“The first cut won't hurt at all; The second only makes you wonder.”
Duel
[NB. I wrote the below blog entry well over a decade ago, and in the current climate of angst and desolation I felt it merited a cautious re-post. If you are suffering, please know that you are not alone.]
Some time in the late nineties I saw a young man on a bus. He was sitting, I was standing next to him: looking down, I could clearly see a series of cuts along his arm that could not have happened by accident. More significantly I saw the flinch, the unease, with which he registered the fact that I had noticed. I went away wondering what would drive a person to do such a thing. I found it creepy, unsettling (notwithstanding the pathologically morbid cast of my mind); yet here I am ten years on, with a lot more scars (less neat, more random than his) and a much angrier flinch. On another occasion I found myself in conversation with someone who disapproved of pharmacological relief and instead advocated the avenue of self-harm. The relative merits of cutting and drugs to ease ennui - we both insisted that our chosen method, if done cleanly and carefully, posed no harm at all, but neither could be persuaded to the other's point of view.
So what has happened in the intervening years for me to augment the transient respite of drugs with the equally addictive hobby of making myself bleed?
During a later bout of depression (2002/3) I began to experiment with alternative therapies (the NHS having failed to provide any workable recourse). Shoplifting was one outlet, but even that soon proved insufficient. I would try pressing a sharp chef's knife against the flesh of my arm. I must have thought that the simple pressure of a sharp edge against flesh would be sufficient - but human skin is tougher than you'd think. I called to mind how hard it sometimes was to cut a piece of raw steak or chicken, and what I was doing to myself was not even cutting, it was simply pushing the edge of a blade against me, and thinking that alone would break the skin. Sure it left indentations, marks in the arm that might look like old scars to some, but which soon healed and faded. The actual act of cutting - of drawing a blade across my flesh and not just pushing it against it - was a challenge to which I could not rise. Was it the anticipation of pain? The fear that I might cut too deep? Or the all-pervasive intellectual arrogance that I was above such things, that my scars would and must be forever hidden, that I could not submit to the stigma of physical self-harm? True, there is something speciously admirable in psychological self-destruction, a faux-heroic stoicism in the grim resilience to emotional despair.
Therein lies the rub: depression is a hidden disease. How many times, when I had felt hollow, in despair, how many times had people commented how well I looked? Sure there are physical symptoms of depression – the tiredness, the appetite loss and nausea, the insomnia… But essentially it is an illness that others cannot see. I am here talking about non-psychotic depression, rather than the manic variety. Furthermore my depression is not only non-psychotic (so alas I must always be responsible for my actions) but also endogenous: i.e. it originates from within (as an aspect of one’s personality) as opposed to reactive depression (which as the name suggests arises as a reaction to external events). The diagnosis most typically applied to me is dysthymia (literally ‘bad mind’): dysthymia is characterised as a ‘mood disorder’ which is on the one hand ‘less disabling’ than major clinical depression, but on the other hand is ‘longer lasting’.
Therein lies another rub. It is a quiet, restless, desolate condition. It tends to be refractory (antidepressants rarely have more than a temporary placebo effect), and while the day-to-day symptoms may indeed be relatively mild, the cumulative effect is soul-destroying. Given the absence of any workable ‘cure’ or lasting relief (and perhaps the fact that dysthymia is taken less seriously?), the suicide rate is higher than it is for those suffering from supposed ‘major’ depression. Even when my suicidal ideation was at its most demonstrative (summer 2001), my hapless NHS shrink had to concede that I was painfully rational, indeed she affirmed (somewhat rashly?) that ‘rational suicide’ was now recognised in the psychiatric community. During a later bout of depression (2003-2004) I was once again identified as a high suicide risk; this time, however, I had made no overt statement of intent, and I did not actually discover that I had been branded a high suicide risk until long after the event… This begs the question: why, if health professionals had deemed me liable to kill myself, were they doing nothing about it?
So here I am, with a pathologically low mood that resists medical and psychiatric treatment. By their inaction the powers-that-be had conceded that suicide is the logical outcome of this mood disorder. Such helplessness, such frustration, makes me angry. While I had hitherto found the means to express this anger in an at least occasionally constructive (writing) but often subversive (shoplifting, narcotics/tranquillisers) manner, it finally came to pass that I needed to express my rage in a directly demonstrative way. My initial acts of self harm were borne out of anger (I deliberately smashed a glass, and used the pieces on myself); a few months later and I am able to slit my skin as a matter of course, while feeling perfectly calm and composed. I actually went out of my way to keep busy (at least by the standards of my stolid social life), but even when I would lurch home from London in the early hours of a Saturday morning the longing gnawed at me: it was almost a treat, to come home, put the kettle on, and round off the night with a slice to the back of the arm.
