Egan, J. (1998, July 27). "Cutting: In an age of tattoos, nose rings and anorexia, self-mutilation is the latest expression of self-loathing." The New York Times Magazine, pp. 21-48.

OVERVIEW

Jill is a good looking, 16-year-old, 5 foot 10 inch, cheerleader with long blond hair. She won her squad’s coveted Spirit Award last year. Jill lives, and attends a Catholic high school, in a nice Irish section of Chicago’s South Side. She travels with an elite group, the cheerleaders and popular athletes. She is popular at school and at parties. Still, she is miserable: "in truth, the pressures of adolescence have wreaked extraordinary havoc in Jill’s life."

Listen as Jill talks frankly about her life:

I feel I have to be all cute and sexy for these boys. And the next morning when I realize what a fool I looked like, it’s the worst feeling ever...‘Oh God, what did I do? Was I flirting with that boy? Is his girlfriend in school tomorrow going to give me a hard time? Are they all going to hate me?’

Around my house there’s this park, and there used to be like a hundred kids hanging out up there (as she recalls her first year of high school). And the boys would say stuff to me that was so disgusting...perverted stuff, and I’d just be so embarrassed. But the older girls assume that I was a slut...They’d give me dirty looks in school.

It is natural for a girl to blame herself for such peer abuse, and that blame easily turned into shame and isolation. It all got worse that year when a boy she’d trusted began to spread gossip about her.

He goes and tells all his friends that I did all this sexual stuff with him, and I was just blown away. It made me feel dirty, like I was absolutely nothing.

I was in the bathroom going completely crazy, just bawling my eyes out, and I think my mom was wallpapering—there was a wallpaper cutter there. I had so much anxiety, I couldn’t concentrate on anything until I somehow let that out, and not being able to let it out in words, I took the razor and started cutting my leg and I got excited about seeing the blood. It felt good to see the blood coming out, like that was my other pain leaving, too. It felt right and it felt good for me to let it out that way.

The temporary relief from so much distress pulled Jill into a pattern of habitual cutting. "Once she left school early, sat in an alley and carved ‘Life Sucks’ into her leg with the point of a compass." Finally one of her friends figured out something was wrong and notified her parents. They took her to Children’s Memorial Hospital where she was given Prozac for depression. She found relief in this for a while, but during the summer of 1996 she began cutting again, and burning, her upper thighs, so her parents could not see the marks. She even wore boxers over her bathing suit. But by January, 1997, she was suicidal. Still, no one had diagnosed Jill’s behavior as self-mutilation.

Self-injury is more common than many realize:

• Princess Diana admitted cutting herself during her unhappy marriage.
• Johnny Depp publicly showed arms with scars from self-inflicted wounds.
• "Female Perversions" is a movie about self-mutilation.
• Psychiatrist Steven Levenkron wrote a novel in the 1970s about anorexia and wrote another in the 1990s about self-mutilation.
• Psychiatric professor Armando Favazza has written a comprehensive book about this ailment, Bodies Under Siege, 1996.
• Marilee Strong’s A Bright Red Stream, 1998, looks at a nation obsessed with cutting.

Dr. Favazza estimates there are two million sufferers from this behavior in the U.S. He defines self-mutilation as "the direct, deliberate destruction or alteration of one’s own body tissue without conscious suicidal intent." His estimates refer to "moderate/superficial self-mutilation" in contrast to involuntary acts such as autistic head banging, or coarse self-mutilations such as the "eye enucleations and self-castrations of psychotics."

Examples of moderate/superficial self-mutilation include:

• cutting
• burning
• plucking hairs from one’s head or body (trichitillomania)
• bone breaking
• head banging
• needle poking
• skin scratching or rubbing skins with sharp glass

Some will tend to see the popularity of tattoos and piercing as something similar to cuttings. (Seemingly, between these body acts is body manipulation: scarification and branding of traditional societies, the flagellant cults of medieval Christianity, and today’s body arts of the new tribalists as well as S&M.)

The fact that awareness to self-mutilation is growing at a time when tattooing, piercing, scarification and branding are on the rise has not been lost on researchers. While experts disagree on the relationship between the behaviors, the increasing popularity of body modification among teenagers, coupled with the two million people who are injuring in secret, begins to make us look like a nation obsessed with cutting (as Marilee Strong has suggested).

Jill’s life came to a crisis in January because of an evening’s events one night mid-way through her Sophomore year. She was trying to do the right things at parties, but once again she got drinking too much.

I was supposed to stay at my best friend’s house, but she left and I didn’t go with her. I was drunk, and it was me down there in the basement with all these boys...I’d walk by and they’d grab my butt or something, so I sat on a chair in the corner. And they tipped it over and made me fall off of it.

