Bright Red Scream : Self-Mutilation and the Language of Pain

Self-mutilation is a behavior so shocking that it is almost never discussed. Yet estimates are that upwards of eight million Americans are chronic self-injurers. They are people who use knives, razor blades, or broken glass to cut themselves. Their numbers include the actor Johnny Depp, Girl Interrupted author Susanna Kaysen, and the late Princess Diana. Mistakenly viewed as suicide attempts or senseless masochism--even by many health professionals--"cutting" is actually a complex means of coping with emotional pain. Marilee Strong explores this hidden epidemic through case studies, startling new research from psychologists, trauma experts, and neuroscientists, and the heartbreaking insights of cutters themselves--who range from troubled teenagers to middle-age professionals to grandparents. Strong explains what factors lead to self-mutilation, why cutting helps people manage overwhelming fear and anxiety, and how cutters can heal both their internal and external wounds and break the self-destructive cycle. A Bright Red Scream is a groundbreaking, essential resource for victims of self-mutilation, their families, teachers, doctors, and therapists.

Marilee Strong was a senior writer of San Francisco Focus magazine.

Chapter One

"The truth about childhood is stored up in our body and lives in the depth of our soul. Our intellect can be deceived, our feelings can be numbed and manipulated, our perception shamed and confused, our bodies tricked with medication. But our soul never forgets. And because we are one, one whole soul in one body, someday our body will present its bill ."

--Alice Miller

The Walking Wounded

" She pays such a terrible

price for her sin and

at last the outside

matches the in

Justice."

--From the poem "Escape" by Camryn,

a nineteen-year-old Australian cutter

THE MORNING AFTER

It's that feeling again. You wake up and see blood stains on your sheets and on your carpet. Books and bits of paper strewn all over your room. Broken furniture. That familiar sting on your arms, on your torso. Your face is smeared red. You were doing so well, too--thirteen days since the last time. You feel numb, dazed, hung over, stupid. You can hardly get yourself up; you haven't eaten for three days and you've lost a lot of blood. Just what are you trying to prove? The maid comes in and sees red-stained tissues on the floor, looks at you, not too sure what to make of it. You try to piece together exactly what happened last night ...

    You'd been working all day, wanted to go out and relax, enjoy yourself. No one around. Went to the liquor store, bought something to drink, sat in your room, listening to your favorite violent and depressive music. Something is welling up inside you, you notice. It feels like at any minute you're going to explode. Your eyes become watery, you start crying. The crying becomes shouts, yells, screams. You try and hold yourself down. Start kicking the door. Throw stuff across the room, out the window. You can't calm down. You don't even know what got you into this state in the first place. You dig your nails into the skin on your wrist. Can't feel anything. It's like you're watching a film of someone; this isn't you. You take your shirt off, look in the mirror. Hate, disgust, frustration, anger, regret. Almost like a ritual, without even thinking what you're doing, you pick up the razor blade ... blood dripping down. Rub in some antiseptic, do it again, do it until you're calm, you're satisfied. Like when you go out for a drink and have one or two and you just want more, and you know it's stupid but you just can't help yourself.

    How do you feel? Alive. Real. Numb. Calm. Satisfied. You smear the blood around. It's sick, but the blood feels real, feels human, feels good! At the same time, you feel the pain; you deserve the pain. You tell some people. They say you're manipulative, attention seeking. You believe it. Only serves to make you feel worse. Some people think you're sick, you're weird. One or two may understand, but they're still wary, still shocked by it. Some think you're suicidal. You're not.

    Cutting is not attention seeking. It's not manipulative. It's a coping mechanism--a punitive, unpleasant, potentially dangerous one--but it works. It helps me cope with strong emotions that I don't know how to deal with. Don't tell me I'm sick, don't tell me to stop. Don't try to make me feel guilty, that's how I feel already. Listen to me, support me, help me.

