A BRIGHT RED SCREAM: Self--Mutilation and the Language of Pain

A compassionate and informed discussion of self-mutilation, the ""addiction of the '90s,"" practiced by two million or more Americans. Self-mutilation has surfaced as a fad of pubescent girls, who use razor blades to carve their forearms with, for instance, names of their boyfriends. It's called ""cutting"" and is what Dr. Armando Favazza, in the preface, refers to as ""superficial/moderate"" self-mutilation. In other cultures or at other times, cutting, flagellation or similar forms of self-mortification have been regarded as physically healing, spiritually uplifting, or tribally bonding. Today Americans are horrified at the idea of painful blood-letting, associating it immediately with suicide. But the cutters described here are neither faddish or suicidal. They are using their razors, knives, broken glass--or cigarette lighters--to live. Like anorexia and bulimia (also efforts to gain control), some forms of self-mutilation serve as controls for unbearable rage and emotional pain that would otherwise lead to a psychotic break. Many cutters have suffered sexual or physical abuse as children, and the trauma they carry with them as adults is similar to posttraumatic stress disorder, says Strong. Among the symptoms is dissociation, where mind and body separate, leaving ""numbness and emptiness."" For some, the only way to reunite the two is by hurting themselves--the pain returns them to awareness. It may also release ""natural opiates,"" like endorphins, that minimize the emotional and physical pain; that may be one reaction that contributes to the addictive nature of the experience. Strong (a journalist who has written previously on child victims of war trauma) examines the theories of physiology, psychology, sociology, and neuroscience in relation to the need to self-mutilate; enriching her research are interviews with more than 50 cutters, some found on the Internet site where selfmutilators can talk to one another. The final two chapters discuss treatment alternatives. Humane, empathetic, and informed exploration of a frightening complex of behavior; it will be valuable to professionals, families, friends, and most of all to the cutters themselves.