The Guardian (London)
October 19, 1984
Self-injury danger / Unemployed men more likely to deliberately harm themselves
By Andrew Veitch
Unemployed men are 10 times more likely deliberately to harm themselves than those in work, scientists report today in the British Medical Journal.
The rise almost doubles for men out of work for more than a year, who are 19 times more likely to commit parasuicide.
Parasuicide is defined as ‘deliberate self-harm,’ and not attempted suicide. It is ‘a non-fatal act in which a person caused self-injury or ingested a substance in excess of any prescribed or generally recognised therapeutic dose.’
Since about 45 per cent of unemployed men have been out of work for more than a year and the figure is expected to rise, the findings are ‘particularly disturbing,’ say Dr Norman Kreitman, director of the Medical Research Council’s edpidemiology unit.
United Press International
September 14, 1985
Self-mutilators begin to go public with disorder
By Rebecca Kolberg
Some cut their wrists. Others tape kerosene-soaked patches of gauze to their skin and set them ablaze. Instances of eye gouging, bone breaking and gnawing one’s flesh have been reported.
Self-mutilation frightens and disgusts most people—but so did alcoholism, eating disorders and drug addiction before those suffering from such problems gained courage to publicly seek help.
“We all mutilate ourselves for fashion purposes, such as pierced ears and tattoos,” said Dr. Lois Conn, a psychiatrist at the University of Maryland Hospital. “We also undergo mutilation for medical purposes, such as drilling teeth and amputating limbs.
“But self-mutilation is defined as the willful production of bodily injury not for purposes of fashion or health.”
Conn, who has treated self-mutilators for several years, said such patients usually fall into three categories: people with a borderline personality disorder, those who are psychotic and the retarded.
The more bizarre types of bodily injury—such as a woman who ate away her shoulder—are usually found in psychotic patients living in mental hospitals. Retarded people tend to hurt themselves through repetitive behaviors such as head banging, biting and skin picking.
But the self-mutilator troubled by a borderline personality disorder could be the girl-next-door.
“So many self-mutilators are basically closet cases because they are ashamed and try to hide it,” Conn said in an interview. “It’s just like anorexia and bulimia have been in the past—people don’t talk about it.”
The psychiatrist noted that self-injury occurs in about 3 to 5 percent of psychiatric patients, and in less than 1 percent of the general population.
“This is a disorder that cuts across all socio-economic groups. I’ve seen professionals as much as I’ve seen the unemployed,” Conn said.
Contrary to popular opinion, Conn said most self-mutilators are not trying to commit suicide when they injure themselves. The psychiatrist said people who hurt themselves openly are usually trying to get attention, while those who hide self-mutilating behavior do it mainly for a sense of emotional relief.
She said young adults seem to be the age group most prone to self-mutilation, but noted that her youngest patient was a 5-year-old who cut her wrists.
More women seek help for self-mutilation than men, but studies have shown that males comprise about 40 percent of individuals who slash their wrists.
According to Conn, wrist-cutting seems to be the most prevalent form of self-mutilation because the wrists are easily accessible and it is difficult to die from wounds there.
Self-mutilators have also been known to burn themselves with cigarettes, caustic chemicals and fire.
“People tend to have a preferred method, just like an alcoholic often prefers one kind of drink, but they often combine them,” Conn said, adding that some people cut themselves every day.
Ronni Boswell, a 20-year-old Chicago resident, injured herself by deliberately spraining muscles and breaking bones by punching walls and pounding her car’s steering wheel.
“I hurt myself because I feel really empty,” Boswell said. “If I see the bruise and it swelling up, I say ‘You have feelings. You aren’t empty.”’
Boswell is currently involved in a self-help group founded by another Chicago woman who stopped hurting herself six years ago.
“There’s not enough talk about recovery. My group helps people get better. There is such a thing as 100 percent recovery from self-mutilation,” said Karen Conterio, 27.
Conterio, who also overcame alcoholism, drug addiction and eating disorders, said her group emphasizes breaking the habit of self-mutilation as soon as possible.
The former self-mutilator, who repeatedly cut her wrists in her late teens and early 20s, said her turning point came when she was transferred from one psychiatric hospital to another facility.
“Someone there said, ‘Karen, just stop.’ No one had ever told me that before, it was always more complicated,” she said in a telephone interview.
Examining the reasons behind self-mutilating behavior are left to later sessions and individual therapy with mental health professionals.
“In Alcoholic Anonymous they tell you to ‘think the drink over.’ I tell members of my group to ‘think the action over.’ Stop and think what feeling just made you want to hurt yourself,” Conterio said.
Conterio said many of the individuals who come to her group—believed to be the only such workshop in the nation—thought they were the only people in the world troubled by self-mutilation.
One woman, who had been cutting herself for 38 years, wrote Conterio “just you coming out in the public gives me hope and relief.”
United Press International
September 12, 1987
Self-mutilation misunderstood, professor says
Self-mutilation, when people deliberately cut, burn or harm themselves, is one of the least understood of human behaviors, says a University of Missouri psychiatry professor who wrote a book on the subject.
“Self-mutilation is more common than most people realize, with as many as 750 out of every 100,000 people experiencing it,” said Dr. Armando Favazza, professor of psychiatry at the University of Missouri-Columbia School of Medicine.
Self-mutilation ranks among the least understood and most puzzling of human behaviors, according to Favazza in his new book, “Bodies Under Siege.” He said he hopes this book will help increase awareness of the problem and lead to improved understanding and treatments.
“By bringing this problem out of the closet, perhaps we can begin to solve it,” he said.
Favazza, who has studied the subject for more than five years, surveyed 300 chronic self-mutilators, interviewed more than 50 and treated several with intensive therapy.
A high percentage of self-mutilators tend to be women and most begin injuring themselves during the early teen years, he said.
“Some people may stop after a few instances of mild self-injury but for others the self-mutilation escalates over time and, in effect, controls that person,” he said.
Self-mutilation is the deliberate destruction or alteration of a person’s own body tissue. Favazzo’s studies show that cutting the skin is the most common type of self-injury, followed by burning, hitting, re-opening wounds or preventing healing, hair pulling and bone-breaking, he said.
Most self-mutilators injure themselves in an effort to gain temporary relief from anxiety, racing thoughts, feelings of depersonalization or other painful situations.
“Many describe feeling ‘a release’ and do not report feeling intense pain when they injure themselves. Others describe self-mutilation as a friend that makes them feel special,” he said.
The majority do not realize why they do it or what made them hurt themselves the first time, said Favazza.
Current treatments include a month of intensive monitoring of the patient in a hospital to break the cycle of self-injury, but Favazza said more research is needed to pinpoint why certain people find relief in self-injury and to come up with more effective treatments.
The Guardian (London)
June 28, 1988
Letting out the big scream inside – Self destructive behaviour is not uncommon among women, their numbers are growing and there is little help for them
By Michele Hanson
The typical wristcutter is young, attractive, female, intelligent, talented and, on the surface, socially adept, says the Journal of Medical Psychology. Maggy, Diane, and Ellie more or less fit this description. They are articulate, witty, pleasant company and they either cut themselves with razors, Stanley knives and broken light builbs, scratch themselves with twigs and watch-strap prongs, swallow glass, punch themselves in the face or bang themselves against walls. They have done so repeatedly, some of them since childhood.
No one knows how common this problem is or what happens to such people in the long-term. Statistics are unreliable because many never reach a hospital. ‘It’s difficult to walk in and say: This is all my own work.’ But twice as many women do it as men and it is on the increase, says Maggy Ross. ‘We fell that it’s so widespread it should be known about, given an acceptable face so people can start owning up to it.’
But nobody seems to know quite what to do with the women who injure themselves when they do own up. Prospects for their treatment are not good, says Dr Gillian Mezey, Senior Registrar at the Maudsley Hospital. ‘It has so far been unsuccessful because of the very emotional nature of what they’re doing. it makes staff fell uncomfortable. The controversy is whether or not you respond to their needs by giving them as little reinforcement as possible. If they receive instant help and cups of tea it may encouraged them to do it again and we don’t want to encourage something so potentially lethal. Psychiatrists are not uncaring but they feel the same revulsion as anyone else and have the same difficulty dealing with their feelings.’
Although Maggy has come across very caring professionals, these women are, on the whole, unhappy with their treatment. The lack of cups of tea and overt sympathy doesn’t seem to be doing them much good. They describe being lift alone with a bowl of water and cotton-wool and told to clean themselves up. They’ve been rushed down the back stairs out of everybody’s sight and nurses often won’t speak to them. ‘Because you can feel that the hospital staff are frightened,’ says Diane, ‘it makes you more frightened. And then you do it again.’
They’re told they are being silly/manipulative/affecting madness, that they can get control of it and it’s only a habit, like smoking. In Maggy’s case drugs only removed her fear. ‘They gave me the courage to really go ahead and do it.’ And as for psychotherapy. ‘What does that do? You sit and talk to someone who hasn’t experienced it, who’s going to judge.’
Then what do they want? What do they think would help? ‘To be in a very safe place,’ says Maggy, ‘and look at my anger and be able to scream. I want someone who’s going to be with me all the time and strong enough to handle it and let me work through all this anger because I’m so afraid of it. I think that’s why I cut myself up. Someone to cuddle you and hug you and let you talk and cry. Let all that out.’
In the absence of any such facility they have set up their own Crisis Centre and Help Line in Bristol. Sometimes it takes people who do it themselves to understand. Being with others also minimises the feelings of utter loneliness and isolation. No one teaches them cutting. They come upon it themselves.’ I hadn’t heard about it,’ says Maggy. ‘I though I was mad. It just happened spontaneously. I thought I was the only woman in the world doing it.’
It isn’t difficult to understand their rage, despite the distressing way in which they express it. ‘I did it when I was little,’ says Ellie. ‘I felt bad about my body. I was feeling bad about all the things that had happened to me, the sexual abuse, why my Mum had left me, thinking I must be a horrible person. When I was in bed with my Dad and my brother I knew it wasn’t right but it was comfort as well. My Mum had gone. Then all of a sudden they said: No, you can’t come in any more. I felt rejected. I used to hurt myself, bash my arms on the walls. It’s like always being not wanted.’ Ellie is now 34, alone with three children and she is still cutting herself.
Diane similarly started very young, at seven. ‘I started cutting myself and getting migraines every fortnight like clockwork. I’d be brought home from school. I knew what was going on in my life was wrong (sexually abused by my grandfather). I think I did try to say something, some time during the first few years of my life. I wasn’t helped so I started to cut myself about and punch myself. There were always bruises on my face as if I’d been in a fight. I can’t remember whether it hurt or not.’
They don’t feel pain at the time of cutting, says Maggy. ‘The body produces endorphins that anaesthetise you. There’s no physical pleasure in it; it’s not masochistic. It’s the relief afterwards. I don’t feel anything, just Phew. You want to see your anger. Cutting is like a big scream inside you and the cutting is a manifestation of that scream.’ Diane calls it ‘letting the evil out, releasing these horrible feelings inside me.’
They feel detached from the process, as if they are watching themselves from elsewhere. ‘I have a set pattern,’ says Maggy, ‘in long lines (up to 50 or 60 cuts at a time). Others cut diagonally. Things have to be set out in the right way. You get the razors, the tissues, the TCP, sit exactly in the same place in the house, make sure you’re on your own and then you start. You watch it all happen, then you clear it up, put the melolin on and then the ritual is over.’
