And I Hide It Well

And I Hide It Well

I am the voice inside your head, and I control you
I am the hate you try to hide, and I control you
I am denial, guilt and fear, and I control you
I am the lie that you believe, and I control you
I am the truth from which you run, and I control you
( Mr. Self Destruct- Nine-Inch Nails)

        Self-mutilation, or self-injury (SM-SI) isn’t a specific disease or condition, it is a type of abnormal behavior that commonly starts in preteen to the early teen years, though it can start in adulthood. It is the act of deliberately damaging body tissue, trying to alter what is perceived as unbearable feelings. Knives can be used to cut at the skin, or matches can be used to burn the leg. The pain inside becomes so critical, that the self-injurer needs a way of releasing them. Anything can be used as a weapon in the self-injurers eyes, be it a pencil or slamming the hand against a wall. In America, 3% to 5% of the population has purposely hurt themselves at some point in their lives. (Mayo Clinic) That’s not counting the ones who have kept silent for fear of being ridiculed, nor is it counting the ones who hurt themselves quietly and their lives ended in suicide because they didn’t get the help they needed. To prevent either of these, the population needs to understand that SM is nothing to be ashamed of, its just an unhealthy coping mechanism that usually can be pinpointed to a event or lifestyle in childhood. This issue is not to be looked down on or seen as weak or attention seeking, saying either of these statements is going against what the very sufferers feel. Many to all hide and are ashamed of their troubles, thinking misguidedly that something is wrong with them or that they’re  freaks or weird. That just isn’t so. They're just people looking for ways to get through their troubles. People who suffer in silence are suffering needlessly, especially if they have  gone to someone close and been rejected  because of their problems. To self-injure, there are no lines drawn in the sand between races, classes, or religions. It simply is. There is no way to just snap out of it and it won’t just go away. SM is a serious problem that needs to be understood and treated. Through a combination of understanding, finding causes, finding alternatives and treatment, self-injurers can live healthy lives.
The majority of the population doesn’t really even know what SM is. This is a major impasse in recovery because understanding from friends and loved ones is important. First, self-harm isn’t a suicide attempt, it is the deliberate act of harming the body with the intent to change a mood state. It can come in any form, from cutting and scratching the body, to breaking bones, pulling out hair and the extreme of self-amputation of limbs. (Mayo Clinic) Any area of the body can be subjected, though it is typically the arms, legs and front torso, because these areas are easily reachable and hidden.. It can be a way of coping with a variety of mood states. For some, it allows a way to express internal distress, for the outside to look like what the inside feels like. Some do feel pain when hurting themselves, but welcome the pain as a punishment or distraction from the pain on the inside. Others don’t feel any hurt at all, they just go blank. People who harm themselves usually feel overwhelmed by a range of emotions, such as anger and rage, to depression and hopelessness. They become upset and instantly feel the impulse to hurt themselves. It is a way to cope with unwanted or overpowering emotions. It can even offer a sense of control when the self-injurer feels like they have control over nothing else or a sense of calm and a release of emotions.  On the flip side, SM can also be inflicted in a controlled, methodical manner, a way to feel something besides empty. (Mayo Clinic) Though SM may provide a quick fix for crushing emotions, in the long run, it only causes more problems. It inspires shame in the self-injurer, and distances them from others. The person will start to feel so separate from the rest of the world, that it feels like they’re a completely different species. It can also lead to an addiction-like behavior. It’s plain that the self-injurer is hooked when it’s no longer crushes, school, jobs, family or hobbies that are on the mind, but the overwhelming need to damage the body. They will feel upset and instantly turn to self-harm versus any other type of way to manage feelings. It becomes conditioned into the person to always use self-harm as their way of dealing. SI will circulate in a vicious cycle of the person hurting the body then feeling ashamed and wanting to damage one’s self even more. SM can lead to blood poisoning, scaring, or accidental death when an artery is hit, which just says that,  in the end, SI leads to more harm then good. Eventually, to avoid self-destruction, the self-injurer will need to find and overcome the cause of their harmful impulse. 