Andrew's vivid, stream-of-consciousness rant comes via e-mail from halfway around the world, perfectly evoking the fractured, alienated mindset at the heart of cutting. The twenty-two-year-old Scottish chemistry major only started cutting a year ago, yet his use of self-injury to cope with an internal sense of chaos began very early on. Between the ages of two and ten, he would sometimes bang his head against the wall until he knocked himself unconscious. Like most male cutters, he injures himself more severely than his female counterparts. He used to carve his skin with a kitchen knife but today restricts himself to safety razors so that he doesn't lose too much blood. "Four months ago I felt really out of control," he says. "Now I know I should stop but I don't necessarily want to. I'm not sure if it has become more a habit than a necessity."

    Sometimes he has no awareness of the act itself. He wakes up the next morning in horror at the damage he has done. These "black out" states, an extreme form of dissociation (an altered state of consciousness akin to physical and emotional anesthesia), are probably enhanced by his use of alcohol and sleeping pills to ease his depression and blunt his mounting anxiety. Before cutting, as tension builds, he feels distant, outside himself. When the blood starts to flow, "everything is real and back to reality."

    Since he began cutting, Andrew's life has gone into rapid decline. He won top honors his first year at university; the second year he failed. "I was going to class drunk or stoned, not handing in assignments, not caring what happened," he says. After a year and a half of feeling severely depressed he went to see a school counselor who referred him to a local psychiatric hospital. For six months he underwent cognitive therapy, in which he learned to trace back the negative thoughts and feelings that lead to self-mutilation and examine the errors in his reasoning. "One of the central fears that comes up for me," he realized, "is that I might hurt or even kill other people, directly or indirectly, by what I say or do."

    Andrew now sees his cutting as a form of self-punishment. It is also a way of siphoning off aggressive impulses that might otherwise be outwardly directed. He blames himself, however irrational it may be, for the deaths of his grandfather from alcoholism and his grandmother from a stroke--both of whom died in his presence. "I should have called an ambulance, done something," he says. "I knew my grandmother was very depressed and I always made an effort to try to talk with her and help her. But I obviously didn't give her enough because it was the stress that killed her."

    He also feels responsible for his mother's fragile mental health, which has declined since her parents' deaths to the point that she is a virtual shut in, plagued by agoraphobia and panic attacks. He seems to have inherited his acute sense of guilt from his mother, who always took the blame for every family problem and also feels responsible for her parents' deaths. His relationship with his father, who works abroad and spends only weekends at home, is strictly formal. Both keep their emotions well hidden from each other.

    He credits therapy with helping him feel more in control. Yet his newfound awareness has changed his behavior only "from having to cut to wanting to cut."

    "Self-injury may be desperate, but it is something I can do," he says. "For me it's a kind of hope, a way out. It's not giving up."

BLOOD SISTERS

"The first time I cut I just wanted people to see how much pain I was in," says sixteen-year-old Melanie, who has been cutting and burning herself for the past three years. "I wanted somebody to notice me."

    Instead, her father criticized her technique and showed her the more deadly way to slash her wrists.

    Melanie attributes her father's response to his "wicked" sense of humor. She calls her mother her best friend and says her father's a "great guy" deep down. The family seems more like strangers trapped in an emotional labyrinth: a father who hides in his room to avoid his family; a mother who makes excuses for her husband's behavior "because he works so hard"; and two daughters, who share little more than a penchant for things sharp, left to their own devices to find comfort and attention.

    "I hardly ever see my father," says Melanie's fourteen-year-old sister, Jennifer, who herself took up cutting a year ago. "The most we ever usually say is hi. We rarely even eat together. I usually just stay in my room. But Melanie was always big on trying to get everybody together, planning dinners, family outings. For a while she tried to get everybody to spend time together in the living room on Thursday nights. We even tried family counseling but the minute we got home things went back to the way they were."

    Jennifer says she's done some of her cutting "just to see how much pain I can withstand. I used to not really feel anything. Now I get so frustrated it's the only thing I can think of other than punching something." The few people she has ever confided in about the behavior have simply gone mute with disgust. "It would be nice if someone just asked why?" she says sadly.

    Melanie is unhappy to see her sister following in her footsteps. "It's hard to know what to say to her because I don't know what would make me feel better," says Melanie, just a week out of the hospital following a drug-induced mental breakdown.