Cutting apparently follows a period of tension and the sight of blood brings relief. They know they are going to do it a week or two before it happens. They can put it off, until the children are in bed, until the visitors have left, until the next day, but they know they’ll have to do it in the end. ‘It builds up, becomes a compulsion,’ says Maggy, ‘but I can avert it, stop it, by coming here.’
But as well as ‘delicate cutting,’ Maggy, like the others, has also inflicted sudden and violent injury upon herself. When she lost her job because she had become pregnant she injured her leg every severely. ‘I’m a lesbian now, which is fine,’ she says, ‘but I spent a lot of time trying to convince myself that I was heterosexual. It got to the point that whenever I slept with a man I felt so violated and appalled that I got a wine glass and cut my face up. The only way I could cope with myself was if I had a face covered with blood.’
They all describe an enormous sense of emptiness, feelings of being terribly alone, of not being heard and of being very angry. ‘But they can’t get angry in an open frank way,’ says Gillian Mezey. ‘This way they punish themselves and others. Men (not exclusively) tend to express anger externally. These women turn their aggression inwards. Cutting expresses deep pain but they need to be encouraged to express that pain in a positive way. Self-help might be the first stage. They need someone who is sympathetic and will set limits on what is or isn’t acceptable. Who’s going to provide that?’
Meanwhile they have each other and they know that cutting is unacceptable. ‘I don’t want someone saying it’s all right or it’s a good way to live your life, just someone who understand. This is the whole point of having the Centre,’ says Ellen, who has also suffered eating disorders. She feels that both bulimia and anorexia are just another way of harming yourself, with food. The revulsion that people expressed reinforced her behaviour just as it reinforces cutting.
Perhaps cutting wouldn’t appear so shocking if it could be seen not in isolation but as only a part of a whole spectrum of self-injury, including even psychosomatic illnesses. The Journal of Postgraduate Psychology also lists car-racing, parachuting stunt-driving and Russian roulette as potential self destructive behaviour.
There’s nothing new about self punishment. Anchorites, Sytlites and centures of selfmortifiers have sat in caves on poles, crawled up steps on their knees, flogged and starved themselves. No one objected. Letting blood, like bulimic vomiting, is a purge but more dangerous, frightening and ultimately unsuccessful.
Fortunately these women feel that they are, with the help of each other, coming through it. Maggy no longer feels the need to do it. ‘Given time, space and encouragement,’ she said, ‘the compulsion does go away. You won’t be doing it forever.’
‘I don’t need to have razors in the house any more,’ says Ellie. ‘I know I’ve got a lot of phone numbers I can ring and say: ‘This is how I’m feeling.’ We’re doing something about it. We all have someone who won’t look shocked or go away.’
Larry King Live
June 15, 1990
Transcript # 67—2
KING: It is a frightening and most bizarre disorder. It causes its victims to turn simple household items like an iron or a razor onto themselves, causing mutilation. With me tonight are two sufferers who struggle daily with the thought of harming themselves. Shelly G. has undergone five plastic surgery operations to correct the harm he has wrought upon his own face, and Barb Torrise has been cutting herself for eight years and is just now starting to control this compulsion. We welcome to Larry King Live Shelly G. and Barb Torrise. In a little while, Karen Conterio, a self injury therapist at Hartgrove Hospital will join us. She’ll be at our studios in Chicago. Shelly, you want to tell us when you started to harm yourself?
SHELLY G., Self Abuser: Well, the first thing, it all sounds so- lime a horror show, you know, when you hear this.
KING: It sure does.
Mr. G.: When I first started to shave, when I was about, oh, 11, 12, I started to pick the hairs out of my face.
KING: Causing pain.
Mr. G.: No, it didn’t cause pain. I just pulled the hairs out of my face. They were ingrown hairs. There wasn’t any pain. I knew that I just had to get them out. And as the years went on and on and on, it got—I started to scar. I then also proceeded to drink a lot. It wasn’t until I stopped drinking, which was close to seven years ago, that I started to realize things that I learned about my drinking behavior that I was doing the same thing with this picking. All I know is that I had a lot of scars, people thought I was a fire, in an accident, and I started to talk about it, and others started to talk about it, saying they did a similar thing. I had seen Karen Conterio on a television program. I called her. I waited about two years before I went into the rehab. It was the first time that I really became aware that this is a syndrome.
KING: You’ve had five plastic surgery operations again?
Mr. G.: Uh-huh.
KING: What is it called, this syndrome?
Mr. G.: Originally, they called it trichotillomania, something like that, just pulling out the hairs. There was an article recently in the Washington Insight magazine, and it was interesting, because they talked to some psychiatrists, one who just wrote a book called Bodies Under Seige, and he’s saying that now he’s calling this a syndrome, where he thought it was an addiction similar to alcohol or drugs.
KING: Do they have a guess as to why? And there’s a name for it?
Mr. G.: There’s not really a name. We just call it self abuse.
KING: All right, do they have a— do you have a guess or do you know why you self abuse?
Mr. G.: The groups of us people that—and I know quite a few—some of the common denominators is there’s a connection to sexuality. That’s why we even heard about your prior-
KING: By the way, for the benefit of our viewers, both guests said that the young lady sentenced to 90 years in prison was apparently abused by one or both parents.
Mr. G.: Right, and she abused herself.
KING: That’s right, and this is a result of-
Mr. G.: Well, it’s not going to result. We’re finding out that to really over-simplify it, it’s the abuse tops and we continue. Now, I wasn’t physically abused, and I wasn’t incested, but my own sexuality—I hated my own sexuality.
KING: I see. Barb, how did you start, or what do you do to yourself?
BARB TORRISE, Self Abuser: I- I’ve cut myself, I’ve burned myself with irons, I’ve chemically burned my genitals, and I’ve been doing it for about eight years now.
KING: In other words, you would take an iron, a hot iron, and place it where?
Ms. TORRISE: On my legs especially. I didn’t want to do my arms a lot, because I didn’t want people to see, so-
KING: And do you know why you were doing this?
Ms. TORRISE: I think I had a lot of anger inside me from things that happened from my childhood, and-
KING: Were you incested as a child?
Ms. TORRISE: I was sexually abused, yes.
KING: By your father?
Ms. TORRISE: No, by somebody I trusted.
KING: Uh-huh, and you were very young?
Ms. TORRISE: Yes, very young, and I think I turned all my anger that I had towards myself. By doing it, I would just turn the anger towards myself and that was real manageable, to be angry at myself instead of being angry at other people.
KING: What age did this start?
Ms. TORRISE: The cutting started- the cutting and burning started when I was 17.
KING: Okay. Why didn’t the pain of cutting and burning, and this is asked by a layman, a total simpleton here, stop you from doing it?
Ms. TORRISE: I felt it, but I didn’t feel pain. It didn’t hurt.
KING: It didn’t hurt.
Ms. TORRISE: No.
KING: To put an iron on your leg didn’t hurt.
Ms. TORRISE: No, but I felt it.
Ms. TORRISE: I think it was pain like other people experience pain, except it gave me a sense of satisfaction rather than discomfort.
KING: When- have you stopped doing it?
Ms. TORRISE: Yes.
KING: How long ago?
Ms. TORRISE: Forty-eight days now.
KING: Forty-eight days.
Ms. TORRISE: Yes.
KING: Shelly, how long for you?
Mr. G.: I haven’t stopped.
KING: You still abuse.
Mr. G.: I still abuse, and it’s very interesting, because coming here today, I was attacking my fingers, my fingernails.
KING: Attacking them?
Mr. G.: Well, in other- picking, constantly picking. If I’m not chewing, I’m picking or pulling.
KING: Do you want to do it now?
Mr. G.: No, no.
KING: But you might do it tomorrow.
Mr. G.: Yeah, I never know. It’s a- the ritual is usually, it’ll be forced starting the day or ending the day.
KING: Are you being treated?
Mr. G.: Oh, I’ve been in therapy for about, oh, close to seven years for this, too.
KING: But still-
Mr. G.: I’ve been to the rehab. I didn’t touch myself for 30 days. What I’m finding out, there is anger, and I do it in a way that I’m so angry I want the world to see my anger.
KING: Have people licked it for a long time? Are there patients that have not self abused in two years, three years, four?
Ms. TORRISE: Yes, yes.
KING: Do you think you’ve licked it?
Ms. TORRISE: Yes.
KING: All right, we’ll come back, and we’ll be joined—Shelly G. and Barb Torrise—we’ll be joined by the young lady that Shelly mentioned earlier, Karen Conterio, self injury therapist at Hartgrove Hospital. She started this program. It is the first and only one in the country. Back after this.
KING: Our guests are Shelly G., who continues to self-mutilate, for want of a better term, and Barb Torrise, who has not, in 48 days. We are now joined in Chicago by Karen Conterio, self injury therapist at Hartgrove Hospital. She started this program only four years ago. It’s the first and only one in the country. What got you onto this, Karen, to start it?
KAREN CONTERIO, Self Injury Therapist: Hi, Larry. It was five years ago. What started it was a feeling that there was a lack of treatment out there for this type of behavior. I don’t know if it’s a syndrome. I look at this as symptoms of an underlying problem that’s going on, and-
KING: How did you know about the problem?
Ms. CONTERIO: I experienced it in the early 80s. I experienced it after a severe depression. I was put in a hospital, and-
KING: Oh, you’re a- you were a mutilator yourself?
Ms. CONTERIO: I did for a short period, yeah, in the early 80s.
Ms. CONTERIO: And I think that being in the hospital, basically, reinforced my desire to self-injure. I was very frustrated, and it felt like I was not getting any help, and it was after I got out of the hospital that I decided that something needs to be done about this, and-
KING: And no had been treating it as a- as a- in a setting like a center?
Ms. CONTERIO: Nobody, no, not at all. You know, it’s still being looked at and tried- It’s trying to be treated. Unfortunately, it’s just somehow being reinforced.
KING: Do we have any idea how many people do it?
Ms. CONTERIO: Yeah, I worked- I did a national study with Dr. Fevazza out of Missouri, and he made a projection of 750 per hundred thousand population. I don’t know if that’s conservative, I don’t know if that’s exaggerated, but I’m seeing- I’ve gotten hundreds and hundreds and thousands of letters and calls from people.
KING: What kind of therapy do you use to top it?
Ms. CONTERIO: What we do at Hartgrove, it’s a 30-day in-patient program. We work on the mental health of the individual. What we try to do is allow them to take responsibility for their behavior. It’s highly structured. We work on the underlying issues. Some of the underlying issues that were mentioned was the self abuse- I mean, the sexual abuse, physical abuse. A lot of times, these people come from real dysfunctional homes where there’s- the communication is real poor and, basically, what we let them do is to look at all of this. We don’t have a big focus on the symptoms, such as the self injury.
KING: Okay, now there are- there are lots of self abuse, people going to psychiatrists and psychologists who keep repeating similar problems that they’ve had all their life of a psychological nature, and there are people who take drugs and people who drink, and that’s a kind of self abuse. And there are anorexics and people who don’t eat, that’s a kind of self abuse. Do you know why, in your particular case, the abuse would be physical pain?
