Actress Angelina Jolie recently went public about her most private pain: she cuts herself. So do thousands and thousands of apparently well-adjusted people. What is self-mutilation? What prompts it?
Christina Ricci also cuts herself. So, we now know, did the late Diana, Princess of Wales. It's no surprise that the self-abusive Courtenay Love also cut herself.
But what might surprise you is that your colleague, or housemate, or boss might also, in the privacy of their bedroom or bathroom, be taking a knife, razor blade or safety pin, and cutting themselves - light, superficial slices across the wrist or thigh, deep enough to bleed, but not deep enough to kill.
Of course it's bizarre behaviour. It's also potentially dangerous - cutters can lose so much blood that they pass out, and they're vulnerable to infections. They may misjudge the depth of the cut, and need stitches, or need to be hospitalised.
But the real issue is emotional. When somebody self-mutilates, they leave behind more than surface damage – they leave deep emotional and physical scars. Many times, no one comes to the rescue, as self-mutilation usually happens behind closed doors, and the evidence covered up.
But isn't this quite rare?
Unfortunately not, say the experts.
In Britain, health-care researchers estimate that one in ten teenagers may practise some form of addictive self-mutilation, and US school guidance counsellors are also apparently concerned at a rise in the practice, saying it is perceived as "cool, a trend". There are no figures available within South Africa, but the existence of websites dedicated to self-mutilation is very, very worrying.
Self-mutilation usually occurs in families which do not have open communication channels. Cutters are usually middle or upper class, well-educated, and have above-average intelligence. It's more common among teenagers and young women - but by no means restricted to them.
Many who self-mutilate do not aim to hurt themselves permanently, and they often do not mean to continue with the behaviour. Experts believe they rarely have the intention to commit suicide, but rather do it to get immediate relief from emotional pain.
“Self-mutilation overwhelmingly affects females more than males. It is estimated that only 20 to 25 percent of people who self-harm are male,” says Dr Juan Schrönen, a psychiatrist at Panorama Medi-Clinic in Cape Town.
Why do they do it?
Many of those who cut themselves see self-mutilation as a coping mechanism and, says Schrönen, "would rather self-mutilate than seek professional help."
"Self-mutilation often becomes an addiction and is used as a form of escapism. Those who have suffered a traumatic experience could start mutilating themselves. Even living through violence could lead to the start of a self-mutilating habit," he added.
Those who cut themselves, are substituting emotional pain they with physical pain. "A cycle of addiction starts,” says Schrönen. “The person experiences an adrenalin rush and feels euphoric for a while. The emotional pain becomes unbearable and the physical pain, although unpleasant, is something with which they can cope."
It is suspected that those who self-mutilate have not developed healthy coping mechanisms. When they reach a point where their emotions surge to unbearable heights, they opt to do dangerous things to themselves. It is a roundabout way to regain a sense of control.
The roots of this behaviour, Schrönen suggests, may lie in a glitch in the parent-child relationship. In many cases, the child sees itself as the problem person, rather than observing family dynamics as a whole. He says if the problem of self-mutilation is ignored, it will not simply just disappear. Professional help should be sought, and medication may be needed to control the behaviour. “Every case is unique,” says Schrönen.
Emotions that can cause disruption
Feelings which self-mutilators find difficult to express could range from anger, hurt, shame, frustration, and depression.
People who cut themselves may also have a mental illness - it is .associated with conditions such as bipolar disorder, anorexia and bulimia, obsessive-compulsive disorder (OCD), and depression.
What it feels like
If done often, the brain eventually starts to associate abusive activities with a sense of relief. It starts as an impulse, which and many have described as a sudden switch over from their normal everyday behaviour, to an episode of self-harm.
In Rolling Stone Magazine, Christina Ricci is quoted as saying: "It's like having a drink. But it's quicker. You know how your brain shuts down from pain? The pain would be so bad, it would force my body to slow down, and I wouldn't be so anxious. It made me calm."
At first, in the case of cutting, the feeling is good. Once the realisation of what has been done kicks in, self-mutilators feel guilty and try and purge this by opening up the wounds again. Cuts are usually along the wrists, arms, legs, and stomach.
Self-harm can also affect the body image of the victim. They begin to feel comfortable with bruises and lesions on their skin. Self-harm gives the person a feeling of immense control in a world in which they feel they lack control.
(Matthew Louw, Health24, October 2005; updated Heather Parker, Health24, June 2007)
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