    She lives in a Blue Velvet swatch of California suburbia, where too many parents tend their rose bushes and scrub their sidewalks in the waning afternoon sun, oblivious to the pain of their children's reality. To create the family she has lacked, Melanie has attempted to create her own with an ever-changing group of street kids she has collected like stray cats since the first two followed her home from the mall six months ago. Many are cutters like herself. They stare blankly at a massive wide-screen TV--"my father's pride and joy," Melanie says, her large expressive eyes, weary beyond their years, hidden behind a shock of black hair.

    Inside Melanie's bedroom her little-girl past collides with her Sylvia Plath present. Teddy bears and trolls nestle incongruously next to pictures of the dead celebrities she idolizes: Marilyn Monroe, James Dean, John Lennon, Judy Garland. Her most prized possessions, however, are kept in a red suitcase: a lock of her formerly purple hair, a lock of her ex-boyfriend's hair, and reams of morbid poetry she has been writing since the fifth grade. On dog-eared sheets of binder paper and scrawled into journals are the grimly elegant, chillingly honest contents of her head: a letter to God she wrote praying for help when she thought she was going crazy, the contents of a "first and final suicide letter," and this deceptively simple description of the pain she can and can't control:

`This' pain I can see it but I can't feel it

It haunts me

When I cut myself I can see where the pain

is coming from and watch it heal

And I can easily care for it

`This' pain doesn't have a specific place

It moves around and creeps into strange places.

Melanie has cut her wrist with a shaving razor, burned herself with cigarettes, and carved words and pictures into her arms and legs. On the back of her left hand is the ultimate ironic statement: a Happy Face symbol branded into her flesh. Melanie, like many other cutters, discovered that the top of a disposable cigarette lighter could be heated and then pressed into the skin to leave a mark that looks exactly like the treacly '60s icon.

    "The whole idea of cutting yourself is ironic," she says, fingering the Happy Face scar. "Making yourself hurt to feel better is a really wicked and deranged thing. But to me, it's normal."

    Melanie first cut herself in the eighth grade, a loner and an outcast without friends to share her pain. "I didn't like who I was, I didn't like the way I looked, I didn't like anything about myself," she recalls. She didn't even resent that her classmates called her a witch and a vampire because of her dyed-black hair and all-black clothes. "At least they noticed me," she says.

    Today the kids hanging around the house have given her a sense of community. They've also given her perspective. "They've helped me find who I am and what I want to be and what I don't want to be," she says. "I don't want to be dead, I don't want to be a junkie, I don't want to be homeless. I just want to get my shit together so I can do something with myself where I'm happy."

    She talks of finishing school, marrying, having kids of her own one day, becoming a writing teacher. Enrolled in day treatment, starting to work out her feelings in art therapy, counseling groups, journal writing, she says she's "maturing" out of cutting.

    "It was a stupid teenage thing to do," she says. "I look at my scars and think I was really dumb because they're not pretty. I've come to the realization that I'm either going to kill myself and get it over with, or I'm going to pull things together and not do stupid little shit like this."

    Less than a month later she tried to kill herself.

QUILTED FLESH

"Cutting without drawing enough blood is like having salad and yogurt instead of steak and potatoes," says Fran, a fifty-three-year-old wise-cracking New Yorker. Those words would be startling coming from anyone, but are even more so spoken by a middle-aged Jewish mother from one of New York's most exclusive neighborhoods--a woman raised in the posh Westchester suburbs she refers to as the "Golden Ghetto."

    Fran has been cutting and burning herself for more than thirty years. The longest she has ever gone without hurting herself over those three decades has been the nine-month periods of her two successful pregnancies. Yet, unlike most self-injurers, she has no desire to stop. In fact, she describes her scar-covered arms almost proudly as looking like "patchwork quilts"--even though she has sliced one open from wrist to elbow down to the muscle and burned herself so badly she required a skin graft. Sometimes, for reasons she can't explain, she even draws pictures with her blood, including crosses, Stars of David, swastikas, and the "mark of the beast," the numbers 666 .