Ms. CONTERIO: I’m not sure. What I have found with the patients that I’ve worked with and the letters I’ve received, is that a lot of these women and sometimes men have, like, an interchangeable, like, addictive behaviors, where they might have anorexia or bulemia, they might have the alcoholism. They give up symptom and they take up another one. Why someone chooses to physically harm themselves, I’m not sure, and I don’t know if anyone is really sure about that.
KING: All right, do you know why Shelly hasn’t been able to lick it?
Ms. CONTERIO: I don’t know, Shelly. I’ve been working with Shelly for a long time. I’m not sure any more with Shelly.
Mr. G.: It’s tough, it’s tough.
Ms. CONTERIO: Shelly, just stop it. It’s your choice.
Mr. G.: I know. It- it’s interesting, because it has nothing to do with will power.
Mr. G.: Because it’s-
Ms. TORRISE: It does for me. It’s will power for me.
Mr. G.: But again, too, you mentioned that you were on the drug and you’re getting some help from-
KING: Oh, you take a- you take a drug? What drug?
Ms. TORRISE: Right, I’m taking Prozac right now.
KING: Prozac, the most famous drug in America.
Ms. TORRISE: Right, right.
KING: Usually that’s a drug for depression.
Ms. TORRISE: Yeah, anti-depressant.
KING: Why don’t you take it?
Mr. G.: Because I’ve realized that- I’ve decided that this week I’m going to start on Anaphronil, which is really used for obsessive compulsive disorders. I also believe that this is a obsessive compulsive disorder, that there is a chemical dysfunctioning in the brain.
KING: And that belief is based on what?
Mr. G.: Pardon?
KING: Why do you base the belief on it?
Mr. G.: I base it on the belief because I’ve tried everything. I’ve started the program, I know everything about what causes this- this syndrome, whatever we want to call it, and I have yet to be able to stop.
Ms. CONTERIO: But Shelly, you stopped for 30 days.
Mr. G.: Right.
KING: Okay, if you did it for 30 days, why not 31?
Mr. G.: I stopped for 30 days because there I was in an environment where-
KING: You did it in Chicago?
Mr. G.: Yeah, everything was taken care of. Food was taken care of, I had nothing to think about. There was no fear of not having money or dealing with the world, and then the minute I came home, you know, that was my outlet. This is my release. It’s my anxiety release, and I’m not even aware that I’m doing it. I’m sort of like in a state of- you don’t realize I’m doing it until I’m in it. I have also found out that one of the reasons why I’m talking on the show is that we live in a society where- where women keep things to themselves. They- they don’t let out the anger. I have identified with a lot of the women because I don’t let out the anger the way most men do. Most men will either engage in sports-
KING: Punch a ball.
Mr. G.: Punch a ball, rape, or get themselves tattooed.
Mr. G.: Beat up, go on motorcycles, a la, you know, a lot of macho stuff.
Mr. G.: Yeah.
Ms. CONTERIO: Right.
Mr. G.: And I really kept a lot of stuff within. One of the things I’ve learned was that I was afraid to get angry.
KING: Were you at the center, Barb?
Ms. TORRISE: Yes, I was, yes.
KING: In Chicago, where- where Shelly- in other words, you were treated by Karen, helped by Karen.
Ms. TORRISE: At Hartgrove Hospital.
KING: Now, he- Shelly came home and found that he didn’t have that- that nurturing system. You came home but continued to lick it, right?
Ms. TORRISE: Yes.
KING: What are you doing he’s not?
Ms. TORRISE: I have a very supportive family, I have a good therapist, I think the medication has helped me a little bit, but that’s not it, it’s me, it’s not the medication and it’s not the therapist, it’s me. I know I have- I have the choice of whether I want to injure or not.
KING: Since Prozac has had such an effect, we ought to do a show on Prozac, it’s had such extraordinary success, and people talk about the drug and have rave reports. Why haven’t you been put on that drug?
Mr. G.: Because people in our group in New York that have been on Prozac for a while, we’re still doing it.
KING: So it has been tried.
Mr. G.: People also- people were still using Anaphronil and still doing it.
KING: Karen, what about the drug use at the Hartgrove Hospital?
Ms. CONTERIO: We’re real conservative on the medication that we give out at Hartgrove, and the reason being is in Shelly’s case, there might be a biochemical problem, I’m not sure, with trichotalomania, a lot of the hair-pullers, a lot of the OCD, obsessive compulsive disorders, Anaphronil, Prozac has been real helpful. I believe again that it’s the underlying issues that the individual has to look at and start dealing with.
KING: Were you abused as a child, Karen?
Ms. CONTERIO: There- I was medically abused when I was age 4, and I don’t think that a lot of people take in account—this was, like, 28 years ago—to subject children to operations and procedures and not be there to comfort them and let them know what was going on. It was quite traumatic.
KING: What do you mean? What happened to you?
Ms. CONTERIO: I was having internal problems and had to go in with- for some procedures that was to me very violating. I was screaming bloody murder, I had to be held down, and back then, they used ether, and it was just quite traumatic. Parents weren’t allowed to be there.
KING: A bad medical experience.
Ms. CONTERIO: A Bad medical experience.
KING: We’ll come back and include your phone calls on this extraordinary and new to us topic. Don’t go away.
KING: That one of the great cities of the Far East, Singapore. To your phone calls. Crestview, Pennsylvania, hello.
8th CALLER: [Crestview, Pennsylvania] Yes, Larry, first of all, I’d like to preface by saying I’m not involved in self-mutilation, whereas I don’t cut or burn or anything like that, but something just clicked by watching your show. I have this insatiable jealousy towards friends, towards my girlfriend, and I punch things. I punch walls, I punch the hood of my car, and I-
KING: That’s your own hand. That’s mutilation, sir.
8th CALLER: Okay.
KING: Okay? What is that, Shelly?
Mr. G.: That’s exactly what we do.
KING: You’re a self-mutilator, sir.
Mr. G.: Yeah. There are people that I know who just beat their heads against the wall, therapists that I’ve met.
Mr. G.: Physically, take their- after their clients leave, and take their heads and bang it against the wall.
KING: You have the- what should he do, Karen? Shelly? Karen, what should he do?
Ms. CONTERIO: I would suggest that he find a therapist and look at what’s going on underneath.
KING: Have you tried to help yourself, sir?
8th CALLER: Well, see, the point is, people that are close to me- and I just had surgery on my right hand, my fist. I had a plastic knuckle implanted, and they think that it’s just like I’m- I’m a hot-tempered young man, and it seems to just drop on at that.
KING: You mean it’s just dismissed as hot-tempered.
Ms. TORRISE: It’s acceptable for a man to do something like that. It’s acceptable in this culture for men to be physically-
Ms. CONTERIO: Macho.
Ms. TORRISE: Macho, thank you.
KING: In other words, he can get help. Okay, let’s go to Maple, North Carolina, hello.
9th CALLER: [Maple, North Carolina] Yes. I work with a gentleman, and he’s constantly picking at himself, his arms and his neck, at little sores,and they become big sores, and I was wondering if this is a type of self abuse. It’s a constant- it’s a constant, you know-
KING: That’s what you do, right, Shelly?
Mr. G.: That’s right, he’s one of us. That’s exactly it.
Ms. CONTERIO: Also, the inner-
KING: All right, let me get- all right, go ahead, Karen.
Ms. CONTERIO: Okay, the interference with the healing process of wounds such a scab-picking is not uncommon.
KING: Let me get a break, and we’ll have Shelly fix his ear so he can hear the calls, and we’ll come back with more of them after this.
KING: And if you write to us, we’ll forward the necessary information on to Karen in Chicago so that you might get some help. Sacramento, hello.
10th CALLER: [Sacramento, California] Hi. I’m a 22-year-old college student, and I became suicidal in November. I cut my wrists and I overdosed, and I was- and then I was at the psychiatric hospital, and I was taking medications such as Adavan [sp?] and Thorazine. I had been on them for years for just anxiety, and when I got out of the hospital, even though I had overdosed on those medications, they put me back on them, and then I started cutting myself, and I got some literature from the doctors at the hospital, and it said that benzodiazepines and other medications like that can sometimes make somebody more likely to do these things. I was wondering if she could elaborate on that.
KING: All right, Karen, have you heard about that?
Ms. CONTERIO: Since we come across so many individuals with addicted behavior, such as alcoholism, drug addiction, I think that just, it might set off the cycle of addiction. Again, we’re real conservative on the medications. We try to use medication that is really non-addictive.
KING: Shelly told me during the break that he stopped two habits that are the two worst habits in this country, smoking and drinking.
Mr. G.: Uh-huh.
KING: You licked them both, alcoholism and tobacco addiction.
Mr. G.: Because I had this to fall back on. I’m also a compulsive sex addict, but that stopped.
KING: What do you mean, you had to have sex all-
Mr. G.: I had to have sex all the time. That stopped, because I had my last addiction to fall back on. Most of us, if we have that last thing to fall back on, it’s very easy to give up all these other things that are interfering with our lives, because we have something to hold onto.
Ms. CONTERIO: But Shelly, I really believe that once you start feeling, and accepting your feelings, and working through this anger and getting more in touch with what’s going on, you’re not going to have to have things to constantly fall back on that are destructive.
Mr. G.: Well, I guess what happens is that the feelings sometimes get overwhelming.
Ms. CONTERIO: Then talk about it. You know this, Shelly.
Mr. G.: Yeah.
KING: Coming here is a step forward, isn’t it, Shelly? Don’t you think, for yourself?
Mr. G.: This is easy. This is easy. It’s actually feeling feelings within me.
Ms. TORRISE: The hardest part.
Mr. G.: It’s the hardest part, because I feel I’ll go out of my mind.
KING: Rockville, Maryland, quickly, hello.
11th CALLER: [Rockville, Maryland] Hi, oh, hi, Larry, how are you doing?
11th CALLER: I’d like to know, has this disorder affected their ability in any way to form positive relationships, sexually or otherwise?
KING: Good question, Barb?
Ms. TORRISE: I’m terrified of intimacy.
KING: You are.
Ms. TORRISE: Yes. I’ve just recently started developing relationships with people.
KING: Is that common, Karen?
Ms. CONTERIO: I think that’s real common, very common.
KING: Wasn’t in your case, though, was it?
Mr. G.: Well, I mean, it’s relationships have gotten worse because of the fact that now, I’m so mutilated, I don’t want anybody to see my body.
Ms. CONTERIO: And a lot of times, they can form real destructive relationships, but the interpersonal relationships are very difficult.
KING: Thank you all very much, and I hope you all get better. Thank you very much. Good luck, Shelly.
Mr. G.: Thank you for being so gentle.
KING: What, I’m going to be hard on you, Shelly? What am I going to do? Thanks for being gentle. You abuser! Our guests have been Shelly G., Barb Torisse, and Karen Conterio. Donna and Patrick are standing by.
The Washington Times
June 20, 1990
Psychiatrists seek to ease self-slash syndrome
By Tom Dunkel
Sometimes it seems that the closet of human behavior has been pretty much emptied of taboos. Incest, euthanasia, satanism, child pornography, spouse swapping, drug addiction, sadomasochism: They all have been dragged into the bright light of public debate.