In order to understand what I do, I have considered the various ‘explanations’ as to why people self-harm, and the degree to which they apply to me. In admirable homage to my perennial refusal to be pigeonholed or stripped of a single shred of stubborn egoism, for a long while I resisted sheltering under the ‘self harm’ label. What I was doing was not harming myself: it was saving myself. Perhaps it is for this reason that the term ‘self-injury’ is preferred by some to ‘self-harm’. I did not even like the more specialised term ‘cutter’: somehow despite my demand for linguistic precision I did not quite believe that slicing myself till I bled was the same as ‘cutting’.
So, in no particular order…
1. Pain displacement – “whatever gets you through the day”
The oldest known painkiller: inflict an alternative, controlled pain to take away the focus from the pain one cannot control. In the case of emotional/psychological pain, the infliction of a physical injury externalises the pain and makes it more palpably ‘real’, and therefore easier to cope with/explain.
This is, to my mind, a perfectly rational act. I was therefore stoked into more than customary indignation when I read the following statement on a website that (one would think) really ought to know better: “Some find it difficult to give up the behaviour despite realising that it could be life-threatening and is not rational.” Leaving aside how poorly written that sentence is, who the fuck are they (the BBC) to make such crass generalisations? If someone goes for a few drinks to let off steam after a stressful day, are they berated for acting irrationally? Yes, in the strictest terms of logic the correct solution would be to avoid stressful incidents in the first place, but sadly we cannot all exist in a cocoon. The problem with people who make such patronising judgments as that quoted above is that they are unable to address the fact that for some of us self-harm is a perfectly safe and effective (and thereby perfectly rational) means to relieve pain and anxiety that would otherwise cripple us. Furthermore, where do we draw the line when defining self-harm? Some would say that digging one’s nails in one’s flesh to compose oneself is an act of self-harm. Or biting one’s lip? Or pulling one’s hair? What about smoking? Is there any other habit more pernicious to one’s health, and yet which people continue to undertake for the momentary relief it brings, even while it kills them? Yes, stimulant and hallucinogenic drugs are also damaging to the health; however alcohol, sedatives and narcotics, taken sensibly, aren’t going to do much harm to the average user.
2. Sublimation - Manipulation
A variant of the above, when the pain/stress experienced is a result of someone else’s actions (or lack thereof: being sidelined or snubbed can wreak cumulatively catastrophic psychological damage). For whatever legal or moral reasons, it is inadvisable to take out one’s pain on the source of one’s annoyance: i.e. I might want to take a shard of glass to someone else’s wrists, and the only means to overcome this anger is to inflict the revenge on myself. Cutting oneself to register the pain another person has caused is not necessarily a conscious punishment of that person (and it could be that the cause of one’s aggravation would be quite untroubled to think they had incited an act of self harm). However in some cases people do self-harm to provoke a reaction (or manipulate a response) and to punish the person they hold responsible. I once had a boyfriend who was a reformed cutter; the only occasion on which he relapsed occurred when his (Evangelical Christian) parents objected to him seeing me. By cutting himself (and so posing the threat of cutting himself further) he ‘persuaded’ them to reconsider. It would however be dangerous (and offensive) to assume that someone who self harms does so with the intention of manipulating others. As my experience of bleeding progressed I did begin to use it as a means of venting the frustration other people had caused me; it would however be inaccurate (albeit tempting) to blame (or praise) any one person directly for my cutting. Most self-harmers go to great lengths to conceal their habit: I always wear long sleeves in public (in the tiresome event of me living to see another summer, I will have to review this procedure). Other self-harmers may invent a cover story to explain their injuries; I wonder that people so easily believed that I could accidentally sustain cuts across my arm from clearing up a broken glass. Incidentally, those who did see through my fib were soon to confirm that ignorance was the safest bet. Thus is manipulated the very perception of truth.
3. Dissociation – Affirmation
My first counsellor had worked extensively with prisoners, and took no time at all in identifying my predilection for psychological self-harm. We touched on the issue of physical self-harm: she (wrongly at the time, but as it turned out oddly prophetic) opined that I was anorexic, before commenting that many prisoners turn to physical self-harm precisely to remind themselves that they are still alive, that they can still feel, that they do have some power. And so it now is with me: in a world that is dull, apathetic, numb and unfulfilling, what better way to prove myself than by demonstrating, quite literally, that there is still blood thundering through my veins? Anhedonia (literally the absence of pleasure) is a key symptom of dysthymia, which is not to say that all sufferers who experience emotional emptiness turn instinctively to harming themselves simply to satisfy the need for any sensation.