    "Cutting has become, over the years, such a part of my life I really don't think about it that much," says Fran, who has been on psychiatric disability since 1993. "It simply feels good. If I'm not hurting anyone but myself, why are people making such a big deal out of it?" In fact, the only negative feelings she has about what she's doing to herself is her complete lack of remorse--"like a serial killer who knows he should feel guilty about that line of bodies he's left behind."

    "It would be nice to put this aside," she says. "But that would be like asking somebody who smoked a pack a day for thirty years to imagine doing without cigarettes."

    On the surface, Fran is wry and chatty, an entertaining storyteller with a biting sense of humor. Perhaps it is a well-orchestrated cover for the forbidden emotions she cannot allow herself to express. For it is anger that drives Fran's cutting. For her almost any kind of negative feeling--fear, frustration, sadness, abandonment--cascades quickly into a rage so intense she likens it to a volcano exploding or being knocked over by a tidal wave. "There's no time to hold any kind of internal dialogue: Should I cut or should I not cut?"

    What would happen if she didn't give into the urge? "I don't know," she says, perplexed, as if the thought had never occurred to her in thirty years of cutting. "I'd be afraid to think what might happen."

    Much of Fran's anger involves her mother, with whom Fran had a difficult and enmeshed relationship. Fran's mother was the child of immigrants, the only one of five daughters to go to college. A brilliant woman who also earned a master's degree from one of America's top universities, she expected her own daughter to strive the way she had to strive, to do anything to avoid the humble roots she had once known. Unfortunately, she used criticism as her primary motivating tool--constant criticism. When fifteen-year-old Fran waited until the last minute to start a term paper, her mother ripped into her. "If you do poorly in school you won't get into a good college," Fran's mother told her. "Then what am I going to do with you? Send you to work in a factory?"

    The sensitive teenager was shattered. "Suddenly I saw my future as so bleak and hopeless--all stemming from this one term paper--I swallowed an entire bottle of aspirin." When Fran went through her mother's things after she died last year, she found that her mother had kept all of her daughter's report cards, all the notices of Fran making the dean's list, being elected to Phi Beta Kappa. "My father was actually interested in what I was learning, what I thought about," Fran says. "But all my mother was interested in was the results."

    Her father, a workaholic, died of a heart attack when Fran was just nineteen, propelling her into an early marriage. "God forbid I should be left home with Mom!" she says. At twenty-one she was pregnant, a situation her mother opposed because both Fran and her husband were still in college. (She later suffered a miscarriage.) One day her mother began fighting with her over what to name the baby. That was the day that Fran started cutting. She went upstairs to shave her legs and suddenly, impulsively, cut a few lines across her wrist. "I watched the blood well up and I felt relief, like opening a safety valve or letting steam out of a covered pot," she says, sounding still amazed at her unexpected discovery.

    As she got further into her twenties, the cutting became more frequent and insistent. After a second miscarriage, she even slashed her legs up while still in the hospital. It also became quite ritualistic. "I liked to light candles around the bathroom, take a long, hot, scented bubble bath, towel off, then go at myself with the razor," she says. "I loved to watch the blood run down. I thought I was the only person in the world who did this, which made it feel more good than bad."

    By her thirties, cutting was less about ritual than release. "It took very little to trigger me," she says. "I would carry a razor blade around in my pocketbook and sometimes even go into the ladies' room at work just to nick myself a little--anything not to explode. It was a lot safer than keeping it all inside."

    When she cuts or burns herself it is like she is outside her body watching herself--what she calls "stepping out." It was a form of psychological escape she had been utilizing since the age of nine or ten, when in response to her mother's harangues "I would give myself what I describe as a push and I'd be standing outside myself watching the whole scene with rather bemused detachment." After the release of self-injuring, she feels sleepy and contented, "like after sex, although I never feel sexual feelings about cutting."

