The first time Erica, a counseling-psychology graduate student in Orland Park, hurt herself intentionally, she was just 4. In her brief lifetime, she had already been sexually abused by both parents. Her mother had been left severely mentally and physically delayed by a major brain operation, and her father has since been arrested for drugging and taking explicit photographs of Erica and for sexually assaulting another young girl.
Erica was later molested by foster parents and told by her birth mother that she would never be loved if she got fat. Unable to communicate her unimaginable anguish, Erica taught herself to use physical pain to relieve her mental hurt.
“I would scratch myself until I bled, and then I would interfere with the healing,” she recalled. In her teens, the self-injury escalated until she was cutting and burning herself on her legs, hands and arms. “I was numb. Every time I self-injured, it was always a relief. For me, it was looking at the blood and thinking, ‘I’m getting rid of what I feel.’ “
Doctors ignored Erica’s sores, treating infections with antibiotics but no prescription for counseling. Her aunt, with whom she lived throughout junior high and high school, ignored her cries for help, accusing her of being manipulative and simply seeking attention. In college, if people questioned her wounds, “I would just make up some excuse.”
Practiced by a shocking 3 million people in this country alone, according to experts in the field, self-injury is defined as the physical alteration of one’s own body tissue, via cutting, scratching, burning or purposefully breaking bones. And the self-injury can be quite covert. Knives or razor blades present an obvious threat, but a home office or kitchen boasts a virtual arsenal of equally self-injurious tools: paper clips, needles, tacks and scissors to cut oneself; oven cleaner, bleach and matches to burn. Affected individuals typically irritate the wounds to prevent healing, donning long-sleeved shirts and pants to hide the marks.
The question hangs so heavily in the air, it seems palpable: Why?
The answer, as it turns out, is analogous to the driving force behind other addictions. Much like an alcoholic seeks solace in the bottle or an anorexic is comforted by a rumbling stomach, self-injurers feel so depressed, so numb, that hurting themselves is, paradoxically, the only way they feel alive.
“The internal conflict is so overwhelming, they can’t articulate it emotionally,” said Karen Conterio, who in 1985 co-founded in Chicago the nation’s first inpatient center for self-injurers. As administrative director of S.A.F.E. (Self-Abuse Finally Ends) Alternatives, where she and co-founder Wendy Lader receive 5,000 calls per month, Conterio said the self-injurer’s actions serve to re-create a communication scenario typically reserved for childhood: “Like when a little kid skins his knee, his mom kisses it. Or when a baby’s fussy, the parent must interpret.”
Conterio said the strongest risk factor for self-injury is a poor-or non-existent-family communication network, a modern scourge made worse by a profusion of computers and televisions. About 50 percent of all self-injurers have a history of being physically–and often emotionally or sexually–abused.
“In one way, they want to punish the body,” Conterio explained. “The body was ‘bad,’ it betrayed them. When they start to heal, the pain is immense.”
Self-injurer demographics are similar to those of eating disorders: overwhelmingly female and white, intelligent and perfectionistic, much like Princess Diana, who in a 1995 BBC interview disclosed that she had dabbled in self-injury. One of her biographies reports that she threw herself into a glass cabinet at Kensington Palace and cut herself with razor blades and a lemon slicer as ways of dealing with an unhappy marriage.
Rapper Eminem sings in one song; “Sometimes I even cut myself to see how much it bleeds/It’s like adrenaline, the pain is such a sudden rush for me.”
The phenomenon made headlines recently when a Connecticut teenager was arrested for carving the phrase “Forever yours” into his girlfriend’s back. The boy, who had numerous self-inflicted cuts on his arms, reopened his wounds in jail and used the blood to draw their pet names, encircled by a heart, on the wall.
For even the healthiest of teens, adolescence is a time of physical and emotional susceptibility. S.A.F.E.’s clinical director, Lader, explained that young adults are separating from parents, their bodies are changing, their sexuality is emerging and self-esteem issues start to surface.
“It becomes, ‘There’s something wrong with me,’ not ‘There’s something wrong with this situation,’ ” Erica said. Such changes clear the way for what Lader called the “body as bulletin board” phenomenon, expressed both by healthy teens simply seeking a tattoo or piercing as well as by self-injurers.
“It’s a way to make a statement, using skin as a bulletin board to say who they are, where they belong, what their affiliation is E to set them apart,” she said. But with so many teenagers experimenting with body modification, how can a parent differentiate between a child’s harmless foray into self-expression and a more serious psychological disorder?
Dr. Barbara Stanley, a research scientist at the New York State Psychiatric Institute and Columbia University, said that body modification and self-injury do not, in fact, exist on the same continuum.
“I think it does the problem a disservice, saying [self-injury] is just a cultural variant and just further down the continuum from body modification,” she said. “There’s nothing pretty about self-injury. People can’t fathom it-even people who treat it.”
According to Lader, key factors distinguishing self-injury from body modification include motivation and drive. A healthy teenager may seek out an assortment of piercings without being at risk for self-injury. The problem has appeared when the desire evolves into a need. “They see blood as life-affirming,” Lader said. As Erica explained, “I made a conscious choice. It wasn’t painful in the moment. I was so caught up in getting it released that I just shut that part out.”
In an effort to tease out the factors feeding into self-injury, Stanley has been conducting research comparing its possible clinical and biological roots. Stanley said research has indicated a possible link between self-injury and the release of pain-regulating opiates. This may explain why sufferers are able to cut or burn themselves, undeterred by pain that would otherwise prove unbearable.
“In the moment,” Erica said, “it’s trancelike.”
In December 2000, Erica attended S.A.F.E., where she and Lader developed a bond much different from those she had experienced with previous therapists. (One therapist had once exclaimed, “Wow, your parents really did a number on you,” Erica recalled, still in disbelief.) At S.A.F.E., now housed in Linden Oaks Hospital at Edward in Naperville, patients sign a contract agreeing not to self-injure. Erica said she received non-judgmental treatment, and the onus was placed on her to make healthy, responsible decisions.
Ultimately, according to Lader and Conterio, patients have to want to get better, and it appears that most agree. S.A.F.E. estimates its two-year success rate at about 75 percent.
“We have patients who have been told, `You will be nothing, you can accomplish nothing,’ ” Conterio said, “and they’re getting married, holding down a job.”
Outside and in, the wounds are healing.
