Self-Injury - Suicide Attempt or Survival Tool?

By Dina Bachelor Evan, Ph.D., MFCC

Question: "At a recent meeting, a man in attendance identified himself as a 'cutter.' I have never heard this definition before and wondered if this is part of the disease I need to know about?"

In order for you to understand the concepts we are about to discuss, I would like you to do an experiment with me. I want you to put a sheet of paper on a chair or sofa seat. Then hold a tennis racket with both hands, bring it over your head, and with all the momentum you can muster I want you to slam the racket down on the paper as hard as you can. Now, pretend that piece of paper is a child. That is what the un-imaginable pain and trauma of abuse feels like. There is no way to protect the self, or cope with the demands of this overwhelming intrusion into the psyche and the body. In addition, in the majority of cases, children also deal with the horror of living in a dysfunctional family, often filled with substance abuse.

What the person at your meeting was referring to, in calling himself a "cutter," is a self-injury process that can occur in children, or adults, who have early histories of sexual abuse, significant childhood losses or abandonments, poor childhood health, physical abuse, substance abuse or who have witnessed violence. The kind and severity of the trauma, and the age at which it occurs, tend to effect the specific kind of self-injury that results. Since we are now discovering as many as 60 percent of the women in this country, and 40 percent of the men have experienced abuse in some form, it is not inconceivable that millions have also experienced these issues, but have never talked about it. On one end of the continuum, many people in my own practice report having slapped or hit themselves in a moment of frustration, and at the other end of the same continuum, perhaps more than we care to count - have secretly acted out their own pain in self-mutilating behaviors.

Self-injurious behavior is often misunderstood because it seems so extreme and appalling. The first thing most of us want to do is move away from anyone who is participating in this behavior, because we feel helpless to understand or stop it. We may even feel responsible for inciting or triggering it, if it occurs as a result of some encounter we have had with a survivor. Of course, none of this is true. You are never responsible for this behavior in another person, and there is nothing you can do to create it. But, none the less, that is our response and this reaction obviously leaves the survivor feeling even more alone and misunderstood.

Self-injury is very different than attempts at suicide and is understood by the therapeutic community to be a coping mechanism. A cry for help. The intent of someone who self-injures is to take control back. A survivor may injure him or herself as an attempt to stop or avoid some threatened, real, external or internal pain. This process is also an attempt to manage traumatic stress. It may be an unconscious way of dealing with a sense of self-loathing before one reaches a point of suicide. It is a way of releasing or getting the pain out. Many survivors have reported, "feeling the pain leave as they see the blood run" from self-inflicted scratches or minor cuts. It is an "I will survive this," message rather than an " I will end my life," message.

For instance, a person may cut to release unmanageable pain, or to feel his or her body and be able to return from a dissociated state. Children may punish themselves with self-mutilation in the hopes that having done so, a perpetrator will not have to be abusive. The voice inside says, "If I do this to you, maybe Dad will leave you alone."

Adults also do this behavior as a means of getting back control. Usually, self-injurious behaviors begin in childhood in kids who bang their heads repeatedly against the wall or burn and cut themselves. These behaviors can continue into adulthood with cutting, hitting, burning, body piercing or excessive tattooing. Often this behavior is done with the unconscious desire for someone to notice the pain - the child, the inner child or the adult - is experiencing and take action to prevent or fix it.

This response may also take place because some external incident or person has inadvertently triggered or activated some unresolved memory which then feels unmanageable to the survivor. Self-injury is used as a means of coping and getting control back. The act of injuring oneself brings the focus back to the present and back into the body. Dissociation ends and control is regained.

Because we are a society that has not wanted to face our capacity for inhumanity, until recently we had a tendency to miss the pain this behavior was portraying. Or, we chose not to know. "If we don't talk about it, it won't hurt us, and maybe it will go away." And, that is why child abuse is still the best- hidden and fastest-rising crime in America today. There are still, unfortunately, many clinicians who even hesitate to address this issue because of the panic, uncertainty, and discomfort it evokes.

Very often self-injury is a re-enactment of a childhood trauma. It shows others what happened in childhood without actually breaking the abusers demand for silence that was instilled in childhood. When this behavior takes place as an adult, it could mean an opportunity for healing is at hand. Some portion of the abuse may have been triggered or released due to some current event, and has now become accessible for healing. To understand this concept we must first understand how traumatic memory is stored.

Remember the impact on that sheet of paper? The way a survivor copes, is to portion out parts of the event or memory, and then compartmentalize them into manageable components. That means a survivor might store in different places in the body or psyche - what was seen , what was felt emotionally, what was felt physically, and what was heard. All different parts of the same memory, stored in different places. This allows the survivor to manage the trauma and not be overwhelmed by it. This response is, in fact, a most intelligent and responsible response to abuse, and prevents the child or adult from becoming mentally shattered for life. Part of a survivor's healing process is pulling these stored parts of the memory back together in order to release and heal them. In doing so, one also regains segments of missing memory and time lost in childhood.

Although many feel the program is most often all that is needed in order to heal, the kindest thing one can do for oneself if this issue arises is go get help from a professional specifically trained in the areas of abuse. The main reason is that one can continue talking about his or her abuse for years and never get to the core of the issue in order to heal it because of a lack of individual attention and understanding about how memory is stored. A professional can support survivors in pulling all the parts of the memory back together and help them to release and heal completely. After all, as children, many of you were alone when you were abused. Now, as adults, you deserve to have the best possible support and comfort as you revisit these issues in order to heal them in the fastest and least painful way.

If you know someone who tells you they are involved with self-injury, try to understand that this is a response to how badly this person has been hurt, and does not mean he or she is crazy,  or a threat to you. This is a person who is in pain and who needs your support.

In some sense when you really think about it, many of us have been into self-injury in some form. We do it through berating ourselves, self-medicating ourselves, abusing ourselves with substance and on the far end of the same continuum, self-mutilating. Hopefully, the more we understand this issue, the more support we can provide to those who, up until now, felt this was the only way they had of coping with their pain.