    Fran's relationship with her mother remained painfully entangled until the end. For thirty-two years, beginning with the death of her husband, Fran's mother believed that she, too, at any minute, might die of a heart attack. Every phone call brought a new crisis. Eventually, after years of nagging, Fran and her husband even took an apartment in her mother's building. Just months before the older woman died, Fran's brother confronted his mother about never giving him any emotional support. "Emotional support--what bullshit!" their mother exploded in anger.

    "This was a woman who'd been a wife, mother, grandmother, teacher, and guidance counselor," Fran says, shaking her head, "and she thought that emotional support was bullshit." Though Fran says she was relieved to have her mother out of her life, her cutting has actually increased since her mother's death. For the real critic did not go to her grave. She is inside Fran.

    The only treatment that has ever helped Fran stop cutting is massive doses of psychotropic medications, like Haldol and Thorazine, "but I turned into a very overweight vegetable." Sometimes, if she can catch herself when the anger is just starting to build, five or ten milligrams of Valium can ease her through a crisis. "But if the feelings catch me unaware, or build too fast, I don't even want the Valium," she says. "I want to cut."

TOO DEEP FOR TEARS

"Everyone tells me I'm so lucky," says Daphne, a sixteen-year-old high school junior from Alberta, Canada. "I have a wonderful family, get good grades, live in a beautiful house in a wealthy area, have great friends. If only they knew the truth."

    It is a terrible truth, perhaps even more terrible than Daphne knows.

    "I have no memories of my life before about a year ago," she explains. "I always wondered why I couldn't remember things, if there was something I was trying so hard to block out. I know that when I was four, my father killed himself. Took a gun and shot himself in the head while my sister and I were sleeping upstairs. And I know that I've had nightmares and thoughts that terrible things might have happened to me. But I was always too afraid to dare mention them, too afraid to even let myself think of them."

    She started cutting a year ago. It all began quite by accident. She nicked her leg shaving one day "and there was just something about seeing the blood." She's used razor blades, an X-Acto knife, even the plastic cap of a pen once when she was desperate. She's also burned and intentionally bruised herself. She moved from her legs to her arms then to places less likely to be discovered. Today she mostly cuts on her breasts. "I don't know if there is any significance to where I cut," she says nervously, her mind spinning off into a realm she cannot allow it to go. "I don't want to think about it. God, it's scary! Did somebody do something to me there? No. Of course, not. Nobody did. Not him. Nobody."

    Self-injury provides the only satisfying release that Daphne knows. "There are times when I just hurt too bad--too deep for tears--so I cut and it lets out some of the hurt," she says. "It's like when you see the blood flowing out, the pain and fear are flowing out with it. Or at least I want them to. I guess they never really do.

    "Sometimes I self-injure to make myself feel something because I'm just totally numb. Other times I cut to make myself numb because I can't deal with what I'm feeling. I mostly do it when I'm angry. Maybe I was raised not to be angry, or show anger. But whenever I'm mad, I find myself to be at fault so I punish myself. The anger builds up, higher and higher until something has to happen--and for me, that something is self-injury. I concentrate on the cuts, on the blood, and it calms me. But I'm also always scared somebody is going to walk in and see what I'm doing and send me to the hospital."

    It happened last November. Her mother found her and freaked out, convinced her daughter was going to bleed to death. "I guess she thought I was trying to kill myself all those times," says Daphne, referring to her numerous scars. "But if I did, I wouldn't be cutting where I was cutting." She stopped for a while, but thirty-one days is as long as she has been able to go without cutting. Now she cuts when she can and looks forward to the day when her mother's scrutiny wanes. "I know when it's winter and I can wear long sleeves my arms are going to be covered with slices and scabs," she says. "It's just something that I need, and probably will for a long time."

    When Daphne considers her future, she draws as big a blank as she does about her past.

    "It was my birthday just five days ago and I planned to kill myself," she says matter-of-factly. "But I'm still here. God knows why, but I am. So I don't know what my plans are for the future. I guess to live until tomorrow, to make it just one more day. I know I love children more than anything, and would love to have my own family and work with children. But right now, my goal is just make it five more minutes ... then five more."