Finally realizing the danger of her situation, she went upstairs to get a friend to take her away. That didn’t work out. She was afraid to call her parents and had nowhere to go. She actually ended up at a friend’s 20-year old brother’s place nearby. This turned out just as badly.

I wake up the next morning, and these guys were basically dirty 20-year-olds, and they tell me: ‘You want a job living here with us? We’ll pay you a hundred bucks if you strip for us once a week.’...I was just like: ‘I have to go home! I have to go home!’

When she did at last get home that morning, she found out she was grounded. Shame, guilt, and confusion were pounding within her.

All Sunday I just slept and slept, and I was so depressed, so disgusted with myself...I felt like the dirtiest thing ever because of everything that had happened the night before.

By now both her parents and the friend, with whom she was supposed to stay, were angry at her. As popular as she was, why didn’t she talk it over with friends and get some support and reassurance from them?

I felt really inferior to them (her cheerleading friends), like they’re so much better at everything than me. I feel like I have to be the pleaser, and I can never do anything wrong. When I fail to make other people happy, I get so angry with myself.

She so dreaded going to school Monday; by then, many would have heard of her drunken situation and would be critical of her.

Monday morning came and I was scared to death to have to go to school and see people. I started cutting myself. First I used a knife—I was in the bathroom doing it and then I told my mom because I was scared. She was like, ‘Why the hell are you doing this? You’re going to give me and your father a heart attack.’...She took the knife away. So then I took a candle holder and went outside and cracked it against the ground and took a piece of glass and started cutting myself with that, and then I got fingernail clippers and was trying to dig at my skin and like pull it off, and it didn’t help anymore, it wasn’t working...That night, I was like, ‘My mom is so mad at me, she doesn’t even care that I was doing this,’ so that’s when I took all the aspirin (maybe 30)...That night was the scariest night of my life. I was puking and sweating and had ringing in my ears and I couldn’t focus on anything.

It is amazing that Jill slept and made it through another day. Only that evening did she tell her parents what she had done. She was rushed to the hospital and put in intensive care for three days (suffering from arrhythmia or irregular heartbeat) with IV s working to flush out the results of her overdose.

Jill’s parents were shocked. Her father is a soft-spoken lieutenant in the police force who speaks very carefully:

That was very shocking, to think that she was going through so much pain without us being aware of it. That’s a ton of denial. It’s like: ‘It happened once, it’s never going to happen again. It happened twice, it’s not going to happen three times.’ The third time you’re like...(but that thought seems too hard for him to finish).

Self-mutilation does happen again and again, rarely stopping after two or three incidents.

According to the only large-scale survey ever taken of self-injurers (240 American females), in 1989, the average (cutting or self-mutilation) practitioner begins at 14—as Jill did—and continues injuring, often with increasing severity into her late 20s. Generally white, she is also likely to suffer from other compulsive disorders like bulimia and alcoholism. Dr. Jan Hart, who surveyed 87 high-functioning self-injurers for her 1996 doctoral dissertation at UCLA, found their most common professions to be teacher, nurse, followed by manager.

The notion of teachers, nurses and high school students like Jill seeking ways to hurt themselves in a culture where the avoidance of pain and discomfort is a virtual obsession may seem paradoxical. But it isn’t. People harm themselves because it makes them feel better; they use physical pain associated with feelings of anger, sadness or abandonment. Often, the injury is used to relieve the pressure or hysteria these emotions can cause, as it did for Jill; it can also jolt people out of states of numbness and emptiness—it can make them feel alive.

In other words, it is better to feel something, anything at all, than to feel nothing. Self-mutilation seems to give the sufferer back some control over a life that is out of control or under the control of others—and brings feeling back into an intolerable numb void.

In Women Who Hurt Themselves, author Dusty Miller portrays a society that gives approval to a kind of antagonistic relationship between women and their bodies.

Our bodies are always too fat, our breasts are too small...The body becomes the object of our own violence.

Although women seeking treatment for self-inflicted injuries far outnumber men, it will surprise most that the ratio of self-mutilation between boys and girls is almost equal. (And it shows that men too are subject to social toxins in regards to themselves and their bodies.) Self-Mutilators Anonymous is a New York support group founded by two men in 1986. One of the founders is Sheldon Goldberg (59) who gouged his face with cuticle scissors to dig out ingrown hairs.

I would have so many bandages on my face from cutting that I would sit on the subway all dressed up to go to work and people would look at me and I would realize a wound had opened up and I was bleeding all over my shirt. (Now, five reconstructive operations later, the lower half of Goldberg’s face is solid scar tissue.) But men can get away with it. When people ask me what I happened, I say: ‘I was in the war. I was in a fire.’ Men can use all the macho stuff.

The arms and legs of self-mutilators can be an appalling sight. Jamie was twice a patient at the same psychiatric center in Illinois where Jill was treated. Of her wounds she says:

I can look at different scars and think, yeah, I know when that happened, so it tells a story. I’m afraid of them fading.

