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Self Mutilation:

The Medicating of Pain with Pain

By B. Brake

Self-mutilation, or self-injury, is a phenomenon that defies reasonable explanation. Most "normal" human beings would not take up a weapon to use against themselves in order to avoid strong negative feelings, but that is what self-harmers do regularly. We medicate pain with more pain in a different form, and strange though that may sound, in some manner it makes sense to us.

Some of us cut, or burn, or bang hands or limbs until bones break or bruising occurs. Some may scratch or bite themselves, or ingest small doses of toxic chemicals or overdoses of medications without suicidal intent. Regardless of the method used, the objectives are the same. There are generally two main reasons that we self-harm: either because we are overwhelmed with pain or emotion and we desire to stop it, to take control; or because we can feel nothing, we are numb, and self-injury provides a stimulus that lets us know we are still alive, still human. Some of us also feel that we “deserve to be punished,” that we are bad or flawed human beings.

Self-injury is strong medicine, make no mistake. It can prevent us from dissociating, stop a panic attack in its tracks, and give us a focal point when we fear we're drowning in emotion. Yet this act is harmful in and of itself, a disordered behavior, an extreme "coping mechanism" that can lead to more and more serious problems. It can escalate rapidly from a feature of a disorder into a problem all its own. And, yes, there is an element of addictiveness to the behavior; if not from a physical standpoint then certainly from a psychological. For who would want to give up this magic cure that has such power to stop the pain, if only temporarily?

There are obvious drawbacks to self-injury, not least of all in the obvious and ugly cosmetic effects. It becomes difficult to hide the scars after a period of time, difficult to explain them away. Also, many of us who self-harm hate the face that we do it, hate the guilt that comes afterwards because we feel "dirty," or that we've failed again in having to resort to this.

Some self-injury is said to originate in a fusing of pain with attachment. It comes from feeling like we must "take the good with the bad," as we have had to in many key relationships. Abusive relationships have a high possibility of spawning self-injurious behavior. Take for example a small girl who is beaten by her father regularly, even while he tells her that he loves her. She unconsciously learns to associate pain with love, and in later years may resort to inflicting pain upon herself during periods of loneliness in order to recreate feelings of safety and love.

It is estimated that more than three million Americans engage in some form of self-injury, and that one out of every 200 teen girls between the ages of 13 and 19 regularly practice self-abusive behavior with a reported 2 million cases in the US alone. 90% of self-injurers begin the behavior as teenagers, and it usually escalates in severity throughout the twenties. More than half of self injurers are victims of abuse, and most report emotionally abusive or neglectful childhoods. The majority of people who self-injure are women. The main reason for this is that men tend to display their aggression-hurt-pain outwardly towards other people or inanimate objects, while women tend to turn that hurt and pain inward upon themselves. Most of the women who self-injure have been sexually or physically abused. In many people, self-injury occurs concomitantly with another disorder such as eating disorders, depression, an anxiety disorder, or obsessive-compulsive disorder.

Self-injury is treatable! It is not an easy process, but with proper therapy and support, most self-harmers can find other methods of coping and will eventually be able to give up their self-injurious behaviors. Nurturant-authoritative therapy has had good success in the treatment of self-injury, as have many other approaches. The client should be encouraged to find other coping mechanisms and creative outlets for her energies. She should not be forced to give up the behavior immediately, or threatened in any manner with termination of therapy or immediate hospitalization if she self-harms. It should not be made a condition of therapy that she not self-injure. This serves only to put extra pressure on the client and fosters mistrust. The behavior will diminish almost on its own when other applicable coping methods are found. Most self-harmers are attached to this method of coping only because they know no others. The majority know that it is not healthy, and many hate that they do it, but feel trapped. It is the therapist's job to aid the self-injurer in finding alternatives.

In short, though self-injurious behavior is dramatically disturbing, it can be successfully treated. Self-injurers should not be viewed as "crazy" or as irreparably flawed. We are simply human beings in a great deal of pain who are coping in the only way we know how. Given some alternatives, and a measure of caring guidance, we can and will get better.