BETTER THAN SEX

"If you had seen the look on my face when I hit the artery you would know what the expression 'unholy glee' means," says Lukas, a forty-three-year-old lawyer describing a recent episode in which he cut his arm so deeply he needed to get two pints of blood transfused. "I have no particular desire to kill myself at the moment, but I'd probably be perfectly happy watching myself bleed to death because the feeling I get when I hit the vein and the blood comes out is better than anything. It's better than drinking, it's better than any drug I've ever taken, it's better than sex."

    Until a year ago, Lukas was a successful, hard-driving attorney. He graduated first in his law school class, and worked for one of the top-three firms in the country for his legal specialty. Then his perfectly imbalanced world began crashing in.

    As a boy and young man he had inflicted minor injuries on himself: pulling on his nails until they bled and sometimes came off, picking incessantly at scabs and wounds to keep them from healing. In college he even gave himself a concussion a few times banging his head against the wall. But throughout most of his adult life, alcoholism and workaholism kept his inner demons in check. "I was pretty bad--sort of like Nicolas Cage in Leaving Las Vegas ," he says of his prodigious drinking ability. "I'd work sixty, seventy, eighty hours a week and still go through two and a half cases of beer on the weekend."

    Then the bottom fell out of the market for the kind of law in which his firm specialized. "I watched as most of the people I worked with were slowly downsized, or whatever the euphemism was at the time," he says. To save his own job, he scrambled to master a new specialty. But a huge blow-up with a partner led his colleagues to question his sanity. The firm made him undergo a psychiatric evaluation. "They determined I wasn't a postal employee in waiting," he says, in his deadpan, acerbic way. The sense of betrayal he felt seemed to unleash something deep inside him. One day, totally wasted, he plunged a steak knife into the back of his calf down to the bone, "just to see what it would feel like." Shortly thereafter, he stopped drinking, and with neither of his longtime defenses working for him anymore, his life and his mind quickly began to unravel.

    He became depressed but medication only made him worse. "I was totally nonfunctional," he recalls. He checked himself into a mental hospital, using up two thirds of his family's lifetime insurance benefits for mental health care on medication, group therapy, and electroshock treatments. It didn't help. Within a month of his release he tried twice to kill himself.

    While struggling to find a psychiatrist who could help him, Lukas began cutting. He quickly escalated "from scratches to nicks to cuts to slices to gashes--just constantly going deeper." Within seven months he had fifty scars--his worst inflicted just a week before our interview, when he managed to work a double-edge razor blade completely beneath the surface of the skin, puncturing the artery.

    "I cut secondarily for the pain, primarily for the blood," he says. "Watching the blood pour out makes me feel clean, purified. It's almost religious, in a way. It feels like something bad or dirty is leaving with the blood, so the more blood spilled, the better." He likes to make patterns with the blood on paper towels. Sometimes he even tastes it. "It looks so beautiful coming out I just have to taste it," he says.

    When Lukas is debating whether to cut he feels like an argument is going on in his head between warring selves: a stronger part that believes he deserves to be punished, and a weaker part that doesn't. He does not think they are separate personalities, but different aspects of his self that, for whatever reason, have acquired more independence than they used to possess. "When I was healthy, it wasn't unusual for me to lie in bed, unable to sleep, and go 'round and 'round with a problem in my mind trying to figure a way through it," he says. "The process would sound like an argument, but there was no perception that I was fighting with myself; it was purely an intellectual exercise. These really feel like arguments."

    Lukas even admits to undermining his own therapy because there is a part of him that wants to stay sick. "When my psychiatrist comes up with some strategy to deal with an immediate problem so we can get back to the real therapy, within two sessions I will have come up with a new crisis to up the ante," he says. "I think part of me feels that I deserve to have this illness, that it's just weakness and a real man ought to be able to shrug it off and get down to business. And then there's a part of me that just wants to take the ride for all its worth."

