Self-Harm: It Makes Sense

“For a burn or a cut might be shown, might be nursed, might scar or heal… would anyway be there, on the surface of her body, rather than corroding it from within.”  Sarah Waters, The Night Watch

“My head was full of wild ambitious urges to hurt myself… I wanted my interior pain out in my body… I wanted this vague pain to be specific. That’s how I explain it.” Charles Baxter, The Feast of Love

**This post contains material that may trigger strong feelings or reactions.

In the moments after a client first admits to me that she cuts herself, that he burns himself, that she hits herself, I often hear the words, “I’m crazy.” My first response is always “You’re brave.” It takes tremendous courage to tell another person that you struggle with self-harm. Telling may be the hardest and most hopeful thing you ever do. Think of this step as an act of strength, not of weakness.

Starting Therapy for Self-Harm

There are people who can help you,– people who will not turn away in disgust or panic, as you fear. With the right therapist, you can expect:

• warmth, compassion, respect, and a safe connection.
• space to build a deep sense of trust over time.
• efforts to explore how your self-harm makes sense,– to you, to your therapist, even to other friends and family members who are open to hearing what it has meant to you, how it has worked for you.
• some control in the process. No one can force you to give up self-harm. But as you discover how hurting yourself has helped you to cope with overwhelming feelings and unmet needs, you will begin to have other choices. You won’t need to cut or burn yourself as you have in the past.

Understanding that Self-Harm Makes Sense

The bottom line is that people hurt themselves intentionally in order to take care of themselves. Self-harm always serves a purpose. Here are some examples of ways it can seem to help.

• An act of self-harm has a beginning and an end. Very often, self-mutilators describe intense panic when emotions overwhelm them. “This will never end.” “I can’t make it stop.” “I’m drowning.” Panic intensifies uncomfortable feelings, and the only way out seems to cut or burn. An episode of self-harm has a distinct endpoint, and the instant relief that follows seems worth the pain. In Bodily Harm: The Breakthrough Healing Program for Self-Injurers, the authors explain: “…the injuring act– paradoxically– produces a calming, soothing sensation. The tension and agitation ‘drain’ out, and the patient feels she can control her thoughts and feelings once again. Once the cut is made, the danger has passed.”  But self-mutilation easily can become a full addiction when used to escape emotional discomfort.
• Self-harm provides a “language” in the absence of words. People who hurt themselves may be excellent listeners. They may be sensitive, caring, and present for others who need them. But they do not know how to talk about themselves,– their own thoughts, feelings, and experiences. Self-mutilation is a language. A client once commented to me that each of her scars tells a story; she can recall exactly what happened before, during, and after each episode of cutting. Her body has been her voice.
• Self-harm is a way to validate emotional pain. In his book, Cutting: Understanding and Overcoming Self-Mutilation, Steven Levenkron writes, “The human self, made up of our innermost thoughts and feelings, is verified when reflected back to us by a trusted person. We are validated when we are understood.” People who self-harm, for whatever reason, have not had a trusted person to reflect back to them their feelings and experiences, to help them to know and accept themselves. Acts of self-harm, as well as the cuts, burns, bruises, and scars they leave, can literally replace meaningful relationships because they are reassuring mirrors of inner pain. For this reason, the idea of giving them up can be terrifying and heart-wrenching. Healing must include grieving this most trusted “attachment” and replacing it with honest, accepting, validating connections with others.
• Self-harm gives a sense of control. People who self-mutilate tend to see relationships as dangerous. They may long desperately to be understood, but most are filled with shame or disappointment and have given up hope. Isolation takes over as a way of life. Decisions about where, when, and how to self-harm provide people with control and predictability. They may feel a sense of power because they are able to “handle” problems without help. But, as with any compulsion or addiction, self-harm ends up controlling the people who use it to feel control.
• Self-harm can serve as anger release. Anger and conflict are normal parts of a healthy family life. In family environments where anger is not acceptable, self-harm may be discovered as an outlet. Sometimes, a family member (usually a parent or significant caregiver) is anxious or depressed, fragile and easily wounded, rigid and authoritative, or simply unable to handle any expression of uncomfortable feelings. Common responses to expressions of anger may include: “How can you be upset with me after all I’ve done for you?” “You’re hurting my feelings. I thought you loved me.” “How dare you talk back to me! Go to your room.” In these situations, it is not hard to imagine a person resorting to self-harm.
• Self-harm is a way to manage shame. Sadly, a self-inflicted wound or bruise can act as a punishment for perceived failures. Many people who self-mutilate are perfectionists and hold themselves to impossible standards. They are frequently overcome with shame and tend to have rigid ideas about how they should be,– how they should feel (“Something is wrong with me. Why don’t I feel happy? I deserve to be punished for having these bad feelings.”); how they should look (body weight and appearance); how they should act (“Why did I say such a stupid thing in the cafeteria today? I’m sure they’re mad at me now.”); how they should perform (in classes, sports, music, the arts, etc.). Self-punishment provides temporary relief and sometimes a brief “clean slate,” but a vicious cycle takes hold when nothing is ever good enough, and there is no room to be human.
• At times, self-harm is a way to feel alive. Some people who hurt themselves have trouble feeling real and present. This group tends to have a history of trauma or abuse* and has coped with pain and helplessness through dissociation. They use self-harm to ground themselves in reality. The physical experience of pain or the sight of blood may bring them back from a sort of trance.