My own initial experience of cutting was borne of rage (point 1), but latterly I am more likely to incise my arm as a diversion from boredom than a displacement of pain.
4. Perfectionism
The perfectionist’s mindset is predisposed towards the fulfilment of unachievable goals, an ‘all or nothing’ stubbornness and hypersensitivity. The perfectionist often rubbishes his or her achievements and abilities, in the belief that he/she should do better (perfectionism can therefore parallel self-loathing, below). This self-undermining is often a subconscious act, and the perfectionist who is critical of his/her self will often be enraged if someone else casts them in a negative light (“I am the biggest hypocrite […] heaven forbid I be criticised/ heaven forbid I be ignored” as Alanis puts it in One).
In pathological cases, any failure to attain one’s idealised potential must necessarily be punished, i.e. the threat of self-harm is used as a deterrent from erring from one’s course. Perfectionists may also gravitate towards relationships with ‘damaged’ individuals (drug users, or indeed self-harmers) in the vain (in both senses) belief that they can redeem/improve the damaged goods. Suffice to say, damaged individuals are spectacularly ill-suited to any such relationship (“You only build me up to tear me down,” in the inestimable words of that other great poet of the subconscious, Smokey Robinson). When the perfectionist begins to infer that his or her protégée stubbornly prefers ignorance to enlightenment, a crisis ensues. This generally goes two ways: a reaction against the chosen one for failing to live up to its promise (thereby requiring (2) sublimation); and a reaction against oneself for the folly of placing hope and faith in the resolutely unworthy object (thereby leading to the below).
5. Self-loathing
In tandem with the above… when perfection (however unrealistic) is not achieved, a state of self-loathing is effected. Imperfection must be punished, else what was the point in seeking something better? Due to the compulsive nature of self-harm, one who is predisposed towards perfectionism can easily be led (however subconsciously) to sabotage his/her self, in order to bring about the frustration and disappointment that will provoke another episode of self-harm.
Despite the prevalent psychiatric tendency to misdiagnose self-loathing as a derivative of low self-esteem, it should be stressed that self-loathing is technically quite distinct from self-pity. The latter is passive, attention-seeking, defeatist. Self-loathing is active (self destruction as opposed to weary surrender), defiant, and above all secretive. As philosophers and psychologists have argued for centuries, hate is an emotional passion (unlike contempt, which is an intellectual judgment [as Schopenhauer tells us]). The object of one’s hate is elevated by virtue of its capacity to command such hate: self-loathing is therefore a covert assurance that one’s self is worthy of being hated, rather than pitied or ignored or (most damaging of all) rejected.
I once summed this up in one of my novelistic fragments: “What he detested in others he shaped and honed in himself, the consciousness of hypocrisy adding a thrilling kick of humiliation to his mortal self-loathing. What was undignified melodrama in any other was measured self-possession in himself.”
Even now I find myself conflicted by my status as a cutter. As my counsellor admiringly concedes, I know precisely what I’m doing, and why I’m doing it, each time I cut myself. By means of easy casuistry I therefore argue that what I am doing is an act of power, a demonstration of my resolve to test myself and change my state of mind. Ergo, I am quite distinct from the hysterical teenager who self harms helplessly and recklessly (I won’t belabour the point, but I have become aware of people who cut so thoughtlessly that they pay no heed when their wounds go septic). Such people are (to my haughty mind) quite weak and contemptible. In summary, even as an acknowledged self-harmer I choose to separate myself from anyone else who might fall under that label.
6. Nihilism
In additional to its function as an alleviator of pain (both physical and emotional) and numbness/boredom, self-harm can also express a profound intellectual despair. The trait of self-loathing as discussed above can also be a sublimation of a chronic dissatisfaction with external situations (not least for the thwarted perfectionist). For example, it may be perfectly natural to hate the world, the frailty and folly of the human condition, the hypocrisy of society and the parasitic nature of human conduct. However when faced with such feelings of revulsion and despair at everything around you, it is unfeasible to express these feelings constructively: the world hardly cares whether you like it or not. But we are each of us a part of this world: harming ourselves is a safe and steady outlet, a mocking statement of the worthlessness of our and every existence. It is true that some people have expressed their dissatisfaction with the human condition by engaging in killing sprees, but such behaviour is a trifle vulgar, nay American.