    Lukas has difficulty understanding his sudden bizarre preoccupation. "Some of this doesn't make sense even to me," he says. He thinks it leads back to his relationship with his father, an immigrant engineer who desperately wanted to fit into American society. "He wanted a son who would do all the things American boys do and instead he got me," Lukas says drily. "Nothing I ever did was good enough. If I got good grades I should have gotten better grades. And I didn't share his tastes. I watched PBS instead of football. I read too many books. I didn't have any real athletic skills. The funny thing is that he didn't have any either. But I think he felt that if he could never be the all-American kid then `by God, my son will!'"

    Lukas thinks one of the reasons he cuts, and cuts so savagely, is because he has internalized his father's contempt. 'I hate myself," Lukas says unequivocally. "It's almost an insult for people to refer to it as a self-esteem problem. I'm talking active, passionate hatred. Even now I still have enough of the image he tried to force into me to think that whining just because your dad didn't compliment you enough is weak and lazy."

    His father abandoned his mother and family for another woman when Lukas was sixteen, and the son saw his father only three more times. When his father died last year, Lukas didn't even attend the funeral. "He always told my mother she didn't need to work or learn how to drive because he would always be there," Lukas remembers. "Then he found somebody else and she was stuck with no money, no skills, no transportation." Yet Lukas also seethes with anger toward the mother who never intervened in the denigration his father heaped on him. He fantasizes about showing his mother his scar-riddled arms on Mother's Day and telling her, "The cheerful, happy, perfect boy you think you raised doesn't exist."

DADDY'S GIRL

Barbara is not a "split personality." But, like Lukas and most other self-injurers, it seems like there are two completely different people inhabiting her body. The woman most people see is a successful forty-nine-year-old professional, a happily married wife of more than twenty years, mother, grandmother, Sunday-school teacher, and devout Mormon. The other Barbara has been secretly hurting herself on and off for forty years. Her hands, arms, legs, and feet are covered by at least a hundred scars. She once cut herself so badly she needed a tourniquet and seventy-five stitches to staunch the bleeding. She has seared her flesh with hot irons and boiling water, crushed her foot with a purposely dropped bowling ball, cut through the nerves in her hand. She became such a danger to herself that she would allow herself to cut only in her car parked outside the local hospital emergency room, just in case things got out of hand.

    Both Barbara's mother and grandmother suffered from manic depression and were in and out of mental hospitals throughout her childhood. Barbara's biggest fear is ending up like either one of them. Her grandmother, who came to live with the family when Barbara was young, was frequently manic, highly agitated, wildly irrational, and sometimes violent. Her mother, who had long lived with the fear of becoming like her own mother until she too fell sick, tended to swing to the other extreme--falling into depressions so crippling she would become almost catatonic. Some days Barbara would come home from school to find her mother seated on the sofa in the exact same position as she had left her in the morning, having not moved a muscle all day. At her sickest, she would stop speaking altogether, and expect her daughter to bathe her and dress her and care for her like a child.

    From the age of ten, Barbara was thrust into the role of de facto mother and wife--a situation she both dreaded and embraced. In all but sexual matters, she was her father's helpmate: cooking and cleaning and doing the grocery shopping. They were very close, and Barbara comforted herself to sleep at night with fantasies of being the only daughter of an attractive single father. When her mother went away every year or so for six to eight weeks of shock treatment, Barbara took guilty pleasure in her absences. As a young girl on the cusp of adolescence, it was both flattering and shameful to be able to fill her mother's shoes.

    "It's what every little girl wants--to get rid of her mom and take her place," says Barbara, not unaware of the Oedipal ramifications of her situation. "But you don't really want it. And you're not supposed to get it."

    Her mother openly resented the closeness between her husband and her daughter. Barbara now thinks that her mother was probably jealous because her own father died when her mother was just thirteen. But Barbara grew up believing her mother hated her, and she didn't know why. "It must be because I was bad," she concluded as a young girl.

    Barbara's earliest memories of self-injury involve burning her fingers with matches in the attic and cutting her hand. Barbara's mother noticed her daughter dressing the cut and told her it wasn't "bad enough" to require a Band-Aid. Those words--emblematic of her mother's lack of nurturance and the painful reversal of their parent-child relationship--still resonate for Barbara forty years later. For when she hurts herself, she can't stop until her wounds are "bad enough."

