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Self mutilation in psychiatry - one patients view by Anonymous Once, on a March night, I returned to my hotel room in a state of extreme psychic distress. I found suicide inviting, but could not bear to abandon my children. I found myself searching for a sharp blade, but could not find one (I had packed only what was needed for a short stay). Finally, I put a disposable razor into my mouth and bit down hard, freeing the blade within. I was then frightened as well, because I felt I was slipping out of control. I had no more idea of what that hand with the blade would do than if it were the hand of another person. I gently dragged the blade over my body, taking in how it felt. When it felt right, I pushed it hard against my skin and slid it along. I cut again and again and again... To my great surprise, the tension and anxiety eased. I felt some pain, but also a powerful almost erotic pleasure. Who would have thought that one would become hooked after the first try. I cut often for the next 7 months or so. In the end I was hospitalized for mania, and after that had little desire to cut. I was lucky, most cutters continue for years. Also, I never cut deeper than the skin, when I reached the point where you could lift up the skin on one side of the incision, while the other side did not move I stopped (more often I started a new incision). I liked seeing the blood flow in little streams along my skin. Several times I wrote angry notes to my estranged wife, in blood. Once, I cut with a girlfriend present, and she played with the blood, making designs upon both herself and me. My cutting produced scars and keltoids very similar in appearance to the results of decorative cutting shown in the body-mod E-zine. The designs were far less artistic, and I eventually began to use "steri-strips" (essentially a kind of tape for skin) to hold the wounds closed and reduce scarring. Other than the time I cut with my girlfriend (that was essentially a command performance), my cutting had features that are in common with the overwhelming majority of cutters:
"Cutters" are all different. I tended to make many shallow cuts, while some make one or two short deep cuts. Some cut to experience pain, while others cut to lose blood. Many cutters engage in other forms of selfinjury, most often burning, while some self mutilators don't cut at all, but only burn, or break bones, or ... There are documented cases where cutting seems to have been "contagious". Outbreaks typically occur in institutions, such as prisons and some mental hospitals. In one correctional institution for girls over 80% of the inmates began to cut, during one outbreak. Intentional harm to oneself is surprisingly common, it has been estimated that 0.75% of the population engages in "self-mutilation" (note that self-mutilation has become the accepted term for self harm, even though the "mutilation" is often mild). Thus, with the exception of the mainstream body-mods, such as ear-piercing, small tattoos, etc., self-mutilation is more common than body modification. For comparison, the major mental illnesses, schizophrenia, and manic-depressive disorders each has an incidence in the 1% range. Self-mutilation covers a wide range of behaviors, from making shallow cuts on the skin (cutting) to eye enucliation. The severe forms, such as eye enucliation or castration are extremely rare, while cutting accounts for most of the self harm, followed by burning and then bone-breaking. By definition, self mutilation does not include suicide attempts, or injury that is incidental to another activity, such as masturbation. In short, it includes injury done with intent to injure, but not to kill. Self-mutilation usually causes severe suffering for its practitioners. Those who cause serious harm require hospitalization to treat the injuries and have long painful (and expensive) recuperations. Most cutters feel very alone, as they are not knowledgeable as to the widespread nature of the practice. A sense of social isolation arises, as they are different from "normal" people. They have conspicuous scars, which cannot easily be explained, and often wear long pants and long sleaved shirts all year round. I have heard it suggested that cutters turn to piercing, etc., as a more socially acceptable outlet for the need to experience injury. In this vein, I have several ear piercings which I actually enjoyed getting, while others seem to regard piercing as something to be endured for the sake of beauty. Cutters tend to be far more likely to be female than male (I am male, so this does have exceptions). Cutters also have a large likely hood to have an eating disorder, particularly bulimia, or anorexia. Often a person will cut for a period, then stop cutting, but become bulimic and so on. Selfmutilation is often regarded as being part of the personality damage which results from childhood sexual abuse. In my case, however, it appears to be a way to deal with some of the less pleasant mood states resulting from manic-depressive illness. Cutting is almost allways a method to deal with a more fundamental problem. One is often worse off if cutting is stopped without first treating the underlying problem. To get a better perspective of the phenomena, I recommend the following books and web sites (and references therein). Books Bodies Under Siege -- Self-Mutilation in Culture and Society by Armando R. Favazza, M.D. This is generally regarded as the best overall book on the subject. If it has any drawbacks, they are that it devotes too little time to minor mutilations such as superficial cutting, and the causes thereof. On the other hand there is a wealth of information on severe mutilation, especially in other cultures. This covers such related topics as castration of Chinese men who intend to work for the emperor, scalping, etc. which are not strictly Self-Mutilation. Women Who Hurt Themselves -- A Book of Hope and Understanding by Dusty Miller. Despite the title, much of what is in this book applies to men too. The emphasis of this book is upon victims of childhood abuse, which accounts for many, but not all self-mutilators. Within this range it is very good. How to get help I have not located many sources of help that are specific to self-mutilation. The first step is to recognize that you are not the only one that does this, and that it is treatable. The Secret Shame website gives things one can do to lessen the need for cutting. I have occasionally been able to defuse the desire to cut by talking to a friend. Tragically, some cutters are so socially isolated that they feel they have noone to call, at least no one they trust. If you are a victim of child abuse, severe trauma, or you you have another condition(i.e. Borderline personality), then seek help for that condition first. Most cities have self help groups which meet in person, and there are also resources on the internet. Rock Creek Center has an inpatient program specifically for self-mutilation and they have an 800 number, 1-800-DONTCUT. They have information packages and can help by giving referrals. Most of the psychiatrists and psychologists I have talked to have some knowledge of self-mutilation. Most self-mutilators can benefit from professional help, and should attempt to attain it. Be warned that finding a compatible therapist is quite difficult, often the first one will not be appropriate for you. Where I live there is some free mental health treatment available, to anyone. I also know of people on medical assistance (in the US) who are able to get very good care. If you don't have money, you can still get treatment. Where I live, there is a "firstcall for help" telephone number, for people who need help and don't know where to get it. Top of page Webmaster: wulff@ratatosk.net |