Jennie Bristow on self-mutilation: therapy's latest gravy train
'One February day in the seventh grade, I was apprehended in the girls' bathroom at school, trying to cut my arm with my Swiss army knife. It is always February in the seventh grade, that terrible border year, that dangerous liminal interlude.'
Caroline Kettlewell's Skin Game: a cutter's memoir continues in this whimsical, quasi-poetical fashion, as she spends 178 pages recounting how and why she used to cut herself as a teenager. Kettlewell, according to the book jacket, is 'an intelligent woman with a promising career and a family': not somebody you might expect to court fame through a pathetic tale of adolescent angst. But self-mutilation has found a market - and Kettlewell is not the only one to have cashed in on it.
Looking for a light read on self-mutilation? Try The Scarred Soul (1997), A Bright Red Scream (1998) or Cutting the Pain Away (May 1999). Memoirs and novels about cutting (such as Shelley Stoehr's Crosses and Steven Levenkron's The Luckiest Girl in the World) are hitting the bookstores in the USA, while young British and Irish novelists like Rebbecca Ray and Lara Harte have taken up the cutting theme to give their angsty books extra authenticity. Although the fascination with slashing is more overt in America than in Britain, all the literature points out that the idea came from over here. 'Until 1996, the public had little familiarity with self-mutilation', points out psychotherapist Steven Levenkron in Cutting: understanding and overcoming self-mutilation. 'Then Princess Diana volunteered that she had been a cutter, and articles on the topic began to appear in popular magazines.'
What is behind this new obsession with self-harm? Therapists point to the scale of the problem, and bandy around figures claiming that there are two to three million self-mutilators in the USA; while in Britain, over 22 000 young people a year reach hospital having deliberately hurt themselves. But I blame the therapists themselves.
There is nothing new about the act of self-mutilation. In Bodies Under Siege: self-mutilation and body modification in culture and psychiatry - widely regarded as a 'bible' for therapists dealing with self-mutilation - Armando Favazza documents numerous cases of self-injury by seriously mentally ill individuals (often in institutions) which, while gruesome, are not new. Favazza also studies the cultural practices of different societies, where rituals or initiation ceremonies might involve self-mutilation. In Western societies body piercing, tattooing and scarification are the most obvious forms of culturally sanctioned self-injury.
More significantly, there is nothing new about teenagers taking a razor blade to their arms or a lighted cigarette to their legs in a fit of angst, frustration, fury or even curiosity. The nature of teenage angst is such that young people are probably as likely to have a go at self-injury as they are to drink white cider until they throw up. Yet the new school of self-mutilation therapists is trying to turn unremarkable teenage angst into yet another serious teenage disorder.
The kind of self-harm that attracts these therapists is neither fashion nor attempted suicide, but a form of behaviour in which somebody hurts themselves deliberately and fairly regularly, but not fatally. This is understood primarily as a 'coping mechanism' - using physical pain to relieve emotional pain. So the theory goes that a teenager who hurts him or herself is doing so to cope with some deep-rooted emotional trauma.
In some cases, this appears to make a lot of sense. Regularly setting about yourself with a razor blade is obviously not normal behaviour, comparable to piercing your ears or belly button. But there are numerous reasons for teenagers to embark on this kind of non-normal behaviour. The attempt to theorise self-injury as indicative of severe trauma raises some worrying questions.
When a young person undergoes a traumatic experience about which nobody knows, what tends to be assumed? That the person in question has suffered from some form of abuse - usually at the hands of a family member. Most other traumatic experiences would be known about and talked about. So when an apparently 'normal' young person starts cutting herself, the new self-mutilation theory perceives this automatically as a potential reaction to childhood abuse. And the way this theory of cutting-means-trauma is formulated contains ghosts of the biggest recent scandal of modern psychology: recovered memory therapy.
In Steven Levenkron's teenage novel The Luckiest Girl in the World, ice-skating star Katie cuts herself with scissors every time she feels herself dissociating, or 'spacing out'. Cutting brings her back to reality, forcing her to engage with immediate life. After therapy, she finds herself able to confront her dominating mother with the memory she has forced to the back of her mind: that she broke Katie's rib as a child. Lara Harte's Losing It has the heroine's elder sister scratching her face and burning her hand, as she copes with the process of remembering how she was raped by a teacher at primary school. In the non-fiction Cutting the Pain Away, Carol Nadelson explains the impact of trauma on the victim's memory: 'those who suffer from chronic dissociation in response to a series of events may become seriously forgetful and endure periods of amnesia, blackouts, and a severe inability to function in daily activities.' She then refers to the 1973 case of Sybil Isabel Dorsett who, following childhood abuse at the hands of her mother, apparently 'split' into 16 multiple personalities, embodying 'feelings and emotions with which the "real" Sybil could not cope'. The book and film about Sybil's life brought the term 'multiple personality disorder' into use.