I suspect that nihilists are the most likely to be rational suicides (despite Dostoyevsky’s attempt in The Devils to depict atheist suicide as vainglorious folly): if it can be rationally deduced that our existence is fundamentally meaningless, and that whatever meaning we do place upon it is a sociological construct, it follows that the world will not be affected by a single life or death. In terms of our function in society we are all eminently replaceable. In personal terms we may well mean the world to someone, but this is of course subjective, and thereby irrational… Why should I stay alive simply to spare other people’s feelings? What sort of life is it, existing purely for another’s sake, never living for oneself? On the flip side of nihilism is the true self-denial of religious piety. Here too we find people who self harm, whether it be ascetic hermits who half-starve, or pompous clerics with a hair shirt or girdle of spikes beneath their robes. It’s funny how people who self harm from spiritual guilt have tended to be considered admirable, self-sacrificing specimens, while those who injure themselves for any other reason are deemed mentally ill. Clearly it’s the other way round.
7. Thrill-seeking
It has been posited (in a commendable if transparent effort at flattering my ill-concealed intellectual arrogance) that I clearly possess the imagination and insight to find a “less scarring” form of self-expression. This crucially fails to acknowledge that scarring is part of the pay-off: I do not simply wish to feel pain, but to see it too and know that it is real. The mood-altering adrenalin rush, the thrill of breaking the taboo, the wilful damage to one’s physical self… The seeking out of self-destructive, socially proscribed activities has proven to be a far more effective antidepressant than any chemical. Even the ultimate pharmacological taboo heroin was a disappointment compared to the mood-enhancing thrills of shoplifting and self-harm. As an aside, I do wonder whether I had the misfortune to be supplied with inferior goods on the few occasions I went dragon chasing – or had years of steady sedative use dulled the brain to the impact of a wrap of cheap smack?
In addition to relieving anxiety/anger/numbness, self-injury also triggers the release of endorphins in the brain. To be honest I doubt I do myself sufficient physical injury to trigger such a response; however I can flatter myself that I do. So much in life requires us to deceive ourselves in order to be happy… but I can rest content that I have never been reduced to the pitiful self-delusion of the theist.
It goes without saying that behaviour characterised by the seeking of thrills can (rightly or wrongly) become allied to a craving for attention. Some may wish to provoke a crisis, which, however uncomfortable (a shoplifter being arrested, for instance), provides at least a passing resolution. While for most practitioners self harm is a secret punishment/reward, some may be overtly exhibitionistic: Russell Brand writes openly of glassing himself. If we think of the stereotypes of self-harming individuals, such as moody teenage Goths, we can almost envisage scars as a badge of honour. Even today some people will assert that smoking makes them look ‘cool’: why should cutting be any different?
8. Practice makes perfect
My first reaction to Heath Ledger’s death spoke volumes, and unsettled even me: I envied him. People go to great lengths to explain that there is no correlation between self-harm and suicidal ideation, and indeed the majority of self-harmers neither kill themselves nor harbour any wish to do so (to quote the faux-wisdom of wikipedia: “The person who self-injures is not usually seeking to end his or her own life; it has been suggested instead that he or she is using self-injury as a coping mechanism to relieve emotional pain or discomfort”).
However it must be noted that some people who self harm do graduate towards a more permanent method of self-destruction.
From my own experience I can testify that I am already sufficiently resistant to the pain of slicing flesh, already seduced by the invidious well-being that derives from watching blood seep and thicken down the hairs of my arm. If I can cut myself without flinching (where once I had to grit my teeth and steel myself with vodka and a sedative before I could inflict so much as a scratch), what will I do next? Sometimes I tell myself it is fortunate that I live ten minutes walk from a major hospital, and if I do carve a little too deep, it won't be too hard to seek medical attention… unless of course I cut too deep by design.
When asked by my GP whether my intentions were tending towards suicide, I replied that I was always careful not to cut near arteries, which of course sidestepped his actual question. Sure I have no immediate intention to extinguish my existence, but the longing, the fascination, the stark sense of relief surrounding suicide: these are always present, always nagging and consoling by turns.
Addenda
I have omitted the potential 9th trigger for self-harm: in the middle ages it was de rigeur for well-to-do Europeans to bleed themselves on a regular basis, to ensure that they maintained the healthy pallor appropriate to their standing. It is only in recent times that a bronzed/tanned complexion has been construed as healthy or attractive (we know from Renaissance literature that ‘sunburnt’ is a euphemism for ‘ugly’).
I also abjure that other (perhaps more popular) trigger, sexual masochism. Is it considered self-harm if someone wills another into flogging, slapping, or cutting them? I would say no, given that examples 1-8 are all typically solitary pursuits, and the relief gained from cutting is no more sexual than the relief one gains from drink, drugs, or a walk in the park (unless of course you’re George Michael). Certainly some people who derive a thrill from sado-masochism may also self harm privately, for non-sexual reasons. It would however be wrong to assume that there is overall a tenable correlation between the two.