Self-mutilation, the gruesome practice of intentionally cutting, burning or otherwise physically abusing one’s body, is just emerging from the shadows, as unnerving as a knife blade in a dark alley.
“We’re only at the step now of recognition, of patients admitting what they’re doing and of professionals getting comfortable with what they’re doing,” says Dr. Armando Favazza, a psychiatry professor at the University of Missouri and author of the book “Bodies Under Siege.”
“Anorexia and bulimia and behaviors like that have opened the door,” adds Karen Conterio, a former “cutter,” as self-injurers are often called, who runs the only U.S. residential treatment program at Hartgrove Hospital in Chicago. “Anorexia and bulimia weren’t talked about 15 years ago. We’re basically at that stage.”
Although there is a lack of consensus on terminology—some call it “deliberate self-harm syndrome,” others opt for the less judgmental “self-injurious behavior,” and still others favor “self-mutilation,” “auto-aggression” or “parasuicide”—this is no newly discovered medical phenomenon.
Dr. Favazza notes that cave paintings in France believed to be 20,000 years old contain handprints with missing fingertips that appear to have been ritualistically severed. There is a reference in the New Testament to Jesus encountering a man who repeatedly slashes himself with sharp stones.
The outer limits of self-mutilation, where psychotics have poked out an eye or lopped off a hand, are well-documented. Studies also have shown that as many as 40 percent of the institutionalized mentally retarded, especially those afflicted with a rare enzyme deficiency known as Lesch-Nyhan syndrome, bang their heads, chew their fingers and lips or otherwise harm themselves.
But how to explain those higher-functioning personality types that erupt in flashes of inner-directed violence? Such “moderate” self-mutilators do not fit into nomenclatural niches.
“To me, it’s one of the most fascinating of psychological symptoms because it is doing what exactly makes the least sense,” says Dr. Ron Winchel of the New York State Psychiatric Institute. “And from the point of view of a rising young psychiatrist like myself, it’s a hot area that hasn’t been adequately explored.”
Based on several small-scale studies, researchers estimate that 700 of every 100,000 people mutilate themselves. That is comparable to the incidence of anorexia and bulimia. As with those eating disorders, self-mutilation tends to begin in early adolescence and continue for about 10 years. But there are exceptions.
Sheldon Goldberg, a 52-year-old New Yorker, started self-mutilating at age 12. He has cut his chest so severely with razor blades that he had to use ice packs to stem the bleeding. But his habitual routine is to pick and gouge ingrown facial hair, sometimes for as long as three hours.
“I’m at the point now where I’ve had five operations on my face,” he says.
A few years ago, Mr. Goldberg entered the Self Abuse Finally Ends program, or SAFE, at Hartgrove Hospital. The 30-day inpatient regimen emphasizes individual responsibility for behavior. Any recurrence of self-mutilation is grounds for dismissal. His treatment cost $40,000 and produced mixed results. He made it through the month unscathed but cut himself the day he got home.
In 1987, he and a friend founded Self-Mutilators Anonymous. The group, modeled after the 12-step philosophy of Alcoholics Anonymous, meets twice weekly at a church in Manhattan. Some participants have managed to break the cycle of self-abuse. So far, Mr. Goldberg has not. “Now I’m starting to pull the hair out of my chest,” he says.
Aside from his unusually long 40-year ordeal, Mr. Goldberg differs from the stereotypical self-mutilator in that the vast majority are female. Psychiatrists offer a cultural explanation for the skewing: Men have a variety of accepted outlets for aggression, ranging from contact sports to barroom brawls, while women are generally left to internalize their anguish.
After “cutter” Karen Conterio appeared on a talk show (“Donahue”), more than 1,000 people wrote in seeking information and were mailed questionnaires. Analyzing the responses of 250 admitted self-mutilators, she and Dr. Favazza found 94 percent were women, 97 percent were white and 91 percent had never heard of self-mutilation before falling victim to it. Three-quarters indulged in multiple forms of mutilation, with cutting the preferred method.
Sue Metz, a college student who completed SAFE counseling in February and is now in an outpatient follow-up program, fits that statistical profile perfectly. Her slide into self-injury came when she slit her wrist after being sent to an all-girls boarding school at age 16. She cut her wrist several more times, and school officials ordered her to undergo therapy, but the pattern continued under a different guise.
Miss Metz would deliberately try to get hurt in school sports—for example, running in front of opponents’ flailing sticks in field hockey games.
By the time she entered college, she was regularly taking a razor to her upper arms and legs. There were two brief stays in a mental hospital, but “I wasn’t getting the help I needed,” she says. She was treated for suicide and depression, not self-injury.
Her condition eventually took a lurid turn. She began draining her blood at least twice a week, and at times daily, holding the syringe over a collection jar. “Afterwards I’d look at it,” she recalls. “It was kind of like a security blanket. It was very comforting for me to hold my blood.”
After a third hospitalization, a therapist encouraged her to enter Karen Conterio’s program at Hartgrove. Remarkably, her family and friends were unaware of her illness. “They just thought I was accident-prone,” she says.
That coupling of a facade of normality with seemingly irrational impulses frustrates patients and therapists. “Very few therapists can take on more than one or two cutters, maximum,” admits Dr. Favazza, who maintains a private practice in addition to teaching.
“They call you at home. The emergency rooms always are calling you. The families are always calling you. You take a vacation, when you come back they greet you with scars all over themselves. . . . They really threaten your professional sense of balance or equanimity. At a very deep level, I think the reason they’re so upsetting is that the notion of self-harm to the point of self-sacrifice and causing blood strikes at the core of religion and the religious impulse. . . . It’s a very scary area, and we try to avoid it.”
The revulsion many people feel toward self-mutilation feeds a popular misconception that such behavior is a latent death wish. “They start out superficially, then go deeper,” Dr. Favazza says of most cutters. “They don’t do it, though, to kill themselves. It’s the opposite of suicide. They do it to get relief.”
Patients report feeling a flood of anxiety before self-mutilating, then a welcomed sense of release. Often the physical act—like a cut from a razor—is painless. What discomfort there is has a masking effect: It temporarily blocks out emotional stress. Also, the resulting attention of doctors and nurses may ease a gnawing sense of isolation, or the bloodletting may be a way to atone for a real or imagined indiscretion.
Barbara, a 24-year-old SAFE graduate who asked that her surname not be used, began self-mutilating at 17 by rubbing excrement into her wounds after having corrective surgery on her foot. She moved on to sticking herself with needles, cutting her arms and legs and chemically burning her genitals with drain and oven cleaner. As a youngster, she had been sexually abused by an older brother and frequently beaten by her father, a police officer.
“I was always told not to feel anything when I was little,” says Barbara. “Now, whenever I have feelings, I want to get rid of them. . . . Things just snowball in my mind and I have to cut myself or something. . . . When I injure myself, it redirects my feelings toward being angry at myself. And that’s a real manageable feeling for me.”
It is much the same for Mr. Goldberg, who speaks of the difficulty in coming to terms with his homosexuality and a quintessential “Jewish mother.” Gouging and cutting serve as “a marvelous tranquilizer,” he says.
Sue Metz says the root of her troubles is an inability to resolve conflicting emotions about her parents: “It felt real good to hurt myself. That sounds bizarre . . . but it gave me a way to handle my problems, and it made me feel like I was in control of things. I felt like everybody was hurting me and this was my way of hurting myself.”
Researchers are hoping to bring the general causes of repetitive self-mutilation into sharper focus. Data indicate a high correlation among victims of incest. An unpublished study conducted at the New York State Psychiatric Institute seems to confirm the existence of a link with anorexia and bulimia. “It’s been speculated by a number of people for years that there’s a high overlap between eating disorders and self-mutilation,” says Dr. Winchel, “but we have direct evidence of it now.”
Psychiatrists believe a web of psychological, social and cultural factors lies behind self-mutilation. Some contend that there is a biological component, too, as is true with most mental disorders. Dr. Winchel points to a “gathering body of evidence” that neurochemical messengers such as dopamine and serotonin play a role in character disorders.
But Dr. Favazza’s colleague Richard J. Rosenthal, a UCLA psychiatry professor, is unconvinced. “My feeling, which is based on cutters, is that it’s a psychological condition,” he says. “I would argue that if some neurotransmitter or whatever proved to be abnormal that it’s a consequence of the disorder rather than a hint at some underlying cause.”
July 29, 1990
Healing process; To stop the hurt, Karen Conterio had to learn to feel
By Mary Kauffold
When I was 4 years old I was put in a hospital for bladder infection, and I was mishandled. It was very traumatic. I felt violated—medically violated.
So I think very early in my life I learned not to trust. I believed that people were bad—were mean. I put my feelings inside.
We’re in a culture that constantly tells us to deny our feelings. One of the strongest traits that self-injurers have is that they cannot express anger toward others. In SAFE, we learn to take risks, to get in touch with anger.
I started drinking and taking drugs when I was real young, roughly 12. I’d smoke or sniff anything that would get me high. It was the beginning of the ‘70s, so I was influenced by the times.
I didn’t see that behavior as self-injurious. I saw it as my ticket to happiness. The first time I drank, I enjoyed it.
By my freshman and sophomore years in high school, I was using all the time. . . . I continued with the booze until I was 21, when I gave up using any kind of mood-altering substances—alcohol or drugs.
About 10 months into my sobriety I was feeling really depressed . . . suicidal. I hated myself. I knew I could not drink or use drugs any more to escape my depression. I was a 21-year-old (with) the mind of a 12-year-old.
So I went into the hospital and the first night I was in the hospital, I was sexually violated by one of the mental health workers. It went on for several hours. He was an authority figure, and I could not say no. The next morning he said, “I’ll see you tonight.” I panicked.
I told my alcoholism counselor at the hospital. She told the medical director. Since the man was quitting anyway in four days, he was allowed to work, but he was told he had to stay away from patient contact.
I came from the school of thought where you don’t tell on people. And here I had told on somebody. I had a razor. I started to cut my wrist, and I thought, “What am I doing? I’m in here for help. How come I’m doing this? This is crazy.” So there was a call-button in the bathroom, and I called for help.
I got a lot of attention for that. A lot of people responded. They seemed to really care. Emotionally, I was age 12. I think that was part of why I started injuring myself. It was my way of saying that something is wrong with me.
Self-injury became pretty routine. I cut myself with a razor, usually my arm.
I was very angry. I was very frustrated. When my life got too hectic, too hard, I knew I could injure myself and I’d go back into the hospital. All responsibility was taken away from me. The staff’s attitude was, “We need to watch you, we need to take care of you, and take responsibility for you.” The hospital reinforced my emotional immaturity.
All I knew how to be in that hospital was a sick person. That’s all. I enjoyed being there. I made a lot of friends in the hospital—not that I carried them outside of the hospital. One of my typical lines was why should I get better when I have a roof over my head, three meals a day, and an audience to act out for?
One of the best things they did for me was kick me out after a suicide attempt. I was put on close observation. They said, “If you injure yourself one more time, you will be transferred.”
I think part of my behavior was a lot of testing to see if they really meant it. So I did injure myself again. They discharged me, and I went to another hospital on the North Shore.