    "If I bruise myself, I have to reach a certain pain level," she explains. "If I burn, I have to have blisters. If I cut, it almost always requires stitches. And each time has to be a little worse than the last. I think the hope is that if I hurt myself bad enough I won't have to do it anymore. But I never reach that point."

    For Barbara, cutting and burning is a form of self-punishment but also a form of control, a survival strategy to keep her emotions in check and prevent herself from falling apart. "It allows me to keep going--because I certainly wouldn't want to become like my mother and stop functioning, or go completely crazy on the manic, angry side like my grandmother," she says. "It's like I try to keep on this tightrope. I never let myself get too high or too low because I knew I was my dad's favorite and I wanted to be what he wanted me to be: somebody who didn't show emotions. The nice, stable, everybody-can-lean-on-you person."

    Barbara graduated at the top of her high school class and earned a bachelor's degree from Brigham Young University. During her college years, she didn't self-injure often. When she did it was usually brought on by demands she felt she could not meet--like being unable to maintain the straight-A average she kept in high school. "Probably through most of my college career I hurt myself during finals," she says. As a Mormon she felt an added layer of guilt about breaking church covenants by abusing her body. The first bishop she confided in told her she might be excommunicated if she did not stop harming herself. She felt so unworthy of God's grace, she stopped going to church for a while.

    "Now I'm trying to use my religion to get help," she says. "I get a lot of healing by going to the temple because it is probably the one place that I truly feel okay about myself."

    During her twenties and thirties when she was having children, she managed to stop hurting herself--first for a period of six years and later for thirteen years. "I didn't even think of it for years at a time," she says. "I thought it was a thing of the past." She explained away her scars as the result of a motorcycle accident and may have partially replaced her self-destructive urges with occasional binge eating. For the most part she was fine until a few years ago, when her husband was laid off.

    "He had actually been laid off from another job before and had ended up changing careers," she explains. "But this time it appeared he would not try to find another job within the company nor look very hard elsewhere. I had visions of him withdrawing into a shell, like my mom." Barbara had other problems to deal with as well. She was on a restricted diet because of diabetes and high cholesterol so she could not binge, she was entering into menopause, and she was working fifty-five-hour weeks when she wanted to only work part time. "I suddenly realized that I could hurt myself to feel better," she says, "then that I wanted to hurt myself."

    After three bouts of self-injury in as many months, she managed to stop herself again and get into therapy. The first time she discussed her self-injury with a therapist back in the 1970s, there was virtually no awareness of the problem of cutting. "My first psychiatrist kept trying to tell me that I got some kind of sexual pleasure out of it, which is not true. He also made me believe that I was doing it to test him, but now I realize I do it to keep my feelings under." Her current psychiatrist, who also happens to be a Mormon, doesn't want her to hurt herself. But he doesn't condemn her for it and he doesn't demand she stop. "He's actually helped me understand better why I choose to cut than all the therapists who tried to get me not to do it with threats and written contracts," says Barbara, who has injured herself only three times since resuming therapy a year ago.

    She's even found the courage to tell her husband and children the truth. She was amazed to find out that her eleven-year-old daughter had read an article about self-mutilation and had suspected that was the real cause of her mother's frequent injuries. "Part of the reason I decided to come clean with my kids was realizing what a difference it might have made if somebody had told me that my mother's being sick was not my fault--that I wasn't this horrible ten-year-old girl who wished her mother would go away and got her wish."

   Barbara looks up at a portrait of Jesus hanging in her living room. Inscribed on the picture are the words I DIDN'T PROMISE YOU IT WOULD BE EASY, I PROMISED YOU IT WOULD BE WORTH IT. "I have to think about those words every day because it's easier to cut myself than not cut myself," she says. "I can't say I'll never do it again. But I'm willing to stay in therapy and not run away from my feelings. I finally got to the point this summer where I started to think I didn't really do anything terrible as a child and I don't deserve this punishment. That's a big step."

Copyright © 1998 Marilee Strong. All rights reserved.