Replacing Self-Harm with Words and Relationships

While your physical safety and well-being are important, the primary goal of therapy is not to make you stop cutting, burning, or hitting yourself. You probably have tried to stop this behavior on your own. If friends or family members have discovered your self-harm, they probably have tried to stop your behavior, too. But a focus on stopping self-harm is not enough.

First, you need to allow yourself to be known by someone you can trust. You then need to find out what your self-harm is doing for you. This part of the process takes time and hard work. Specifically, your therapist will help you to describe all of the circumstances, thoughts, and emotions that led you to hurt yourself, as well as the feelings you had afterwards. Talking through each episode in detail,– finding words for feelings and needs,– is much more difficult than taking a blade to your skin for a quick fix. But over time, a new awareness will become part of you, and you will begin to have choices in the moment. One client said to me, “I don’t really want to cut now. It doesn’t work any more. I’ve come too far to go back.”

One tool I use with people trying to overcome urges to self-harm is a very short list of sentence prompts. I ask clients to begin by giving themselves just 3-5 minutes to write (or type) their answers to these prompts before acting on an impulse to hurt themselves. Even if they still choose self-harm after the pause, they have interrupted a process that is usually automatic, and they’ve introduced a new element of reflection. Below are three completed examples. Please note that this exercise is not meant to replace treatment with a competent professional. 

I want to:  cut myself.

The situation:  I’m home alone on a Saturday night.

I feel:  lonely, worthless, bored

What I really need is:  something I can enjoy

I can do these 3 things to meet my need:

• take my dog for a walk
• invite a friend to meet for coffee
• watch a movie

 

I want to:  burn myself.

The situation:  My professor gave me critical feedback about my class presentation.

I feel:  embarrassed, overwhelmed

What I really need is:  support

I can do these 3 things to meet my need:

• schedule a meeting with my professor to ask for extra help/guidance
• talk with a classmate who had a similar experience
• remind myself that everyone in the class is struggling, it’s okay to make mistakes, and I’ll get through this

 

I want to:  cut.

The situation:  I said yes to too many commitments this week.

I feel:  burned out, exhausted, angry

What I really need is:  time for myself, a break

I can do these 3 things to meet my need:

• take a bath and go to bed early
• put on calming music and make myself some tea
• tell the neighbor I can’t babysit this week and block off the free time to relax

Final Thoughts

If you or someone you love is struggling with self-harm, please seek professional help right away. Take the time to find a therapist who is a good fit for you. You may need to meet with a few different people before finding someone with whom you can build a strong, safe, and honest connection, but this connection is essential to the healing process.

* Sometimes, self-harm is connected to abuse. If you harm yourself on a certain part of your body because you are ashamed of what someone has done to you, because you feel closer to that person through pain, or because you compulsively need to repeat those experiences, you are not alone. You make sense. And you need to tell someone you can trust.