Jill went from her psychiatric treatment center to SAFE (Self-Abuse Finally Ends) the only in-patient treatment center (in 1997) for this affliction. It is located at Keepataw Lodge at the Rock Creek Center (a general psychiatric institution in Lemont, IL). Mornings she studies lessons faxed from her school at the hospital’s adolescent program; afternoons is for individual and group therapy sessions. She looks good and is relieved to be "surrounded by people with her same problem."

It’s really weird how many people in the group have my same kind of thinking. How they grew up feeling like they didn’t deserve to feel their feelings, like they had to keep people happy...I don’t even know who I am anymore, because everything I do depends on what other people want.

It was nice to have her cheerleading friends visit with cards and magazines, but it was also awkward "playing hostess on the grounds of a mental hospital."

I’d make up things like, ‘Oh, I have a group in 10 minutes, so you guys better leave,’ because I couldn’t take it to have them sitting there and me not knowing how to make them happy in such a weird environment.

As Jill returns home and continues her therapy, her parents worry about a relapse. As usual Jill takes the lead in the conversation:

I’ll just turn it off, like I never even knew what that was...Last time we thought it was going to be fine, too. But then eventually it just all fell back even worse than it was before. It’s scary to think about. I don’t want to spend my life in hospitals.

Jill’s fears are real. There are other teenagers at SAFE, but most are women in their late 20s and early 30s. ("SAFE accepts men, but its clientele is 99 percent female.")

Since all this, Jill’s mother has been diagnosed as having an obsessive-compulsive disorder and is on Prozac. The two laugh about their problems and are closer than before.

...it’s easy to see how Jill, as a child with a terrified mother, a chronically ill sibling (Jill’s brother, one year older, has only one partially-functioning kidney) and a father who kept a certain distance from emotional upheavals in the household, might have felt isolated and imperiled. She quickly developed an unusual tolerance for pain. ‘I’d fall and I’d never cry...I never felt any pain, really. It was there, but I pushed it back.

The mix of toughness and a hypervigilant desire to please is still the engine of Jill’s social persona, which mingles easy affection with an opacity that seals off her real thoughts. ‘She never tells anybody how she feels—ever,’ her mother says. Jill agrees: ‘I turn it all inside. I just think I have to help myself, it has to be up to me.’

This is a hard combination of factors for an adolescent: a certain toughness but need for kind attention, the drive to please and longings for romance with a fear of intimacy. Jill’s initial boyfriend after all had betrayed her. And the strong desire to please—and for girls that often means pleasing boys—brings only added confusion and pain.

As this article closes, Jill is through with the program at SAFE but continues in counseling. This author, who got close to Jill, describes her as "making a kind of staggered progress." Jill has lost many of her fears of what other people are thinking andwhen confronted by mocking boys’ looks or comments can take it as "their problem."

Jill says she has no more desire to harm herself:

Part of me always used to want to do it, but that part of me dissolved...I know I have to take care of myself more instead of other people...I’m at peace with myself.

QUESTIONS FOR REFLECTION AND DISCUSSION

1. Do you expect Jill to have a relapse into further incidents of cutting? How do you see yourself relating to Jill if you were her friend, her teacher, or youth leader?
2. How would you express your interest or concern about this issue? Did you receive any new information from this article? Is there something here with which you disagree or would express differently?
3. What constitutes self- or social physical mutilation and what does not? Do you see circumcision, scarification, burning or branding, tattooing and piercing as forms of mutilation?
4. Do you agree with what is stated here: that nearly as many boys as girls get into self-mutilation? Why do you think that to be true? Why do so many more girls/women than boys/men seek treatment?
5. How would you intervene in the life of a friend who manifested some of these behaviors? What would you say to a parent of a teenager who was cutting herself or himself?
6. How would you like to see society change in a way that might make self-injury less common?
7. How might the culture of children and youth become less toxic to one another—especially the vulnerable among them? Do you agree that there is parental child abuse we need to talk about sibling and peer abuse?
8. How can we all work for greater emotional and physical health among children and young people?
9. Would this article make for an appropriate discussion of this issue in a school classroom or youth group? What issues beyond self-mutilation might come up in such a discussion?

IMPLICATIONS

1. All that is not healthy in individuals, families, and communities can lead to serious hurt. Healthy kids, healthy families, and healthy communities in a healthy society is a challenge for all people, governments, and institutions in the world.
2. There is a complicated and dynamic relationship between being hurt and hurting someone else or oneself.
3. New efforts must be taken to teach care for self and one another—and to make particularly consumptive societies to care for those to whom products are marketed.
4. We need to find more effective ways to prevent and to treat illnesses like self-mutilation.
5. For additional information, please see the following topics: Girls, Tattooing and Piercing, and Body Image

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Dean Borgman cCYS