I figured that I could continue to be in hospitals the rest of my life, or I could start looking at my behavior. I got a doctor who was rather laid back, who said, “We’ll start treating you like a human being that we can trust.”
There was only one time that I tested him. I went out on a pass and I injured myself, and I called him. He said, “Well, come back, we’ll talk about it.” There was nothing punitive attached to it. I was shocked. Every other time I had injured myself there was a huge reaction to it. I was never told I could stop. Basically, I was always told that . . . someone would be there to . . . take care of me. None of the responsibility was really placed on me.
I started realizing that I was going to have to take some risks. By this time I had four years of not drinking, and I was starting to mature. I think trust was a big part. I trusted what they (doctors and counselors) said, even if I didn’t believe in it.
After I was discharged, my parents got a divorce and sold their house. I had no house to go back to. When I left the hospital I had to have a job and I had to have an apartment. I left the suburbs and moved to Chicago. That was a big turning point.
When I started the SAFE program, I was not using the group for my recovery. That was not my intention. I wanted to have a group for people who were stuck in hospital systems where there was no (specific) treatment.
Too often the hospital just reinforces self-injuring behavior. The patient is not allowed to be out of sight. It becomes a game where the patient continues to try to find ways to injure. The message to the patient is, “You’re impulsive and we’re here to stop you.”
The reality is no one can be totally protected. I know people who have been in restraints and were able to injure themselves. Our patients must sign a no-harm contract. They have to take total responsibility for their actions.
Self-mutilators are not really suicidal. It’s a way not to have to commit suicide. . . . The abusive behavior varies, but cutting and burning are common.
Self-injurious behavior is an addictive behavior. Once people begin to injure themselves, they find that any time a feeling or an emotion arises that makes them uncomfortable, they react by doing something self-injurious. That behavior becomes a habit.
A lot of people will stop injuring when the pain they feel gets too great. But a lot of times the purpose is to feel pain because of the sense of being so dead inside; I feel pain, therefore I am alive.
Sexual abuse is one of the strongest predictors of self-injurious behavior. In an incestuous home, or when someone is sexually abused outside the home, the victim usually isn’t allowed to talk about it.
Here’s this individual who is often a small child who is asking, “What do I do with these feelings? I can’t tell anybody and I’m just screaming inside.” One way they stop the screaming is to cut themselves, pull their hair or punch a wall. It’s an act of frustration.
There’s a strong need to treat adolescents. My studies indicate that the onset of self-injurious behavior begins around age 12 or 13, when kids need to separate from their parents and find their own identity.
Today I have no desire to injure myself. I allow myself to feel sad. I allow myself to feel happy. I’ve learned that if I stop feeling, if I stop taking responsibility for my behavior, then there’s a chance I might go back to injuring. I know that life can be a bitch sometimes, but I also know I can get over it.
Ten years ago when I was in the hospital, I was saying that there’s a reason why I’m going through this, but I don’t know what it is yet. That crossed my mind several times. Today I’m embarrassed about how I had to cope. But I’m not hard on myself. I realize that that’s all I knew how to do at the time, and it was constantly reinforced.
I have some of my sick writings, crazy writings, and I have all my medical records for the purpose of doing a book. I read through them, and I think, “God, I said that, I thought that!” The thing that stands out to me is the amount of pain I could not express in words.
I wish I had discovered a cure for AIDS. I wish I had discovered something other than self-injury. But I took a risk and asked people to begin to look at this behavior. That’s what I can own. I guess someone had to open her big mouth and let people know that people are hurting themselves.
For more information call, 1-800-Don’t Cut (366-8288), between 9 a.m. and 5 p.m. weekdays, or Hartgrove Hospital, 1-312-722-3113.
Larry King Live
June 13, 1991
Transcript # 323
Recovery for Victims of Self-Abuse
LARRY KING: Good evening. Welcome to another edition of Larry King Live. And if you watched our show last night, Larry Gatlin presented me with a tie and suspenders that match. These are it.
Their lives are hell. To live with the demons from their haunted past, self-mutilators inflict themselves with torture. Joining us tonight are two recovering victims of this terrible illness. They are Steve Pichette and Glenna Mockbee. A little later we’ll meet Karen Conterio, a former self-mutilator who is now helping others.
Glenna, do you want to tell us what you did and how this started?
GLENNA MOCKBEE, Self-Injury Victim: It started about four, five years ago and I started with taking overdoses, and then from there I started cutting myself and then burning.
KING: With an iron?
Ms. MOCKBEE: With an iron. I kept an iron on all day long.
KING: Overdoses of what?
Ms. MOCKBEE: Just different prescriptions that the doctors gave me.
KING: OK. In other words, you would take an iron and put the iron where?
Ms. MOCKBEE: On my arm, and just burn it. And I’d leave the iron plugged in from early morning after my family left and I’d leave it on until I knew they were coming home and then I’d put it away.
KING: All right, when you were doing this did you say to yourself, ‘Why am I doing this?’
Ms. MOCKBEE: I kept- I didn’t want to do it, but I was feeling so much pain and so much anger inside of me I didn’t know how to release it and I just ended up just burning myself, and in burning myself it would make me forget the pain I was feeling.
KING: In other words, you took the pain away from emotional pain to physical pain?
Ms. MOCKBEE: Right.
KING: And that would last for a-
Ms. MOCKBEE: Few seconds. Not long at all, and then I’d end up burning myself again and trying to forget, but after awhile—after a few days burning myself like that—the pain in my arm, I wouldn’t even feel it any more because-
KING: Now, didn’t people around you notice this?
Ms. MOCKBEE: I tried to hide it as much as I could, but eventually it was noticed.
KING: Steven, when did this start for you and what would you do?
STEVE PICHETTE, Self-Injury Victim: It started when I was between 11 and 12 and it’s been around since then in varying intensities.
KING: What was the first thing you remember doing to yourself at age 11?
Mr. PICHETTE: Cutting.
KING: You would take a-
Mr. PICHETTE: I would take a razor- or my father was a painter of wallpaper so there was always one-sided razor blades there.
KING: And you would cut yourself where?
Mr. PICHETTE: Where it didn’t show at that time, on my legs, upper arms.
KING: Now, did you ask yourself at age 11, ‘Why am I doing this?’ I mean, I’m talking about the self-questioning aspect.
Mr. PICHETTE: I didn’t know why I was doing it. I felt a lot of feelings that didn’t go with what I experienced. I felt rejected. I felt alone. I felt different from the other kids. I felt like I just didn’t belong. Yet, I’d come from—as far as I knew—kind of like a Ward-June Cleaver family.
KING: OK, on into early- let’s say into teenagedom—What did you do then?
Mr. PICHETTE: I lessened on what I was doing there because that’s when I ran into other forms of abuse—alcohol and drugs—and they seemed to take center stage.
KING: And then did you lick that?
Mr. PICHETTE: Yes, and as I licked that and as I beat those and as I beat bulimia—other ways that I manifested self-injury—I got left with the self-injury and I finally had to admit it at that point, but until the last time I injured no one knew.
KING: What other things would you do to yourself in adulthood of a physical nature?
Mr. PICHETTE: I broke bones repeatedly in my hands—my right hand.
KING: You would break your own bones?
Mr. PICHETTE: Yes, by-
Mr. PICHETTE: -punching as hard as I could into a concrete wall for the intention of doing that.
KING: OK, now, you had to say to yourself, as Glenna said to herself, ‘Why am I doing this?’ Didn’t you, or didn’t you?
Mr. PICHETTE: No, I asked why I was doing it usually afterwards. While it was occurring and just before it was happening I was- I was like a third person watching the activity. I was removed from it as if I was out of the body and that was happening. I was doing it and there was no questions going at that point.
KING: Was there rage? In other words, when you would hit your hand against the concrete wall to break a bone, was there anger when you did this?
Mr. PICHETTE: Yes.
KING: Even if you were watching yourself doing it, was there anger?
Mr. PICHETTE: Yes, throughout my life there’s a tremendous, tremendous amount of rage.
Mr. PICHETTE: At I didn’t know, until I finally found out what it was.
KING: How long since you’ve self-abused yourself?
Mr. PICHETTE: Let’s see, the last time I self-abused was March 5th of this year.
KING: This year?
Mr. PICHETTE: Yes.
KING: What did you do on March 5th?
Mr. PICHETTE: I took an Exacto blade and opened up my left arm—forearm—approximately seven inches long.
KING: Naturally, you’d have to get medical attention for it, right?
Mr. PICHETTE: Yes, yes, 911 was called. An ambulance came and took me and I had a suture.
KING: And did you tell them it was self-inflicted?
Mr. PICHETTE: At that point I did.
KING: Glenna, when was the last time you self-abused yourself?
Ms. MOCKBEE: Well, I self-abused myself, I guess it’s been about three, four months ago, but it wasn’t anything real drastically bad. I think a lot of it this last time was I was really trying to seek help. I mean, I was scared. I didn’t know what to do, but I knew I needed help before I did something- the self-injury I did on my leg was not as bad, but I knew it was going to start getting bad if I didn’t get help, and I just didn’t know what to do.
KING: So you were February—let’s say January or February-
Ms. MOCKBEE: Uh-huh.
KING: -and you were March. Do you both think you’ve licked this now? Glenna?
Ms. MOCKBEE: Well, it’s hard to say, but I really feel more confident that I’ve got it licked now than I ever did before.
Mr. PICHETTE: Well, when I was at the- in the hospital, up there at Hartgrove, I got all the need I needed- all the tools that I needed to put it together, but when I came home I was lacking the tools- I mean, not the tools but the support.
Ms. MOCKBEE: My husband’s great, but the communication trying to get to talk back and forth was hard. But now the doctors and the staff that I have now is out of sight.
KING: Hartgrove is the hospital in Chicago—we’ll meet Karen Conterio in a moment—where she’s based, right?
Ms. MOCKBEE: Right.
KING: Were you there too, Steve?
Mr. PICHETTE: Yes, I also was there.
KING: And is this what makes you confident too?
Mr. PICHETTE: I’m confident that I got a lot of anger out, learned to express emotions rather than repress them, and have got a real good start and I’m working on the underlying issues.
KING: Do you have support at home?
Mr. PICHETTE: Tremendous amount of support.
Mr. PICHETTE: I’m married, I have children, lots of friends and co-workers.
KING: Is this hard for you—to sit on this program?
Mr. PICHETTE: A little bit, yes, knowing that probably a couple of my children, if not all of them, are sitting here watching. But I think it’s very important that I do it.
KING: Because anybody who knows you casually who might watch tonight now knows that you did this to yourself.
Mr. PICHETTE: Yes.
KING: Do you think it’s good therapy to do this?
Mr. PICHETTE: I think it is in this right format- in the right format. You know, I don’t wear it on my sleeve, but-
KING: Well, you’re not being mocked-
Mr. PICHETTE: Right.
KING: -and we don’t have some studio audience yelling at you. Mr. PICHETTE: No.
KING: How do you feel about doing this?
Ms. MOCKBEE: I think it’s a grand idea. Naturally, there’s going to be people- because I never revealed it to too many people that I was a self-injurer. But I think this is great therapy that I can finally admit out in open that I am. And I feel real good about it because I feel better about myself now.
