Executive Director
of New Hope, Psychologist ChristianSoulCare.com
"I feel dead inside,"
a woman wrote to me after receiving my Christian Soul Care Devotional
in her e-mail. "The only time I feel alive is when I cut my arm.
I have been doing this for a little over two years now. I don't
know how to stop. This seems to be the only way I can cope with
my pain. No other outlet seems to work. Please pray that my pain
doesn't over take my heart. And that I can be set free from this
prison of self-hatred."
Do You Abuse Yourself?
Maybe you or someone
you care about feels like this woman. If so than you know that
self-abuse cuts deep. It hurts a lot inside for the one who cuts
or self-harms their body and for the loved ones who feel torn
up inside and helpless to do anything.
Self-injury has been
one of those taboo subjects that isn't talked about. Those who
intentionally wound their bodies may hide it in shame. Busy emergency
room doctors and staff may get exasperated with those who need
treatment for intentional wounds. Counselors and care-givers may
feel squeamish about the blood and they may fear that those who
cut themselves are attempting suicide. Yet 1% of Americans (about
2 million people) cut or injure themselves on purpose. These figures
include all ethnic and socioeconomic groups and 40% of these are
men. And it's not just young people either.
A few months before
her death in August of 1997 Princess Diana brought the issue of
self-abuse into greater awareness when she confessed that she
reacted to the strain of her marriage by throwing herself down
the staircase and cutting herself with razors, pens, knives, and
lemon slicers. "You have so much pain insider yourself," she said
in an interview with the BBC, "you try and hurt yourself on the
outside because you need help."
As in Princess Diana's
case self-injury is a form of self-destructive behavior that's
intentional and serious, but not the same as a suicide attempt.
Self-injury is when someone deliberately wounds their own body,
causing bleeding or scarring. I've talked with people who cut
themselves with knives, bang their head against the wall, slap
their own face in anger, compulsively scratch at pimples and scabs
until they bleed, pull their hair until they've left a bald spot,
or bite their nails down to the nubs. Others burn themselves or
keep tearing open their scabs until they get infected, become
ulcers, or gangrene sets in. These are all examples of what's
termed self-abuse, self-injury, self-mutilation, or self-inflicted
violence.
Understanding Why
People Injure Themselves
If you or someone you
care about struggles with self-injury try to understand what's
going on under the surface of the flesh wounds. People who self-injure
are frozen in trauma. About 50% were sexually abused as children
and most report having experienced emotional abuse or neglect
(not being listened to and having their feelings validated) in
their past. I think we can say that all people who self-abuse
haven't learned healthy ways of coping with feelings in stress
or crisis (like the ones we'll discuss at the end of this article).
There are four basic,
immediate reasons for why people cut themselves or purposely injure
themselves in another way:
1. To feel alive.
They're detached or cut off from their feelings. They may be depressed
or feel an emptiness. They be "dissociated." When they cut they
experience an euphoric adrenaline rush about doing it and endorphins
are released in the brain as a reaction to the physical injury.
"My blood voices my pain," said one woman, "like a bright red
scream." (Bright Red Scream is the title of a book on self-injury).
Another woman explained, "I do it to feel real when I feel numb."
2. To control feelings
or relieve pain. Their emotional pain is unbearable and they
feel it in their bodies as intense arousal. Their sadness, fear,
guilt, or anger feel overwhelming and out of control. They
feel panicky, jittery, and trapped. These emotions, sometimes
along with frightening flashbacks or self-hating thoughts, just
won't go away until they injure themselves. Then the extreme tension
and arousal in their bodies and souls returns to a more bearable
level. (Research studies have shown this to be true psychologically
and physically.) "Injury gives me focus," a 26-year old man acknowledged.
"I cannot seem to focus and stop the spinning or emotions." A
32-year old professional woman admitted, "I cut myself with razors
because the pain in my chest is unbearable. Almost anything can
set me off. Most of all, the desire to injure myself comes when
I feel like I have failed at something or when I feel as though
someone close to me is going to leave me. Cutting relieves the
pain that nothing else can take away."
3. To convert emotional
pain into physical pain. To deal with their upsetting, out
of control feelings they convert them into physical wounds. The
physical pain feels more manageable. They can see the wounds on
their bodies. They can see the bleeding stop. And they can get
attention for their wounds and they can see them heal. "Because
sometimes it hurts so bad on the inside, it's nice to have something
tangible to relate to," explained a middle-aged woman. "There
is a weird sort of comfort in having an injury on the outside.
