ago, when her marriage began to deteriorate.
Graham was then working as a delivery person for a drugstore. She kept a first-aid kit in the delivery car and five or six razor blades hidden in her purse. In the emotional aftermath of an argument at home, she might park the car in a secluded spot or take a walk into the woods. Then she would again resort to her favorite pacifier.
"I was running away from things I couldn't handle," she said. "It was like an addiction."
It's not that Graham wanted to keep scarring herself. She had gone to a psychiatrist for help, but his verdict was that she was hopeless.
Such harsh judgment is not unusual. Medical personnel have been known to withhold anesthetic while suturing a self-injurer. And emergency room staff often relegate the woman who repeatedly slashes her arms or legs to less urgent status than the "real" emergency cases.
"You know, I didn't go to medical school so I could spend my time stitching up self-mutilators," one doctor told a patient, according to a newsletter for people who injure themselves.
Yet self-injurers can be helped.
Graham sought aid a second time four years ago when she heard about the nation's only inpatient treatment program for self-injurers, at Hartgrove Hospital in Chicago.
The program, which started in 1986, focuses not on the practice of self-injury but on the psychological problems that underlie it. "I treat self-injury as a response to whatever the individual is feeling or doesn't want to feel," said director Karen Conterio.
In the program, Graham was encouraged to explore the abuse, abandonment or other trauma that might be triggering her urge to cut. Some Hartgrove patients also are treated with Prozac and other medications that increase the amount of serotonin available to the central nervous system.
Several recent studies suggest these medications may reduce the incidence of self-injury because they decrease impulsive behavior, and they have become a standard course of treatment for active cutters, said Favazza. Beyond that, there is no single agreed-upon psycho-therapeutic approach.
The Hartgrove program teachers patients alternative ways of discharging the tension that drives their careening emotions, as well. Some former cutters now draw, write or talk when an urge to hurt themselves strikes. Graham takes fast walks in the woods when she feels inclined to reach for the razor.
But the most valuable part of the program for Graham was a "no harm" contract she was required to sign, promising that she would not injure herself for the 30 days she was in residence. Conterio believes people who hurt themselves can, in essence, "just say no." Living up-to the contract convinced Graham that she was in control of her actions and was not, in fact, hopeless.
Conterio has not formally followed up on the Hartgrove program graduates, who come from all over the country, but she believes the prognosis for self-injurers is good. "They can go on to enjoy their lives," she said.
Graham used to cover her scars with excuses: She'd had an operation; she'd gone through the windshield. "Now if someone asks, I just tell them, 'I did it myself,' "she said.
According to researchers and self-injurers alike, the most helpful thing you can do if you hear such an admission is to take it in stride.
"Try not to make it bigger than it is," said a 24-year-old social services worker who injures herself. "People get defined by this one behavior, but we are so much larger than that."