)))title((( Secret Shame )))intro((( Self-injury is one of society's few remaining taboos. Gordon Houghton argues that we should listen more and condemn less. )))body text((( Rachel is sixteen years old, and cuts herself. She takes whatever tools she can find - razor blades, utility knives, scalpels - and carves patterns on her skin. When she's finished, she stems the blood flow with toilet paper and carefully bandages the wounds. She has cut so many different shapes and designs into her arms that the scars are barely recognisable. 'I used to cut daily,' she explains, 'sometimes because of stressful events in my life, other times because of general depression and suicidal feelings, and after a while simply because I was bored and it became just something I did.' An estimated 0.75% of the population are active self-injurers. That's one in every 130 people, a figure which excludes the culturally-sanctioned forms of mutilation such as tattoos, body-piercing and sado-masochism. It's a figure which is also comparable to the incidence of major mental illnesses such as schizophrenia and manic depressive disorders - yet the condition is rarely regarded as an illness, and sufferers are often treated unsympathetically. Self-injury (SI) can be defined as an act which damages one's own tissue with the intent of causing injury or relieving tension. Typical behaviour ranges from biting, pulling hair, picking at scabs and punching walls, through cutting (by far the most prevalent method), burning and piercing skin, to breaking bones and rubbing dirt into open wounds. Because these activities are rarely aired in a public context, plenty of myths surround them. For example, people assume that self-harmers are crazy or a danger to others, that they're attention-seeking and manipulative, or that they're trying to commit suicide. None of these assumptions is true, but all are efficient ways of dismissing what sufferers do rather than discovering why they need to do it. Armando Favazza M.D., author of the ground-breaking book on self-injury, Bodies Under Siege, claims that self-harm is 'the opposite of suicide'. He was one of the first doctors to regard the condition as a syndrome in its own right, and emphasises its links with depression and compulsive behaviours such as bulimia, kleptomania and alcohol/substance abuse. These parallels are reflected in his research, which suggests that the backgrounds of self-mutilators 'often include child abuse (50-60%), and childhood illnesses and surgical procedures'. Deb Martinson, administrator of the Bodies Under Siege (BUS) mailing list on the Internet, enhances this picture: 'The common factor seems to be an inability to deal with emotion. Self-injurers are often people who, when they were children, were told their feelings were bad, inappropriate, or inaccurate; and they have grown up not knowing how to handle feelings. SI provides a quick, dramatic release.' She notes that studies often portray self-harmers as young, white, middle class and female, but her own experience contradicts this. 'I've talked to people on the list ranging from 13 to nearly 60, from both sexes and all walks of life. The one factor which shows up time and again is that these people didn't feel they mattered to anyone... They never felt special or important.' In truth, there are a wide variety of factors which contribute to SI. Background influences include domestic violence, loss of a parent through death or divorce, lack of emotional warmth in childhood, hypercritical fathers, parental depression, and neglect. Common personality traits include perfectionism, disgust with one's own body, hypersensitivity to intense feelings, inability to express emotions and mood swings. There's no such thing as a 'typical' self-harmer. It's generally accepted, however, that two to three times more women than men are likely to injure themselves. Favazza suggests this is 'because in most cultures women tend to turn their aggression inward'. Martinson sees the flip side of this argument: 'Men are socialised not to show feelings, so perhaps they have an easier time suppressing "bad" emotions...' She also offers a biological explanation. 'Serotonin abnormality is implicated in both depression and self-injury, and more women than men are depressed as well as self-injure.' The first question most people ask when confronted with SI is: why do you do it? A group of self-harmers interviewed for this article gave replies consistent with Martinson's observations: 'I cut in order to feel something', 'I don't like myself much', 'it takes away all the black inside', 'it's easier for me to deal with physical pain than the emotional stuff'. It's a way of externalising emotion, and imposing control on something which feels chaotic. Respondents also identified feelings of intolerable tension or emptiness which can only be relieved by self-injury. As Rachel comments, 'the first time I cut, I was struck by the image of all the feeling I had slowly leaking out of my body through the wounds.' But the relief is only temporary. 'At first it did help, and after I cut I would be almost happy... but by the next morning I would be depressed and wanting to self-injure again.' When it comes to the question does it hurt?, the feedback is more ambivalent. Some couldn't remember the pain, or didn't feel it at all because of their emotional numbness. Most said they felt 'a little', but 'it wasn't too harsh', or 'it hurt, but I didn't really mind'. A few thought it was 'very painful', but qualified it: 'I had complete control', 'I think that I deserve it', and even 'it felt great'. In all cases, mental relief was seen as more important than physical discomfort. The connection between self-harming and control is reinforced by ritual. Some people make repeated use of special tools and particular rooms, listen to certain kinds of music, and have a firmly established order of events. Martinson suggests this is because 'the ritual helps the person focus their mind and block out everything except the act'. Favazza's explanation is more clinical: 'Ritualistic behaviours help cutters to bind their anxiety.' While ritual appears to be optional, almost all self-injurers feel shame as a result of their SI. This is reflected in the