It is also a whole lot easier to deal with than crud from the
past and present."
4. To punish themselves.
They feel bad about themselves, about their failings and their
feelings, their needs and their nothingness. They take their anger,
often anger about being abused or violated in some way, and take
it out on themselves saying things like, "I'm too needy." "I'm
too emotional." This is a form of what psychologists like myself
call "identifying with the aggressor." They've agreed with the
abusive or critical people in their life and joined them in hurting
their own selves.
Why you Can't
Just Fix It
The issues I just identified
demonstrate ways that self-injury acts as a defense mechanism
for coping with emotional pain. Temporarily, it works to deny
emotional pain and unwanted feelings. Besides, the cutting itself
often involves an exciting adrenaline rush and then the physical
healing process includes a calming endorphin release. In these
ways self-injury can become an addiction with obsessive (continually
think about doing it) and compulsive (can't seem to stop doing
it) features. In this sense it's a self-destructive coping mechanism
that's similar to addictions to alcohol, drugs, food, or sex.
In fact, some people "switch addictions." This was the case for
a woman who admitted,
"The idea of stopping
for good terrifies me. I don't know what I would do without that
release. I'm afraid I'll go back to abusing alcohol (too messy)
food (too shame-filled) or pot (too numbing) so until I can deal
with why I am hell bent on my own destruction - the cutting is
best coping mechanism I have."
If you understand self-abuse
as a defense mechanism and reaction to overwhelming pain then
you can see that it's a symptom of deeper problems like abuse,
isolation, and depression. Treating symptoms is like filling in
gopher holes: you remove it and it just pops up again or another
one pops up nearby. So I believe that the best way to change self-injuring
behavior is to change the self-injuring person on the inside.
And that kind of inside-out change happens in healing relationships
like psychotherapy, support groups, and the like. And it happens
by relying on God's love and power through relationships with
"Christ's Ambassadors" (2 Corinthians 5:20), his Word, and his
Spirit. Understandably, due to issues of past abuse and the shame
of self-abuse, those who self-injure have great difficulty learning
to trust others, including God because he apparently allowed the
past abuse or neglect and seems not to be providing help for all
the pain.
Shame. Problems deeper
than the skin. Trust issues. You can see why people who injure
themselves can't just stop by trying harder. They have to use
a different approach.
What is the Hope
for Self-Abusers?
The Bible tells the
story about a tormented man who lived among the tombs and cut
himself with stones. One day he heard about Jesus and met him.
He surrendered control of his life to Jesus, falling at his feet
and crying out to him for mercy. He was delivered. He was set
free and became calm and in his right mind. He went around telling
people about Jesus. (Mark 5:1-20)
This man was possessed
by demons. I imagine that's not your situation and yet you may
feel "oppressed" or even "tormented." Probably you do identify
though with the image of being like a sailboat at sea with no
rudder and no dagger board. You're "tossed back and forth by the
waves, and blown here and there by every wind" as the Apostle
Paul described some people to be in Ephesians 4. In that case,
other people have power to ruin your day with a hurtful word.
You're susceptible to being tricked and deceived. Your feelings
go all over the place - up and down, empty to agitated. You feel
little inside and indeed there is a child in you that needs help
growing up. This is what he talks about in Ephesians 4:11-16.
If your in that boat
being tossed around in the storms of life Paul offers great hope
to you saying that you can grow up emotionally and spiritually
through relationships in the Body of Christ, by being connected
by "ligaments" to godly people who use their gifts to care for
and equip you. You need someone who to "speak the truth in love"
to you by giving you helpful feedback on how you're living and
relating and coping with pain so that you can learn new strategies.
Over time in relationships like this Paul says that you can grow
and be built up in faith, knowledge of God, and love. You can
become mature, growing into adulthood so that you can take your
place in the Body of Christ and use your gifts to make a contribution
to others.
What Steps Can I
Take to Heal?
People who overcome
problems like self-abuse or depression do so because they seek
effective help in many different ways and they stick with it for
months or years.