        Self-mutilation has no simple or single cause. A self-injurer always has some type of situational or emotion problem, whether it happened in the past, or is currently happening, that causes them to feel the impulse to hurt themselves. It can also be associated with a mental problem such as posttraumatic stress disorder and borderline personality disorder. More commonly, some type of sexual, emotional, or physical abuse has occurred as a child or as an adult. They are in deep psychological pain, but lack healthy ways to cope. This causes them to turn to a pain that they can control to make themselves feel better. Never even contemplating how SM can truly devastate one’s way of life. While the why’s can never truly be said as it varies from person to person, the self-hatred and loathing are always factors in SM. Again, each person’s situation differs, it can be confusing and sometimes even feel hopeless trying to find the whys. There are always starting points though, things that are known and are obvious about a life style or a past. For example, it is common for SM to be accompanied by either a drug addiction or an eating disorder, this signifies that the person has trouble with control, and is constantly trying to alter the body’s image, whether from self-hatred from sexual abuse or from some other painful event in the past. Most commonly though, some type of depression is involved. While this isn’t necessarily the reason for the SM, it is a contributing factor. It will cause the already raw feelings inside the self-injurer to explode, building up inside the person until they have to find some way to deal with it before it destroys them.  SI is usually the cause of not learning how to protect one’s self in childhood, and they may even  have experienced neglect from a parent or a guardian. It can be from a careless mother who’s never truly showed affection for her daughter, or a messy divorce in which both parents are occupied and don’t have time for their son. As a whole, they are likely to have poor social skills and be impulsive, the SI is actually even sometimes considered to be an impulse control problem. When social skills are needed in almost every aspect of life, this can cause problems in making friends and keeping friends. It takes over life. They feel the need to harm the body to alter a mood and they act on it, not even considering other ways. It can become an overwhelming craving that takes over the entire life. They will sink further and further into their own self-induced shame, no longer able to distinguish between past pain and current pain. The emotions all become jumbled inside, confusing and, in the process, making the SM that much worse. Social isolation and living alone can also increase the risk of self-destructing. The cycle of emotions constantly feeds the SM. Essentially, recycling the pain back into the body each time a cut is made or an arm is burned. While the causes are incredibly varied and it can be difficult to pinpoint the under problems, with the proper tools, it can be overcome. Self-Mutilation is a problem and it needs to be addressed, causes need to be found so that the self-injurer can overcome and get past them. It takes time and hard, dirty work, but in the long run, it will give them a much healthier and happier life.
          Healthy alternatives need to be found to truly overcome self-mutilation. First, it needs to be understood that SI can become an obsession, even an addiction. If SI is stopped for whatever reason, it may be shocking to discover that they still constantly think about harming their body. Despite the fact that they’re no longer hurting themselves, it has been a huge part of their life and a primary coping mechanism. At first, stopping may cause them to flounder a bit, even cause them to grasp at other ways to cope. It is natural that the self-injurer would still think about it, and permission has to be given to the self to not be ashamed if it occupies the mind. Once permission is given, the person will no longer feel embarrassed and the obsession will start to dissipate.
         While still fighting the impulse to harm the body, short-term alternatives need to be found when the feeling arises. First, struggle to delay the action as much as possible. Try taking a shower, going out and being around people, calling a friend, or when all else fails, call 1-800-DON’T-CUT. If this doesn’t, try to express your destructive feelings by breaking something safe, ripping apart old newspapers, or screaming into a pillow. Some non-destructive sensation producers are running, putting a rubber band on the wrist and snapping it, or holding an ice cube to the skin on the inside of the arm. In the end though, its best to try and express feelings behind the impulse. Write about what your feeling, or identify what it is that is hurting so bad that harming one’s self is the only option. What feeling needs to be escaped? These are all only quick fixes though, more substantial and reliable alternatives will have to be found to truly overcome self-mutilation.
            Eventually, healthy alternatives and choices need to replace the need to harm the body altogether.  The self-injurer needs to discover how to have a healthy relationship with themselves. This will take much treatment and soul-searching, the road will be long and painful, but worth it in the end. A commitment must first be made, and acknowledgment has to be given to the source of the self-injuring behavior.  Every person will find different ways to overcome, but all solutions will be centered on learning to care about one’s self and expressing emotions in a healthy way. There’s no shame in needing treatment if it just can’t be dealt with alone.
A combination of both medical treatment and support need to be incorporated when treating self-mutilation, though some type of program may be extremely helpful. Therapy should always be used to overcome both the problems behind the self-mutilation and the self-mutilation itself. Antidepressants may be used in some cases if a contributing factor to the SM is depression or another type of disorder such as posttraumatic stress. The most common drugs, such as Paxil, Celexa, Prozac and Zoloft, are in the group called SSRIs and may have harmful side effects. Each antidepressant has its own effects,  but many are temporary. For example, Celexa is known to cause nausea and dry mouth. It commonly takes several tries to find the right antidepressant. It needs to be understood though, antidepressants are not a quick fix and they take from one to five weeks for positive results to take effect. Most individuals will take an antidepressant for six months to a year or more. The medications should not be stopped or reduced to quickly, as it may result in a withdrawal like symptom. Antidepressants are not enough to stop SM, it just lessens to burden of whatever has caused the SM. Therapy, whether it is group therapy or actually going to see a qualified doctor, is extremely important to recovery. They will help find underlying causes for the SM and help the self-injurer confront and deal with them. A good therapist will help a self-injurer identify the feelings and emotions associated with SM. Therapy should focus on learning to use positive behaviors as an alternative to SM. They may also try to find the triggers for SM, and teach the patient healthy ways to express their emotions.