attitudes of cutters towards their scars, typically self-loathing: 'I hate my body, so the scars don't really make any difference', 'I hate them and try to disguise them', 'I feel as if I deserve the scars'. Rachel's view is more practical: 'Since most people already know about my cutting, I have no fears about showing my scars. The only time I worry is at a job interview, or when I'm trying to impress someone.' Shame makes it hard to admit to what you are doing, and self-injurers find it particularly difficult to find support. The medical profession - psychiatric personnel excluded - is a target for particular criticism. Bulletins on various websites allege that self-harmers are treated as 'a waste of time', and that one doctor even stitched a girl's wrist without anaesthesia: 'It was like he wanted to teach me a lesson, but instead he taught me that I could withstand more pain than I thought.' Deb Martinson argues for a more sympathetic approach, pointing out that SI is little different from alcohol abuse, drugs, smoking and eating disorders. The best hospital programme she's encountered is one in Beckenham, Kent, where 'clients are not forbidden to hurt themselves, but are expected to take responsibility for what they do. If they cut, they bandage their wounds, clean up their mess and talk to staff about what happened and how it could have been different.' Those closest to the self-harmer understandably have most difficulty coping. Rachel says her parents 'were scared by it. My dad gave me a lecture on God and took my blades away. My friends were scared too, though a few of them stepped into help... But people trying to "fix" me only screwed things up more.' Martinson offers some general advice for friends and families. 'The worst thing you can do is go away... and the second worst is to give an ultimatum. In most cases, the person doing this would stop if they knew how. They're generally not doing it to annoy you or manipulate you - although it can feel as though they are.' She also advocates maintaining an accepting, open attitude towards SI, recognising the severity of the sufferer's distress, and encouraging them to seek help from a counsellor. Whether you harm yourself or know someone who does, it's important to remember that you're not alone. In the UK, there's the Bristol Crisis Service for Women, the newsletter SHOUT, the National Self-Harm Network, and many other local organisations. Books on the subject, such as Tracy Alderman's The Scarred Soul, offer a humane and practical approach. On the Web, too, there are dozens of good sites offering both professional help and personal confessions. For Deb Martinson, informality and anonymity are the Internet's great strengths: 'People can look for information without explaining why they want it, and it makes it easier for them to talk about it.' Above all, everyone agrees that self-harmers should look for ways to change their behaviour. Martinson says that first 'you have to make a decision you no longer want to do it. After that, the only way to stop is to find other coping mechanisms and learn to substitute them for self-injury.' She suggests, for example, pressing ice against your skin rather than burning yourself, and then substituting something later for the ice. 'Match the activity to how you feel. If you're sad, do something soothing; if you're angry, do something physical.' The main thing is to be kind to yourself. 'When you lapse, let go of the guilt and move on. Set positive goals and reward yourself for achieving them. Deal with the issues that underlie your self-injury... But do everything in small steps.' She also recommends support networks: 'the more people involved in a self-injurer's life who know and understand what's going on, the easier it is for that person to work towards a recovery.' On a practical level, you should avoid materials which might lead you to self-harm, remind yourself of the long-term consequences, stay away from drugs and alcohol, or simply get a loved one to hold you until the impulse passes. In general, many people have found it helpful to accept their SI as a good thing, while at the same time recognising it as a harmful behaviour. As one respondent said: 'It's okay to cut - it's just better to stop.' If you succeed, bear in mind that your problems won't automatically disappear. As Rachel points out, 'Even if a person has stopped actively hurting themselves, they are still fighting the same battle, every hour of every day. It doesn't mean the issues aren't there, they are just better hidden.' Gordon Houghton is a former self-harmer and the author of The Dinner Party, published by Anchor at £6.99. )))body text ends((( )))box/panel((( Where to find help Secret Shame (http:/www.palace.net/~llama/selfinjury) Deb Martinson's website, devoted entirely to SI. Personal stories, help for self-harmers and their families, chat, medical information, and a comprehensive series of links. BUS (Bodies Under Siege mailing list) On-line support group for 'anyone with an interest in self-injury'. To join, send mail to majordomo@majordomo.pobox.com with subscribe bus as the mail body. Bristol Crisis Service for Women (PO Box 654, Bristol BS99 1XH) Resources for women who self-harm, including a confidential helpline (0117-925 1119) on Friday and Saturday nights, between 9.00pm and 12.30am. SHOUT (Self Harm Overcome by Understanding and Tolerance) (PO Box 654, Bristol BS99 1XH) Newsletter for both women and men who self-harm. A one-year subscription (6 issues) costs £4, and is available by writing to the above address. National Self-Harm Network (PO Box 16190 London NW1 3WW) Support group campaigning for the rights and understanding of self-harmers, with accent on practical advice and dealing with unhelpful medical attitudes. Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry (Favazza, Armando R. MD, Johns Hopkins University Press 1996, £14 pbk) Generally regarded as the definitive book on self-injury. Roots it firmly in a global, cultural context, and treats it as a syndrome rather than as a symptom. The Scarred Soul: Understanding and Ending Self-Inflicted Violence (Alderman, T., New Harbinger 1997, £11.99 pbk) An excellent general resource on SI for those who want to stop. )))ends((( 6 1