1. Talk to someone
who can help you. You can't heal alone. You need the help
of a doctor (medication referral), counselor, pastor, or support
group. You need the care and encouragement of safe friends that
you can learn to trust. Look to people like this as Christ's Ambassadors,
people God can use to show you his love and wisdom.
2. Pay attention
to deeper feelings. What's going on before you self-injure?
During? After? What would it feel like to talk with someone about
what's going on for you? There's a lot going on under the surface
of your skin that you need to understand and get help with. Become
willing to feel this deeper pain with the support of others in
order to get through that pain to a place of care and strength.
3. Stop and think
about your feelings; don't react. Your overwhelming
feelings and the temptations to hurt yourself don't have to control
your life. You don't have to rely on temporary coping mechanisms
like cutting, which only make your long-term pain and problems
worse. You can learn to feel and think about your feelings before
you act if you learn to rely on the care of a safe person who
can help you. The "Think-Feel-Do Triangle" is at the heart of
psychotherapy, support groups, and any healing relationship. You
"talk out" your feelings and thoughts with a caring person instead
of "acting out" in self-injury. You ask someone to understand
your feelings. You think about the negative consequences of self-injury.
You think about the kind of person you want to become, how you
want to change and grow. With continual practice and support you
learn to think and feel your way through problems before acting
on them; you learn to make better decisions that help you over
the long-term.
4. Turn from controlling
to trusting God. Pray that God will help you stop trying to
control your emotional pain (make it go away by cutting) and instead
learn to put your trust in his care as he expresses it through
people in the Body of Christ, his Word, and the Spirit that continually
speaks loving messages to you, not only through people and the
Bible, but also through nature and circumstances. Ask him to help
you learn to internalize and make use of the ways people care
for you.
5. Learn about your
problems. There are websites, books, and organizations that
specialize in helping people understand issues like self-injury.
For instance, there's the S.A.F.E. (Self-Abuse Finally Ends) treatment
program in Chicago. Their website is http://www.selfinjury.com/.
6. Make a list of
options for receiving the care you need. Identify alternatives
for receiving comfort when you're tempted to cut. This could include
many varied options like taking a bath while listening to your
favorite music, taking a walk, playing with your pet, talking
to a friend, saying a prayer, going to a support group meeting,
visiting a mental health chat room, or something else.
She Became Free
of Self-Injury, You Can Too
Listen to the story
of one of our former New Hope Teenline volunteers. This teenage
girl bravely shared her story publicly in a New Hope training
class a few years ago:
In the 7th
grade I started burning myself for no reason. Then I realized
that I was depressed. I started scratching myself with my finger
nails on my arms and legs. It was sometimes bad enough to make
me bleed and always noticeable for a week afterward. I would do
this instead of crying.
I developed a boyfriend
and things he said and did hurt me so much that I was constantly
sad. I spent most of my time in tears. I became so sick of crying.
And I hated that when I was depressed I had no control over my
emotions or anything. And I felt like the smile I wore was fake.
Hurting myself on my body was better than hurting on the inside.
It made me feel like I was in control of my emotions. I transferred
my inside pain to outside pain, something I had total control
over. Only later did I realize that this only made things worse!
I broke up with my
boyfriend and asked God to help me. And when I volunteered for
Teenline the New Hope training program helped me to understand
my feelings and to talk about them with people I trusted, something
I hadn't done as a girl. It used to be that when I was depressed
I relied only on myself to get through it, but then I learned
to ask God to help me and to trust people who cared for me.
Thankfully, I haven't
cut or hurt myself for three years. I can honestly say that I'm
no longer tempted to either.
Notice that this teen
did a number of things over time to overcome her pattern of self-abuse.
She asked God to help her learn a better way to cope. She got
out of a destructive relationship. She worked on talking with
safe people instead of cutting. She took classes to learn about
issues like feelings, relationships, boundaries, alternative coping
strategies, and prayer.
Help comes one step
at a time. "The path of the righteous is like the first gleam
of dawn, shining ever brighter till the full light of day" (Proverbs
4:18, NIV). Each right step leads to a brighter future.
William Gaultiere,
Ph.D. is the Executive Director of the New Hope Crisis Counseling
Center at the Crystal Cathedral and a Clinical Psychologist and
Spiritual Director with ChristianSoulCare.com. On his website
you can sign up for a free, bi-monthly inspirational e-mail.
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