CUTTING: Self-Injury by teens

My friend and I walked together, heading for the world outside our secondary school. I was about to hurt the person dearest to me.

-- from the journal of Kerri*, 16, about an incident that occurred the day after she cut herself so badly that both her wrists required bandages

The notion of a seemingly well-adjusted young woman deliberately hurting herself is not something that many of us can easily comprehend. In fact, Tom* was not the only person who initially doubted Kerri's claim. Dylan*, another acquaintance of Kerri's, didn't believe her either. He remembers when she came to him looking for compassion. "It was tough love," he recalls. "I figured that if I just ignored her and pretended that what she said wasn't true, the problem would go away."

But the problem did not go away. Kerri became even more insistent, telling Dylan almost every day that she was cutting herself. Instead of suggesting she find help, he egged her on.

"One night he decided that it would be clever to try and use reverse psychology on me," recollects Kerri. "He held a Swiss army knife out, expecting me not to take it. He was wrong. The blade was pointed out towards me and I grabbed it, cutting my hand in the process."

Sadly, incidents like this occur every day. A 1986 study by Karen Conterio founder of the original Self Abuse Finally Ends (S.A.F.E) Alternatives program in Chicago, shows that one percent of the population is prone to self-injurious behaviors. Of this group, 97% are female. These behaviours involve the deliberate, repetitive, impulsive, non-lethal harming of one's self. The most common types of self-injury include burning, cutting and punching one's self.

And while the majority of self-injurers are female, the problem also affects males. Jimmy Ray* is a 19 year-old reformed self-injurer. Like Kerri, he was also a "cutter" (a term used by people who cut themselves).

"I started in the summer of 1992," he begins. "I did it because I was depressed, and to get attention, because my family practically ignored me. The first time I was at home alone when I did it. I took a razor blade and drew it back and forth across my wrists lightly until I began to bleed. Then I just sat there until the blood stopped flowing from the wounds."

Conterio says Jimmy Ray's behavior is typical of people who cut themselves. She suggests that people who harm themselves are usually, but not always, from middle to upper class backgrounds, are of average to high intelligence, and have low self-esteem.

Conterio explains that, "in a middle to upper class home both parents are usually working. This means that there is often less family interaction and less support from a family unit." She goes on to say that when young people have no one to talk to, they will sometimes take this course of action to draw attention to themselves.

There are many reasons why people engage in self-injurious behaviours. In the study, Conterio reports that almost 50% of self-injurers had experienced physical, sexual or emotional abuse. They also claim that as many as 90% of them felt discouraged from expressing their emotions - anger and sadness in particular.

Serena Coy, a community outreach worker at Delisle Youth Services in Toronto, adds that self-injurious behaviour is sometimes linked to issues of power and control. Much like eating disorders, these behaviours can be an attempt to impose a feeling of control on the one thing that a young person has a sense of power over - one's body. She says that self-injury can also be a form of group identity, whereby four or five people will secretly engage in it together.

Whatever the cause, Coy says she has noticed an increase in the number of people seeking help for self-injurious behaviours. And if the study is any indication, for every person who cuts or otherwise self-injures, there are many more who consider it.

Of the various types of self-injury, cutting is by far the most common, in part because it is easy to conceal. People who cut often attempt to hide their scars by wearing long-sleeved shirts and baggy pants - even in the summer. And if someone does see their cut-marks, they usually invent excuses.

"I wore long-sleeved shirts in 35 degree weather so my family didn't find out I was cutting until a couple of years after I started," confesses Jimmy Ray. "They found traces of blood leading from the laundry to my room. They questioned everyone (in the house) about the blood and I told them what I had been doing. They asked why, and I said it was because of my grades, having few friends and wanting their attention."

When he was in grade nine, Jimmy Ray was admitted to the hospital to be treated for depression. He remembers looking down at his wrists and seeing the scars. It was only then that he began to realize the extent of what he was doing.

His stay in the hospital was not long. "My parents suggested that I get counseling for my depression, but I declined," says Jimmy Ray. Instead, he overcame his problem on his own by avoiding knives altogether. To date, he has succeeded. He says that it was hard at first, and that he had to fight the urge on a daily basis. But as time went on, it became easier.

Kerri also managed to find a cure for her behavior, though it came from an unlikely source - her friend, Tom. "The thought of losing her was just too much to bear," he recalls. "I really care for her a lot and didn't want anything to happen. The only way I could help was by threatening to break my promise and tell her parents what she was doing. It was one of the hardest things I have ever had to do in my life."

Kerri now understands what she had been doing to Tom, and how she put him through hell. "I didn't want to lose him... and he didn't have to say it, but I knew I would if I didn't help myself."

Kerri and Jimmy Ray have stopped cutting, but these behaviors can often last for 5 to 10 years or longer without proper treatment. "Sometimes all you really need is a good support system," says Kerri. "All I had was Tom as my main support. I tried looking elsewhere for help to start with, but all I found were cold stares and mocking disbelief."

The good news is that help is available. In 1990, the first S.A.F.E. program in Ontario was established in London. It is closely modeled on the original program in Chicago. Today, there are also programs in Toronto and Oshawa. The Toronto S.A.F.E. program, in association with the Centre for Addiction and Mental Health, runs an 11-week educational group two or three times a year.

Ultimately, "cutters" and others who engage in self-injurious behaviours need to know that it's all right to seek help.

"I wanted to tell my story so that others would know that they are not alone, so that maybe I could help them realize that they need help and that maybe reaching out to someone isn't always a sign of weakness," concludes Kerri.

"What is it Ker?" Tom asked as he turned to face me.

"Well," I stammered, "I told you what I've been through, and you know things have been really... pure hell for me. Well, I cut. Last night, I cut my wrists."

Tom stood there looking at me, as if he was trying so hard to believe that those words didn't come out of my mouth. Trying to believe that what I said didn't happen.

"You lie," was all he said. We walked to my first period class. "You lie," he repeated. Then he paused briefly and said, "You don't love me, either." Devastated, I turned away from him so he would not see the tears. Tears I was certain would soon come.