KING: OK, we’re going to take a break, come back. Karen Conterio will join us. She’s a self-injury therapist at Hartgrove Hospital in Chicago, started this program in 1986—first of its kind in the country. And as we understand it, Karen also had this problem.
SHELLY G., Self-Abuser: All I know is that I had a lot of scars. People thought I was in a fire, in an accident. And I started to talk about it and others started to talk about it, saying they did this similar thing. I had seen Karen Conterio on a television program. I called her. I waited about two years before I went into the rehab. It was the first time that I really became aware that this was a syndrome.
KING: Later, Larry Hagman. Here with us in Washington our guests are Glenna Mockbee, recovering from the self-injury syndrome, and Steve Pichette, who’s recovering from what could be called self-mutilation syndrome. We are joined now from Chicago by Karen Conterio. Ms. Conterio is a self-injury therapist at Hartgrove Hospital, started the program in 1986—first in the country. You also had the problem, Karen?
KAREN CONTERIO, Self-Injury Therapist: Yes, many years ago, and I don’t really talk about it so much.
Ms. CONTERIO: I think that the research and the work that I’ve done, I’m able to gather a lot of that information and present that; that being a professional in this field I just know so much more, not based on my experiences but what I’ve learned with working with this population.
KING: But didn’t you begin to work in it because you were familiar with it?
Ms. CONTERIO: I think I just happened to stumble into it. My past experience—How that has helped me was probably in starting the program, in the sense of I knew what I did not want, you know, for a program—if that made sense. I think the treatment center that I was involved in was probably more destructive than it was helpful.
KING: You mean the one that tried to help you?
Ms. CONTERIO: Correct. Correct.
KING: OK. So we can help with that, more destructive why?
Ms. CONTERIO: I think, to me, it was a real oppressive environment. The behaviors- the self-injury was addressed and not the underlying issues. And in the 30-day program at Hartgrove we believe that it’s not the behaviors so much, but the underlying issues. The behaviors might have brought the patient into the hospital.
KING: Uh-huh. How many people are at Hartgrove?
Ms. CONTERIO: We’ll take only eight at a time because it’s quite intense and we do not have the staff—enough staff—to work with this population any more than that.
KING: Are there others around the country doing what you do?
Ms. CONTERIO: About 90 percent of my patients are coming from all around the country, so I assume that there’s probably not too many programs out there—unless we have a track record, which I know we do at this point.
KING: Are there any statistics, Karen, as to how many self-injurers there are?
Ms. CONTERIO: A colleague of mine—Dr. Armando Favasa [sp?]—him and I did a study together and he has a projected figure of 750 per 100,000 population so, you know, it’s quite high. And are we talking about those who never see hospitals? Are we talking about the chronic self-injurer, those who just maybe bite their nails chronically or pick their skin or whatever?
KING: In other words, there are a lot of people who do self physical injury to themselves that we don’t know about?
Ms. CONTERIO: Oh, I think there’s thousands. I think thousands go unreported.
KING: OK. Glenna, why do you think you harmed yourself? Why do you think you put an iron on your skin?
Ms. MOCKBEE: I put an iron on my skin mainly because I wanted to forget the pain I was feeling inside.
KING: From what?
Ms. MOCKBEE: Just different things that’s happened in the past.
KING: Emotional pain?
Ms. MOCKBEE: Emotional pain, yes. And I just didn’t know how to release it. I just never-
KING: And the physical pain brought you a release from it?
Ms. MOCKBEE: Yes.
KING: In other words, by concentrating-
Ms. MOCKBEE: To a degree but, see, what happened is I’d have to just continuously burn or cut myself and so it was getting more severe because, you know, it’d only make me forget for a short period of time until I’d have to go around doing it again. So I knew I needed help.
KING: Do you know why you were cutting yourself, Steve, breaking-
Mr. PICHETTE: I now know, yes.
KING: And it is why?
Mr. PICHETTE: It was from severe sexual abuse-
KING: As a child?
Mr. PICHETTE: As a child, and physical abuse. The sexual assaults that occurred, occurred outside of the family.
KING: You were sexually assaulted?
Mr. PICHETTE: Yes.
KING: By females or males?
Mr. PICHETTE: No, by males.
KING: And you have learned to adapt to that? By learning that, you’ve stopped harming yourself, even though you were harming yourself as little ago as March?
Mr. PICHETTE: I am still working on that and realizing that my work to express and find—express my emotions about the anger that I have and everything—will only continue as long as I keep from self-injuring. Then it gets all confused.
KING: Both of you were at Karen’s program?
Mr. PICHETTE: Yes.
KING: All right. Karen, can you tell us what you do there in Chicago, specifically, to deal with this?
Ms. CONTERIO: Well, the program is- I work with a treatment team consisting of a psychiatrist, psychologist, mental health workers, and nurses. And what we do is it’s a 30-day intensive program. There’s a lot of writing assignments. We help the patient begin to look at and understand that it’s OK to tolerate feelings. It’s OK to manage their feelings. The assignments in many cases are very appropriate to what the patient is dealing with.
I have not found anyone who is real atypical. It seems like everyone is real similar- have similar backgrounds that come into the program.
KING: All right, can we give an overall case as to what takes someone beyond, let’s say, the boy who washes his hands 100 times a day—the obsessive-compulsive—into someone who really deals with self-harm?
Ms. CONTERIO: Well, I don’t want to say that because someone washes their hands they’re going to go into self-mutilation. I think in part there may be two different syndromes. I think many reasons why someone might injure is, one, coming from such a- maybe an abusive home, like Steve talked about—the sexual abuse, physical abuse. There’s a lot of threats that take place. ‘Don’t tell anybody. If you tell, I will harm you. I will harm somebody else.’ Incest—a lot of multigenerational incest. Where’s that child going to be able to run to? There’s nobody safe to run to. So they can only really, you know, attack themselves.
KING: And they do it physically why? I mean, why physically, rather than washing your hands 100 times a day or emotionally bothering yourself? Why physically- Why the physical pain aspect?
Ms. CONTERIO: I think for many reasons. One, I’ve been told that sometimes blood- the patient might feel dead inside and sometimes seeing their own blood represents life to them. It’s very sensational, mainly to themselves and maybe others around them. It can draw attention to them. And I know this is uncomfortable—the word ‘attention.’
A real quick story is one time this woman was sexually- this girl was sexually abused as an adult. She knew that she was threatened. If she told anyone her mother would die and she was hoping that maybe her mother would ask her, ‘Why do you cut yourself,’ and this way she would not be telling on her father. So, again, I don’t think there’s one clear answer, you know, why people choose this.
KING: Yes, I know. Do you have a clear answer for yourself, Glenna?
Ms. MOCKBEE: No, I don’t. No, I don’t.
KING: Do you, Steve?
Mr. PICHETTE: I have three or four answers, starting from that I was very angry at myself. I thought I was responsible for those things that had happened to me. I felt guilty. I felt dirty. And this helped to punish me but was also a release of sorts.
KING: Do you think you’ve licked it?
Mr. PICHETTE: I really don’t know.
KING: You think you have?
Mr. PICHETTE: I think I have.
KING: Do you think you have, Glenna?
Ms. MOCKBEE: I’m trying. I mean, I had a downfall, but the doctor told me that just sometimes this happens like in alcoholics. They can have a downfall, but you’ve got to pick yourself up, and that’s what I’m doing now. And now with all the support I have now, I think I’ve got it pretty well licked.
KING: We’re going to take a break, come back, and start including your phone calls. This is Larry King Live in Washington. Larry Hagman still to come; and tomorrow night Ray Sharkey is going to be here. Don’t go away.
KING: Our guests here in Washington are Glenna Mockbee and Steve Pichette, both of whom are recovering from this tough illness; and, in Chicago, Karen Conterio, self-injury therapist at Hartgrove Hospital. She started this program—the first in the country—started it in 1986. We’re ready to go to your phone calls. Stuart, Florida, hello.
1st CALLER: [Stuart, Florida] Hi. I’d like to ask Steve—He said he started cutting himself when he was 11. Did his- How did he hide this from his parents, or did any teachers or did anyone say anything?
KING: Yes, how could you hide this?
Mr. PICHETTE: At that time I was dressing alone. I cut where it wouldn’t normally be seen. I showered alone. I never went to gym. I always had an excuse for gym all the way through high school. They weren’t as drastic as the stuff I did later, but no one ever asked.
KING: Were you asking yourself, ‘Why am I cutting myself?’
Mr. PICHETTE: Yes. I didn’t know who to turn to and ask about it because I knew that it wasn’t normal.
KING: All right- felt confidence in no one to turn to?
Mr. PICHETTE: No, absolutely not.
Mr. PICHETTE: No.
KING: Mother? No one? Some teacher?
Ms. CONTERIO: Larry, that’s real typical of the families that I see a lot of the patients coming from. They have nowhere to turn to. The house is very dysfunctional. There’s not very clear communication. It’s not OK to feel. It’s not OK to act. It’s not OK to be yourself. And anger seems to be a predominant feeling throughout the household.
KING: Philadelphia, hello.
2nd CALLER: [Philadelphia, Pennsylvania] Hello. I’m also a self-abuser and I have a question for Steve. I was wondering how his wife handled it when he was cutting himself and things like that, how she handled that?
KING: Are you married, ma’am?
2nd CALLER: Yes, I am.
KING: All right.
Mr. PICHETTE: For the most part, my wife would react to it and accept the reason that I gave her which, until I said otherwise, was, ‘It was an accident.’
Mr. PICHETTE: While I was drinking- Alcoholics have a lot of accidents and everything. When I told her when this occurred she told me that she knew that it was self-injury farther back. I had an injury in ’75 that she remembered—things like that—but she was always there for me.
KING: How about your husband, Glenna?
Ms. MOCKBEE: My husband, he’s a great support. He’s one heck of a man and everything. He never could understand why I was doing this to myself, but he would always be there and back me up. And he tried to explain as best he can to the kids too.
KING: It’s none of our business, but what incidents out of your childhood do you relate to causing this?
Ms. MOCKBEE: There was a lot of different things in the past I can’t comment on right now, but there was a lot of- Basically, the same as most self-injurers.
KING: Things similar to Steve?
Ms. MOCKBEE: Uh-huh.
KING: To Spotswood, New Jersey. Hello.
3rd CALLER: [Spotswood, New Jersey] Yes, hi. This is for Steve. I wanted to know that- if he was hoping that people would see him cutting himself, or find that he cut himself, for sympathy or attention?
Mr. PICHETTE: I never thought about the attention thing—not really till I got to Hartgrove and I had to examine things. I never thought about those things at all. It was just something that was really- just happened. Most of the time I was covering it up and hiding it, coming up with a real good excuse for it. By the time I got big accidents as an adult, almost everyone had accepted the fact I was a klutz.
Mr. PICHETTE: Yes.
KING: Yes. What was the worst thing you ever did to yourself?
Mr. PICHETTE: Well, the worst thing I ever did to myself and came to completion was the last injury I had, which is- I described the cut on the arm.
KING: Cutting your arm seven inches?
Mr. PICHETTE: Yes. Yes.
KING: Worst you ever did to yourself was what, Glenna?
Ms. MOCKBEE: I guess mine was the constant burning with the iron that I did for about five, six days in a row.
KING: Wouldn’t that be third-degree burns?