All of these terms - dissociation, multiple personality disorder, periods of amnesia following traumatic events - formed the basis of recovered memory therapy, which assumed that people could, through therapy, 'recover' forgotten memories of child abuse. Following numerous horrific false allegations of abuse, and cases where patients' lives were ruined through therapy-induced abuse fantasies, recovered memory therapy was officially discredited. Yet some of its assumptions seem to be gradually recycled through new theories, such as those about self-injury.
The concept of 'dissociation' or 'depersonalisation' - referred to in all the literature on self-mutilation - arises from the notion that people store memories of abuse in a distinct place in their mind, which affects them subconsciously. The idea that self-injury is about rescuing yourself from this 'dissociated' state implies that superficial self-mutilation is a result of some form of abuse. And the notion that, through therapy, people can deal directly with their memories, rather than resorting to self-harm, assumes - as recovered memory therapy did - that counselling can take you to the root of your problems by making you deal with past traumas that you might have somehow suppressed.
If the theory about self-injury could be trusted, it would be possible to justify the new focus on self-mutilating adolescents. But given the reliance of the cutting-means-child-abuse theory on past discredited methods, it pays to be sceptical about the newfound fascination with this 'disorder' - and the potential consequences of therapeutic intervention.
It is worth bearing in mind that self-mutilation therapists have a real interest in pushing this to the forefront of public concern and debate. Every self-help book on self-mutilation begins with the assertion that self-harm remains a taboo discussion, which only a handful of enlightened therapists (such as themselves) will deal with. This validates the therapists' sense of importance in the world of psychotherapy.
Psychotherapist and author Steven Levenkron best expresses this inflated sense of self-importance. Levenkron made a name for himself in the late 1970s by treating and writing about patients with eating disorders, and wrote the bestselling teenage novel The Best Little Girl in the World about a young dancer developing anorexia. After encountering various harsh and inept doctors, the heroine recovers under the therapy of an understanding psychotherapist Sandy Sherman. Two decades later, Sherman reappears in Levenkron's self-injury novel The Luckiest Girl in the World, as the only person successfully to treat heroine Katie. Sherman (whose wife tells him 'to watch that therapist-as-white-knight complex') now has white hair and white beard. Levenkron, pictured on the book jacket has, guess what? White hair and a white beard.
So yes, the therapists have their own reasons to push both the scope and the scale of cutting - however distorted the theory behind it might be. This would be bad enough even if it only boosted their egos. But for young people on the receiving end of this therapeutic obsession, the consequences are far worse. It risks pathologising some aspects of teenage life that are not disturbed so much as, well, teenage. And in doing so, growing out of teenage angst into a normal, well-balanced adult becomes increasingly difficult.
When Princess Diana 'came out' about her history of eating disorders and self-mutilation, it summed up a particular mood of the times. Whoever you are, whatever you do, there is increasing pressure upon people to create an identity for themselves through talking about a problem they have. Many Brits sneer at the extent to which, in the USA, you are only somebody if you have a syndrome and a therapist - but we are hardly that far behind. More and more schoolchildren and higher education students are diagnosed with disorders and disabilities ranging from dyslexia to attention deficit (hyperactivity) disorder, and counsellors now line the corridors of schools and universities. Teenage magazines no longer confine their discussion of angst to the problem pages - features dealing with everything from bulimia to a friend's suicide to bullying form the heart of the magazines, generally written in the first-person, 'it happened to me' format. One magazine even replaced its celebrity question and answer page with 'Celeb Therapy', where famous people could only talk about their problems.
For teenagers, already struggling with the frustration of trying to create a distinct identity for themselves, the emphasis on defining yourself through your problems has a particularly strong impact. Adolescents - particularly middle-class girls - are notoriously wrapped up in themselves anyway, and prone to dwelling on the apparent miseries of their life. 'Dear diary...I'm so depressed'...sound familiar? Because when you have no job, no independent life, and nothing outside of yourself and your equally melodramatic friends, your problems are all you have. And if you have no problems, you are nobody.
