GORDON HOUGHTON

Secret shame

CUTTING: UNDERSTANDING AND OVERCOMING SELF-MUTILATION
Steven Levenkron Norton, 256pp, £16.95


In Britain, one person in every 130 is a self-harmer. Princess Diana was one. Richey Edwards, the Manic Street Preachers' guitarist who disappeared in 1995, was another. I, too, used to cut myself. At the time, I thought I was the only person who did it.
	Useful information about self-injury (SI) simply didn't exist until the end of the 1980s, and even now you can count the number of helpful books on the fingers of one hand. Levenkron, a psychotherapist, aims to change this with Cutting. He compares the present situation to that faced by anorexics in the early 1970s: the medical profession, patients' families, and the general public regard the condition with fear, anger, disgust and revulsion. He argues convincingly for recognition of SI as a symptom of underlying mental problems, comparable to alcoholism, drug abuse and eating disorders.
	He has written about the subject before, in a novel called The Luckiest Girl in the World. Although this was well-received by critics, many self-harmers considered it superficial, florid and melodramatic. Cutting has none of these defects. It's a gripping piece of non-fiction, and though Levenkron's tone sometimes strays towards self-congratulation (his treatments never seem to fail), his attitude is always sympathetic and his style succinct. 
	He explores the issue in two main ways, beginning with explanations for SI and concluding with advice on how to stop. The theoretical analysis is persuasive, but the most revealing insights are delivered through personal testimony. Many sufferers will recognise this narrative of cutting: "I have to make my feelings go away... I start to cut. It hurts. I cut a little deeper. It hurts a lot. I move the blade. It hurts much more. I start to bleed. The blood means I hurt enough to chase away all the other pain. It's over. I can take a nap after I finish looking at it and cover it with a bandage."
	By connecting experiences such as this with the reasons why they occur and the practical solutions available, Levenkron gradually diminishes the horror of self-harming, promotes understanding and offers hope. Similarly, by adopting a general approach he manages to address the needs of sufferers, their families and health professionals alike.
	It's an impressive piece of work, but not without flaws. For UK readers, the biggest of these is the absence of concrete help. Cutting boasts a fine list of North American resources, but fails to mention major UK organisations such as the National Self-Harm Network, the Bristol Crisis Service for Women, or SHOUT. It also ignores the wealth of web sites, bulletin boards, support groups and chat rooms on the Internet.
	Less seriously, Levenkron focuses specifically on "sick" behaviours such as cutting, hair-pulling and burning, but excludes culturally-sanctioned forms of body modification such as piercing, tattooing and S&M. Nor is there any attempt to answer people who claim to be "comfortable" with their cutting. Richey Edwards - arguably not the most credible example - has even described self-mutilation as "sexual". For a broader picture and an analysis of the global roots of SI, Armando Favazza's book, Bodies Under Siege, is more enlightening.
	My final complaints are purely personal. Research suggests that the ratio of female to male self-harmers is 3:1, but of 29 patients discussed in the case studies, only two are men - a few more would have been welcome. Equally irritating is the persistent implication that psychotherapy is the best solution to the problem of self-mutilation. Even if you take this route, the quality of care inevitably depends on the therapist.
	Cutting is much better than these criticisms might suggest, however. With compassion and patience, Levenkron identifies and illustrates the irresistible cycle of anxiety, gratification and shame which all sufferers feel. He demystifies the condition and brings it into the mainstream of medical practice. He's also very readable.
	If you're still wondering whether a book like this is necessary, it's worth noting that SI is not "officially" recognised as a clinical disorder, and there are many health professionals who simply don't know how to deal with it. When my own GP saw my scars, he just asked a few questions about masturbation and prescribed a course of lithium tablets. His treatment failed. If Cutting had been available to him, he might have been a better doctor.

Gordon Houghton is the author of "The Dinner Party"