Ms. MOCKBEE: Oh, first, second, and third-degree burns. I mean, it was a staff infection because I didn’t get it treated and, I mean, they thought it was- They thought I’d end up losing my arm, it was so bad.
KING: Did your husband know these were self-inflicted?
Ms. MOCKBEE: I think eventually he did catch on, but I was wearing long sleeves for a long time and trying to do everything I could to hide it, but after a while I couldn’t put anything on my arm. He did know.
KING: So if you were hiding it, it was bringing you some sort of satisfaction?
Ms. MOCKBEE: It was- Yes.
KING: As the drug addict hides the drug, the alcoholic hides the liquor.
Ms. MOCKBEE: That’s right. It was just making me feel better in a way that I was hiding pain and trying to conquer everybody’s problems.
KING: New Britain, Connecticut, with Karen Conterio, Glenna Mockbee, and Steve Pichette. Still to come Larry Hagman. Hello.
4th CALLER: [New Britain, Connecticut] Yes, hi. I’m still hurting myself. I’m a registered nurse. I’m out of work right now. I still cut myself. I still hurt myself.
KING: How long have you been doing this?
4th CALLER: Huh?
KING: How long have you been doing this?
4th CALLER: For the last six years, and I’ve been hiding in my house.
KING: How old are you?
4th CALLER: I’m 38 years old.
KING: What should he do, Karen- Are you married, sir?
4th CALLER: No, I’m divorced.
KING: Karen, what should he do?
4th CALLER: Everything ended right after that. Excuse me?
Ms. CONTERIO: So the self-injuring started after the divorce? The self-injuring started after the divorce?
KING: Did you hear that, sir?
4th CALLER: Huh?
KING: Did the self-injury start after the divorce?
4th CALLER: It started after the divorce.
KING: OK, what should he do?
Ms. CONTERIO: Well, I think- I mean, obviously, you’re reacting to the trauma. I would strongly suggest that you find a therapist and start working on, you know, underlying issues. You know, you’ve been in a crisis for six years—or the injuring has been, you know, for six years—and I think you need to deal with the loss. I think loss is very part of, you know, this behavior.
KING: Why do we need a center? Shouldn’t any good therapist deal with this?
Ms. CONTERIO: There’s a lot of- many good therapist out there. I think all too often that this is a very frightening behavior. It’s been looked at as it’s a suicidal gesture and it’s been treated as a suicidal gesture. This is a very- It can be a very difficult patient and doctors really find it difficult to work with them.
KING: We’re going to spend a couple more moments with Steve Pichette, Glenna Mockbee, and Karen Conterio, and take a few more of your phone calls. And then we’ll meet Larry Hagman. This is Larry King Live in Washington.
Tomorrow night, Jack Anderson is here—the nationally-syndicated Pulitzer prize-winning columnist; Ray Sharkey as well. We’ll all be right back with more phone calls. Don’t go away.
KING: In a couple of minutes, Larry Hagman joins us. Our guests are Steve Pichette and Glenna Mockbee—the self-injury and self-mutilation syndrome; and Karen Conterio, therapist, Hartgrove Hospital in Chicago. The call is from Charleston, West Virginia-
Ms. CONTERIO: Larry, could I say-
KING: Hold on Karen. Go ahead, Charleston.
5th CALLER: [Charleston, West Virginia] Yes, I’m calling to find out- I’ve heard both of you speak that you’re dealing with this now in your adulthood. And I was wondering, when you remember as being a child, is there something that parents and people can be aware of for children so that we can intercept this, so that they don’t have to go through life and it perpetuates itself and can even-
KING: Good question. What would you look for, Steve?
Mr. PICHETTE: I’d look for a child who’s isolated, spent a lot of time alone. I’d just look for some practical things to look for.
KING: Like not wanting to take your shirt off.
Mr. PICHETTE: Someone who’s wearing—yes—long-sleeved shirts on a 90-degree day.
KING: Karen, what did you want to say?
Ms. CONTERIO: Well, I want to answer that question too. I think more friends, teachers, counselors, might have more of a chance of noticing it than in the family. There seems to be a lot of denial among the family.
What I do want to say is I want to thank the Chicago Bulls for bringing us a wonderful season this year. Thank you.
KING: [laughs] In that regard, by the way, John Paxson, who was a star last night in the fourth quarter—made the Bulls victory possible—is a big fan of Larry King Live and we’re very close to reaching him, and he may be on this show tomorrow night.
Ms. CONTERIO: Great.
KING: We’ll let you know during the day tomorrow. What a ball player. What a game he had.
San Francisco, hello.
6th CALLER: [San Francisco, California] Hello?
6th CALLER: Hi. I wanted to address the gentleman regarding the self-injuries.
6th CALLER: I was a person before doing these kind of things and I’ve came up and gotten my life together now, but I still have a lot of scars that quite a few of them are still visible.
6th CALLER: And it’s not something you want to make a big deal of every day of your life when people ask you what happened. I just want to know how you deal with those constant reminders when you look in the mirror or, you know, when other people ask you?
KING: Good question. How do you deal with it, Steve?
Mr. PICHETTE: Right now, I’m still pretty close to my last injuring, but they very much are a reminder and it’s very good for me now to have that. At a later date, if I want to have laser surgery or something else I will, but I don’t try to keep it covered for that specifically and I don’t uncover it just to show it.
KING: Do you like the self-reminder?
Ms. MOCKBEE: I can’t stand it. In fact, I’m going to a doctor to see about having it sanded or some of it taken away because I feel like I want to be over the self-injury and I don’t want any reminders of it.
KING: Is there a good common tip to deal with this, Karen?
Ms. CONTERIO: If you want- It’s up to the person if they want to be honest or not. One thing positive about it is that they never have to add another scar to themselves if they don’t want to.
KING: Yes, in other words, if you don’t like the way you look, change it. If you think it’s important, don’t.
Ms. CONTERIO: And if you’re comfortable with yourself with it. Many people come to that, you know.
KING: Yes. Battlefield, Kansas, hello.
7th CALLER: [Battlefield, Kansas] Yes, I just had a quick question for Karen and a statement. First, I just wanted to say that I think that these people are terribly brave, Larry. And I want to thank you for bringing this to the attention of the public.
KING: You’re welcome. What’s the question?
7th CALLER: My question is, you know, Larry, we live in a country where 33 million Americans don’t have access to regular medical care and, for Karen, for the medically indigent in the United States do you have any suggestions where they might be able to turn for treatment?
KING: Yes, do you, Karen?
Ms. CONTERIO: Unfortunately- The only thing I have now for anybody seeking some type of treatment is an out-patient booklet that if a therapist would like to contact me I would be happy to discuss the booklet.
KING: OK, and they can do that at Hartgrove Hospital in Chicago.
Last call—Charleston, South Carolina. Hello.
8th CALLER: [Charleston, South Carolina] Hello.
8th CALLER: Larry, I’d like to ask your guests, do they have any religious background?
KING: Does religion play any part in this, Glenna?
Ms. MOCKBEE: Yes. I got, you know, religious background too and-
KING: Didn’t help?
Ms. MOCKBEE: It didn’t help, but it’s-
Mr. PICHETTE: Yes, played a big part in my early life. I’m raised Catholic—was an altar boy and all those things.
KING: Didn’t prevent this, though?
Mr. PICHETTE: It didn’t prevent it. As a matter of fact, any guilt I might find was magnified. I thought I was going to hell anyway.
KING: Thank you all very much. You are very brave. That caller was well versed to say that. Steve Pichette and Glenna Mockbee and Karen Conterio. If you want to contact her it’s Hartgrove Hospital, Chicago.
The Ottawa Citizen
July 19, 1991
Self-injury; Little-understood psychological disorder may be linked to childhood abuse
Jacqueline Duclos’s arms have a story to tell.
The limbs that create paintings and write poetry are covered wrist to shoulder with scars carved with glass, razor blades and burning cigarettes.
Taking such implements to our own skin contradicts our fear of pain and instinct for self-preservation. But for Duclos, 28, it’s a seven-year-old compulsion that never hurts.
“The more my life is going out of control,” she says, “the more I want to self-injure.”
Fear and rage provoke Duclos to lash out at herself, but in stages. She’s constructed an elaborate set of rules and rituals such as “If I cut the lower half of my arm, I can’t cut the rest of me until it heals.”
No one knows how many people, like Duclos, injure themselves. It’s a little understood phenomenon because it takes such a wide variety of forms. Self-injury includes slapping, head-banging, slashing and injury to genitals and breasts.
The condition is sometimes called adult non-fatal self-harm. Duclos, for example, distinguishes between times she has mutilated herself and times she has tried to kill herself.
Experts say most self-injury victims are either mentally disturbed (such as schizophrenics) or were physically or emotionally abused as children.
Self-injury becomes an addiction for some people, making it difficult to stop. There are few organized treatment programs. But those that exist focus on teaching people better ways to deal with the strong feelings that often trigger self-injury episodes.
Duclos’s childhood is a blur of sexual and emotional abuse. “The basic message,” she says, “is you’re not a person.”
By the time she was 21, she had built up a wall of emotional coldness. “I was like Mr. Spock, no feelings,” she says.
A few years ago, Duclos was surprised to meet someone who shared her habit. Last year, it was cathartic for her to hear self-injury discussed at an Ottawa conference.
The speaker was Jan Heney, a part-time counsellor at Kingston’s prison for women.
Heney was hired to study self-injury at the prison soon after the 1988 hanging suicide of Marlene Moore, Canada’s only female dangerous offender, whose habit of slashing was well-known but little understood.
Heney first encountered self-injury at Ottawa’s Rape Crisis Centre, where she works as a therapist. Available research didn’t seem to describe the women who were confiding in her about their behavior.
Self-injury has long been associated with personality disorders such as schizophrenia. In some cases, it may be the result of a psychotic delusion, such as a voice or hallucination. Some forms of self-injury are catastrophic, involving for example, castration or the tearing out of an eye.
Repeated slapping, self-regurgitation, rectal injury and head-banging are common behaviors among people who are developmentally delayed. In some cases, electric shocks are used by psychiatrists to deter patients from causing permanent physical damage to themselves.
Heney says that in her experience, self-injury is a symptom of childhood sexual abuse. Conventional psychiatric literature, she says, portrays the behavior as pathological and sick. On the contrary, Heney believes it is a way for abuse survivors to cope with feelings of intense anxiety.
She says victims of childhood sexual abuse learn that bad things can and do happen to them. The victim often assumes responsibility, especially when the abuser is someone important to them.
Years after the abuse has stopped, something may “hook” the survivor into feelings experienced during the abuse. They injure themselves because they believe harm is inevitable. At the same time they are in control of how much they hurt.
Heney says the most common forms of self-harm among survivors of childhood sexual abuse include slashing, burning, head-banging, swallowing poisons and anal and genital mutilation.
She says people who hurt themselves usually report a sense of release. “Some are looking for pain. Others are looking for blood,” Heney says. “It takes different things to reduce their anxiety.”
Dr. David Palframan, a psychiatrist at the Childrens’ Hospital of Eastern Ontario, says self-injury, like many psychiatric symptoms, is a compromise.
“It gives some relief but it makes you feel you’re doing something bad. Everybody who self-mutilates has low self-esteem,” he says.