Caroline Kettlewell - a self-confessed cutter who was never abused - sums up the mentality of the 12-year old girl brilliantly: 'I knew how I felt, but I couldn't come up with a good enough reason why I should feel that way. I believed unhappiness was something you had to earn through a suitable measure of suffering, the way characters in my favourite books struggled with blindness, polio, Nazis, shipwreck, blizzards....My life - with its 12-year old particulars of tuna sandwiches and math homework...was way too mundane for suffering.' (Skin Game, p11) Hence the cutting; which, at least to her, gave a concrete validation of her misery.
Now imagine if, as a teenage girl without a problem, you can create a 'disturbed' identity overnight simply by cutting your arm. It saves having to develop a more conventional disorder, like anorexia or even bulimia, which take more effort and genuine suffering. With cutting, you can land immediately in the camp of potential-abuse-victim who, whether abused or not, deserves 'understanding'. You can be part of an exciting new subculture of teenage angst which is labelled by those who claim to understand it as permanently misunderstood. And because the therapists and self-help books are on hand to slap a disorder label on this outburst of twelveness, you can keep your damaged identity for life, if you want to. You could even write a memoir.
Speaking at a conference on 'Self Harm in Adolescence', organised by the Association for Professionals in Services for Adolescents in October, psychologist Vivien Norris spoke of the danger of 'normalising' cutting too much. Her argument was that, if cutting became too acceptable as a way for young people to deal with their problems, disturbed teenagers would turn to more extreme forms of self-harm. But surely the real problem of 'normalising' self-injury is that young people are presented with the notion that the only way to fit in normally is to be disturbed. That's a pretty tough brief for teenagers.
Cutting up our family
My sister, Emily, is 16. She started cutting her arms up about two years ago. Since then my family has had a barrage of social workers, counsellors and therapists interviewing all of us both as a group and individually to determine the 'cause' of Emily's behaviour.
Emily was sectioned a year ago after being admitted to hospital to have stitches for one of her cuts, and then transferred from the hospital to an adolescent unit. Apparently it was imperative that she did not return home. The rehabilitation programme the adolescent unit offers consists of lots of therapy groups, including 'girls' therapy', 'group therapy', 'individual counselling' and 'music therapy'.
Every week a meeting takes place that all the members of the family are asked to attend. As I no longer live in the same area as my family, I was not available to come to any of these meetings until about six months into Emily's time at the unit. At the meeting I went to, the therapist began by telling me I had a bad relationship with my sister - this was news to me. I asked her what she meant by 'bad' and she said Emily had been angry with me in the past. I had thought that was quite normal between siblings - but in retrospect, it seems that for my relationship with my sister to be deemed good we would both have to be saints.
She went on to ask me if I would be a danger to Emily if she got angry with me (as if anybody would say, 'oh yes, I'd kill her') and what I would do if she ever disagreed with me. Then she asked me loads of questions about my sex life. Had I slept with person X who'd visited the house? What about person Y? Would I have sex with somebody if my sister was in the room?
I was beginning to get really pissed off. Not only was it incredibly intrusive but I couldn't understand the relevance of the questions. Physical abuse was not suspected - if it had been, social services would have taken much more drastic action half a year ago. It was like I was being accused of abuse by association. And these questions were being asked in front of my parents, which was embarrassing at best.
In these meetings it is impossible not to answer because then it seems like you're hiding something horrific, not just guarding your privacy. Saying 'that's none of your business' is blasphemy in therapy sessions. The idea, I was told, in having these questions asked while the whole family was present, was so no 'fibbing' could take place, and having secrets in the family was very dangerous. I would have thought it was the most natural thing in the world not to be able to talk to your dad about some of the things you discussed with your mum, and not to want to tell your parents about things that you would your siblings. And who wants to know about their parents' 'secrets'?
Our therapist's mission, though, was to break down all these natural sensibilities in the hope of exposing the reason for my sister's problems. It was assumed that this reason was related to something stemming from our family situation rather than Emily herself. Now my parents and myself are left feeling guilty for something quite undefined, simply because we are the family of a teenager with problems.
Before this 'therapy' my mum and dad would never have doubted their parenting ability and I would never have entertained the idea that I was a bad sister. But when something like this happens, the family is immediately assumed to be to blame - if not of actual abuse then because of the dynamics they've created in their home. As soon as my sister started cutting herself, the concept of my family as a unit that could be caring, loving and supportive went out of the window. Instead, the idea of the family unit is one of a set-up where abuse of a million kinds can occur and be hidden.
The job of the therapist seems to be exposing us, rather than counselling Emily. Somehow I don't think this is doing anybody any good.
All names have been changed
Reproduced from LM issue 126, December 1999/January 2000