SI cannot be overcome without support from outside sources and the drive to get better. Every self-mutilator needs a support system to fall back on in hard times. Whether it’s from a family member or a close friend, each person with this problem needs a listening ear. They need to learn to talk about their emotions, and to healthily cope with them. Loved ones may become frightened by the self-injurers behavior, and distance themselves because of that fear. Self-injurer will need to explain why they are damaging their bodies and what has caused this behavior for outside sources to truly understand.
          There is much that can de done for loved ones who SI – the important thing to remember is that their SI is about nobody but themselves. It is personal and not a reason to feel guilty, hurt or angry. The best thing to be done for someone who tells you they SI is to be supportive and find out as much as possible about SI in order to understand the reality of what it means to SI. If somebody close says that they SI, it is important to use their terminology when talking to them. Such as, if they say “I hurt myself”,  “I cut myself”, “I self-harm” etc. try to use the same phrase. How a person defines their behavior relates to how they see it. It is natural to feel uncomfortable with a loved one who is self-injuring, but do not ask someone, or blackmail someone who self injures to promise to stop or alter their behavior. Self-injury is an outlet or a method of control. It is unfair to take away an outlet without replacing it with something equally successful, and to take away control of an action will ultimately lead to a greater feeling of panic or distress. If explanation is need about their SI, it can be empowering to encourage and help them to explore and understand their SI and the reasons for it. A non-judgmental approach is best. Some type of program the targets SM may be used. There are very few programs in even this modern age that deal with SI. One is called SAFE or Self-Abuse Finally Ends. It is a program located in Berwyn, Illinois. SAFE involves self-mutilators enrolling themselves in the program, and following several ground rules. Patients must have a desire to stop their SM behavior and they must sign a contract that says they will not SM while staying in the SAFE program. The patients are discouraged from discussing or showing off their scars with other patients to prevent triggering. Written assignments must be completed that focus on the consequences of self-injury and the benefits of staying free of self-harm and they are expected to develop and practice at least five alternatives to self-mutilation. SAFE is the largest SI treatment program in the US, which makes it difficult for those who do not live near Illinois. There is also several self-help books that can help the self-injurer cope. One very helpful book is called Women Who Hurt Themselves: a Book of Hope and Understanding,  it was written by a psychologist names Dusty Miller. In it, she discusses a variety  of self-harm methods ranging from cutting and plastic surgery, to alcoholism and drug abuse. She believes that self-harm has root in what she calls Trauma Reenactment Syndrome that causes people to reenact on the body the way they were treated in childhood. Simply going to a local bookstore can unearth several helpful books. There are always alternatives, they just have to be found.
          Overcoming and treating SI may be one of the most difficult tasks when it comes to reinventing the self. It becomes so ingrained into one’s personality, that the self-injurer may start to believe that SI is all they are. A sense of self needs to be established before SM can ever truly be separated from a person’s character. One of the most productive things that the general population can do is to recognize when there is a problem that may lead to SM in either themselves or someone close. This means acknowledging and excepting that SM is a coping mechanism that needs to be replaced with something that isn’t harmful to one’s self or anyone else. Giving thorough knowledge to people at an appropriate age would be very beneficial, it would help people identify if there is a problem and allow them to seek help before self-destructive behavior spirals out of control.  SM is a behavioral problem, similar to drowning sorrows in alcohol or at the end of a needle full of heroin. There’s AA for alcoholics, drug addicts, and binge eaters, all of which are damaging issues, but why are there so few programs that deal with self-mutilation? SM is a serious problem that needs to be understood and treated, not shoved into a closet with the rest of the skeletons. Self-injurers need to realize, along with the rest of the world, that self-mutilation is a treatable, and very real issue. Its not going to go away. But maybe, someday in a world where each individual is truly open and understanding,  psychological problems are better understood and feelings are faced head on, this vicious cycle of abuse can be healed and this damaging and desperate problem can finally end.

10/11/07