Palframan says child psychiatrists usually encounter self-injury among female adolescent patients.
Today, Duclos is trying to cope with her obsession by trying to open herself to feelings other than anger. She also expresses herself through art _ some of which is on display at the Bocco Bakery on George Street. And she is working on a book of poetry about self-injury and suicide.
“It’s really scary to acknowledge deep hurt,” she says. “Before, I refused to admit there were any other emotions. I’m starting to let people in, which is definitely new. It’s progress.”
Orlando Sentinel (Florida)
May 30, 1992
Experts Report Progress In Treatment of Self-Injury
University of Florida researchers are developing new ways to deal with a disorder treated almost exclusively in the past with sedatives or restraints.
About 600,000 mentally retarded or autistic Americans exhibit self-injurious behavior, said psychologist Brian Iwata, director of UF’s Center on Self-Injury.
Iwata said that because most people with the behavior are institutionalized, the public doesn’t know much about this disorder, which is characterized by head-banging, self-hitting and biting.
Iwata said people suffering from the disorder seek attention, so psychologists work to identify and withhold the things that the patients regard as a reward for self-injury. They disrupt the self-injury and gradually replace it with more positive behavior. The treatment is successful in more than 80 percent of the patients.
December 14, 1992
Hope and help can save mutilators from despair
By Ann Landers
Dear Ann Landers: I was stunned when I picked up The Bakersfield Californian and read the letter from the 17-year-old girl who mutilates herself with razor blades. I thought I was the only one in the world who did that.
I’ve been cutting myself since I was 11. I am 22 now and have scars on my hands, arms, legs and feet. I’m not suicidal. If I ever get to that stage, I won’t use a knife. There are better ways to die. A person can always jump out of a window or in front of a train. The least messy is a bottle of pills.
You told the girl who cuts herself to get counseling. Why? I’ve had several hundred hours of counseling, but it hasn’t helped.
I promised myself I wasn’t going to unload on you, so, Ann, I will stop right now and simply say thanks for letting people like me know we aren’t alone. –D.D.D.D.
Dear D.D.D.D.: Thanks for letting me know I helped you in some small way. I wish I could help even more. If you feel inclined to write again, please do it.
I don’t mind being dumped on. That’s what I’m here for. I hope the next letter will encourage you not to give up.
Dear Ann: This is for the girl who cuts herself because the physical pain blocks the emotional pain that she finds unbearable. She doesn’t have to continue to do this. I stopped, and she can too.
I quit carving on myself nearly three years ago, thanks to a few people who saw how desperate I was and offered a hand of friendship. I want to say to anyone who is into self-mutilation, please, when you are feeling self-hate, don’t reach for a razor or a knife, reach for the phone and call someone who cares—a friend, a relative, a teacher, a counselor, a clergyman or a stranger on the other end of a hot line. There is help—get it. You are sick. I know because I’ve traveled that road. –Peggy in Brooklyn
Dear Peggy: Thanks for those encouraging words. Keep reading. You have more soul mates than you know.
Dear Ann: I, too, was a self-mutilator. I came from a severely dysfunctional family. My father was an alcoholic, and my mother disappeared when I was in my early teens. I got it into my head that she left because she didn’t like me. Salvation came from support groups and pen pals. I urge anyone who has this problem to get the help that is available. –Oregon
Dear Ann: I don’t cut myself with razor blades. I punch walls. My bedroom has at least 12 places where I have knocked out the plaster with my fists.
I know this is a cry for help, but nobody is listening. My mother pays no attention to me. It took her a week to notice that I had shaved one side of my head. If you are thinking I’m crazy, you are probably right. But nobody gives a damn. I’ll sign myself. –Just Another Kook Going Down the Drain
Dear Friend: I give a damn. Please write to me at once and give me your name and address. There is help for you, but I have to know how to deliver it. And now a word to all you self-mutilators: I had no idea there were so many of you out there. My mail has been staggering. Contact a doctor, a friend or a counselor. Talk to someone about what you are doing. You need help. Reach out for it. Information is available through the Hartgrove Hospital Program for the Treatment of Self-Injury in Chicago. This is not a hot line, but they can direct you to help in your area. The number is 800-DONT CUT.
The Toronto Star
September 21, 1993, Tuesday, AM
Self-injuring behavior doesn’t have to reflect a real wish to die
By Dr. Diane Sacks and Dr. Irvin Wolkoff
Dear Dr. Wolkoff: I am a female in my mid-20s. For many years I’ve seen psychiatrists for self-injury, which is now under control, I hope. I finally got my act together. I have been back at school. I enjoy it. I have positive friends and supportive family.
The thing is, whenever I read books about suicide, I’m fascinated. I go to the library and I sit in the aisle totally engrossed. I daydream about it, although I have no wish to die. Going back to a therapist, rehashing problems would only make me worse. Besides, I’m trying to break out of the negative mode.
Dr. Wolkoff replies: Most people don’t realize that self-injuring behavior or fantasies of suicide don’t necessarily reflect any real wish to die. Sometimes, such actions or thoughts are an expression of something else, such as feelings of “badness” or a deep sense of helplessness over life, particularly circumstances that are unwelcome and hard to solve or escape.
Some unfortunate folks, particularly those who carry the Borderline Personality Disorder, suffer terrible states in which they feel empty, afraid and indescribably lousy. Harming themselves can, paradoxically, give these sufferers a sense of being real, of pulling loose bits of themselves together.
It seems that your past psychotherapy has made it possible to do some nice things for yourself. You write that you have stopped your self-injuring behavior, which is great, partly because it reduces the risk that you might actually hurt yourself and partly because it has given you the chance to think about what was behind it in the first place—the first step in resolving your fundamental problems.
You have allowed yourself the self-affirming joys of returning to school and accepting the support of friends and family. And here we run into another apparent paradox: people who manage to get their lives going will often suffer a setback.
It’s as if they find living well too foreign or stressful and are trying to get things to feel a little more familiar by going back to the old, well-worn ways of functioning.
It is encouraging that you realize that you have no wish to die and that you have not gone back to actually hurting yourself. The interest and fantasies you describe sound like a kind of compromise—a half-step back. This suggests there may still be some work left to do in therapy. It may involve some scary feelings but they’re not really a “negative mode.” It’s more like grief—it does end eventually.
The Independent (London)
May 3, 1994, Tuesday
When mental scars lead to physical wounds; Why do thousands of women cut or burn their own bodies? Sarah Lee explains how pain drives them, and how sensitive treatment can help
It started suddenly when Kim was 17. “I was in a state of extreme anxiety and began to build up this urge to put my fist through a window. I couldn’t stop thinking about it—about how the blood would be pouring down my arm from the cuts.
“Then one night I did it accidentally. I was knocking on a friend’s window when my arm went through the glass. When I took my arm out there wasn’t a mark on it. So I just picked up a bit of shattered glass and cut my hand with it a few times. Physically it was absolute agony, but I also felt a strange sense of relief.
“After that it became my secret. I’d make cuts on my arms with broken glass and razor blades. I’d use anything I could get hold of—like a nail file or screwdriver—and just cut and gouge until a decent size wound appeared. Afterwards I’d be upset and frightened by the injuries, but I was also satisfied with them.”
Kim is now a 28-year-old local authority Women’s Education Officer from Newcastle upon Tyne. For more than seven years she carried out deliberate acts of physical damage to her own body. Self-injury is a term that encompasses a broad range of behaviour. In its milder forms it can include nail-biting or persistent scratching. It can also, however, refer to acts of severe self-mutilation such as cutting, banging and burning—or, at its extreme, gouging out eyes or driving nails into the forehead.
More than 100,000 cases of self-injury are reported every year in hospital accident and emergency departments in the UK, but it is estimated that at least 10 times as many people disguise what they do as accidents or care for their own wounds. It is believed that self- injury is twice as common among women as men.
Despite its prevalence, it remains one of the least understood conditions within the field of mental health. Consigned to brief chapters in obscure psychiatry books, it is often misdiagnosed as failed suicide attempts or manipulative attention-seeking—and can create confusion, fear and even revulsion among the public and medical profession.
For Kim, a graduate in politics, self-injury was the culmination of a prolonged emotional crisis. Throughout her childhood and teenage years she appeared part of a perfect middle- class family—a bright, happy girl with loving and supportive parents. The reality was quite different:
“In fact my mother was very ill and depressed and my father—the ‘responsible, kindly breadwinner’—used to get very angry and violent. And he was abusing me sexually. I couldn’t say what I was feeling in words, so the cutting and scars became my language. They expressed feelings that didn’t have anywhere else to go. Beforehand I’d be feeling utterly desperate—like my feelings were running away from me and I was slipping down a slope. Cutting myself stopped me going down that slope.”
Like many women who injure themselves, she says: “There was a disparity between how I appeared and how I felt inside. In my breaks at work I’d go into the toilets and cut myself. Then I’d hide the wounds, go back to my job and carry on being ‘successful’. Sometimes I’d cut myself about once a fortnight, but when things were really bad I’d do it up to twice a day.”
Kim says that when she was injuring herself what she needed was “a place to talk”. What she received was completely different: “Psychologists and psychiatrists treated what I was doing with contempt—like a ‘loony’ sign that I was deeply disturbed. I’d get told off in hospitals and people would freak out if they saw my scars. They said I was just being childish and gave me major tranquillisers, which just made me feel completely unable to cope.”
According to Mind, the London-based mental health charity, her experiences are typical of an approach that emphasises the restraint of self- injury. “The distress of women who self-harm is often compounded by hostility, judgmental attitudes and coercive methods of management on the part of staff,” says Alison Cobb, Mind Policy Officer. “These women don’t need punishing again in their lives. Since feelings of powerlessness and lack of control exacerbate self-
harming behaviour, the focus of professionals should instead be on empowering the woman and enabling her to take control over her life.”
An astonishing 53 per cent of calls received by the late-night Bristol Crisis Service for Women—a national support phone-line for women in crisis—relate to self-injury. The service has found that many women believe it is socially unacceptable to express anger overtly—and instead turn it in on themselves. Self-injury is a way of releasing the overwhelming tension that builds up inside. Counsellors at the service say it is just one of a range of coping strategies that include alcoholism and eating disorders. These may be more “socially acceptable”, but are equally damaging in terms of a woman’s self-image.
However, the question remains as to what triggers this mutilating expression of personal crisis. Hilary Lindsay, coordinator and counsellor at the Bristol centre, says there is a clear link between self-injury and abuse: “More than half of the women who call us about self-injury go on to say that they have been sexually abused. For them the only way of dealing with their continuing emotional trauma is to transfer their internal pain to external, physical pain on their bodies.
“Some talk about damaging relationships that have left them emotionally scarred. But we believe that the number who experienced sexual abuse would prove higher, if we asked them directly.”
In an attempt to close the gap between the needs of women and their treatment, the Bristol centre is launching a two-year research programme focusing on the experiences of women who injure themselves and will culminate in a national conference and training programme for health professionals. The aim, says Ms Lindsay, is to put self-injury on the mental health map.
Kim says: “I eventually found what I needed—a place to explore the reality of my past. Being listened to took the place of having to cut myself. I’ve reached the stage where I can say I’ll never do it again.”