The History and Mentality of Self-Mutilation

An estimated 2 million Americans practice some form of self-injury, and there is a common misperception that — like anorexia — the problem afflicts mostly young women. But self-mutilation isn't exclusively a modern adolescent issue. The disorder is an ancient one, and it is best understood as an attempt to relieve rather than inflict pain.

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Kim Schumer is one of the voices we're hearing through StoryCorps, and her experience is not uncommon. It's estimated that two million Americans practice some form of self-injury, and self-mutilation has been around for centuries. NPR's Alix Spiegel reports the disorder is best understood as an attempt to relieve pain rather than to inflict it.

ALIX SPIEGEL reporting:

In the late 19th century, two American doctors--George Gould and Walter Pyle--documented something they saw as a strange medical phenomenon. They reported that women all over Europe were puncturing themselves with sewing needles. In fact, this practice was common enough that European doctors had developed a name for the supposedly hysterical women who practiced this form of self-torture. They were called needle girls. However, according to psychiatry professor Armando Favazza, this was not the first time or place that the behavior had surfaced.

Professor ARMANDO FAVAZZA (University of Missouri): Self-mutilation spares no social class. It spares no gender. It spares no ethnicity.

SPIEGEL: Favazza, who works at the University of Missouri, has spent years studying self-injury and has found ample evidence of the practice in all kinds of settings. It's a problem in monasteries and nunneries, as well as modern-day prisons, and could even be found, he says, in ancient Greece. Favazza reads an excerpt from the work of the famous Greek historian Herodotus, who wrote of a Spartan leader who was thrown into the stocks after exhibiting strange behavior.

Prof. FAVAZZA: `And as he was lying there, fast bound, he noticed that all the guards had left him, except one, and he asked the man, who was his serf, to lend him his knife. As soon as the knife was in his hands, he began to mutilate himself, beginning on his shins.'

SPIEGEL: It's difficult to understand why anyone would deliberately harm themselves. Most of us, after all, spend our lives trying to avoid pain. But after years of research, Favazza says this behavior is best understood as a form of self-help, albeit a morbid form of self-help. For people whose emotions are hyper-reactive or for those raised in an emotionally chaotic environment, it often seems like the best way to silence a swirl of pain and anxiety.

Prof. FAVAZZA: They describe it as popping a balloon. All the anxiety just seems to just go away.

Ms. REBECCA RAYE(ph) (Practices Self-Mutilation): Part of me almost feels like I am--that all the things that are really hurting me at the moment are just kind of leaving me, along with the blood.

SPIEGEL: This is 19-year-old Rebecca Raye. A series of fresh inch-long cuts climb Rebecca's arm like a ladder, 60 neat parallel lines. She made these cuts five days ago after realizing that her financial situation was not what she hoped it would be. Overwhelmed by the stress, she went to her room and pulled out what she refers to as `the kit.'

Ms. RAYE: It's a little purple basket, and it has a new pack of razors in it. It has a pair of scissors and a pink towel.

SPIEGEL: Whenever Rebecca is distressed, by work, by family, she returns to this kit. Before she cuts, she says her mind is exploding. But once she feels pain, there's a kind of peace.

Ms. RAYE: I'll just be really calm and my thoughts will finally kind of be making sense, instead of them like racing through my head and nothing quite clicking. Just kind of centralizes my thought on one thing.

SPIEGEL: Now she cuts only a couple times a week and is trying to stop, but at her worst, Raye was cutting three times a day and wouldn't go to work without a razor blade in her pocket.

Ms. RAYE: There are still times, like, where I can't leave the house without actually having something with me, because I'm afraid that if I need it, then I won't have anything to use.

SPIEGEL: This is common, says Armando Favazza. He points out that people who harm themselves don't experience pain in the usual way.

Prof. FAVAZZA: And the fact is that most self-mutilators do not feel pain when they mutilate.

SPIEGEL: You say cutters, particularly people who have been abused in some way as children, frequently respond to stress by dissociating, a mental state which, in a sense, protects them.

Prof. FAVAZZA: What's being done is being done to their body but it's not being done to them because they're kind of floating out there away from their body.

SPIEGEL: Unfortunately, says Favazza, dissociation is a very uncomfortable feeling, particularly for adults.

Prof. FAVAZZA: And one of the sure ways to end these episodes of depersonalization is to cut yourself. They see the blood and they say, `OK, that's where my body is because the blood is coming out from my skin, and I know where the boundaries of my body are,' and then the depersonalization or the dissociative process ends.

SPIEGEL: Ends by reconnecting the mind and body through pain. Again, Rebecca Raye.

Ms. RAYE: When I first start, like I can see the razor going through my skin, but it's like it's not there at all, so it's not until I've been cutting for a while until I start to actually feel the pain, and as soon as I feel a little bit of pain, I usually--it's usually like maybe one more cut and I stop.

SPIEGEL: Like a lot of coping mechanisms that people develop to deal with stress--alcoholism, anorexia, drugs, smoking--cutting is a difficult habit to shake. There's a new treatment which has had some success called dialectic behavior therapy, and Rebecca is thinking of trying it. She's never been treated for cutting before and has practiced some form of self-injury for over 10 years, so it won't be easy. And though Rebecca is intent on stopping, she understands why she turned to the behavior in the first place.

Ms. RAYE: It was just something that seemed--I don't want to say like a good idea, but seemed like something that would help me at the time, and it did.

SPIEGEL: For NPR News, this is Alix Spiegel.

INSKEEP: You can find more information on self-mutilation at npr.org.

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