Self-inflicted pain

During the time I worked as a therapist on a trauma unit of a psychiatric hospital in Dallas, I saw a fair number of patients who were “cutters.” These were individuals that would carve on their bodies with sharp objects from time to time. When I first encountered this behavior, I was completely mystified as to why someone would do that. But after talking to patients who engaged in this type of self-mutilation, their reasons for doing so became clearer.

One reason people self-mutilate is to punish themselves for whatever unforgivable crimes they believe they have committed. I saw this a fair amount with patients who had experienced a severe history of childhood sexual abuse. The belief that drove the behavior was along the lines of, “I am responsible for the abuse, which means I am a terrible person.” The funny thing about this particular belief is that the vast majority of people who express it believe it is true only for them, and no one else. Everyone else was an innocent victim, but I alone am guilty of causing my abuse, or so the thinking goes. Most people who hold this belief can recognize the absurdity of it, but that doesn’t mean the belief just goes away. The reasons for this are numerous and complex, but that’s a topic for another time.

Another reason people self-mutilate is to escape from emotional pain. One patient told me whenever she felt overwhelmed with sadness, she would cut on herself and the sadness would go away “as soon as I saw the blood.” There is no way to ascertain the truthfulness of such a statement, but that’s what she said, so I took it at face value. Other people I’ve met have made similar statements.

A third reason some people self-mutilate is because they think it is cool. I saw this particular phenomenon occur a number of times when I was working on the adolescent unit of the same hospital I mentioned above. It would happen like this: the unit would have about twenty-five kids or so, and no one was doing any cutting. Then we’d get a new kid that was a cutter, and within two days, half the kids on the unit were cutting on themselves. Let me be clear: none of the reasons I’ve identified, or any other reason, is a good reason to self-mutilate. There is no good reason to self-mutilate. But doing it to be cool is the worst of the bunch, in my opinion.

Self-mutilation is obviously a very dramatic and visible form of self-inflicted pain, but only a small percentage of the population does it, and a fair amount who do will eventually stop doing it. But there is another form of self-inflicted pain that occurs on a much more widespread basis. It is far more subtle and invisible than cutting on oneself, but it causes a significant amount of pain. It occurs everywhere, in every society, among every age group. Most of the people who are doing it aren’t aware that they’re doing it, but that doesn’t change the fact that it’s making them fairly miserable. I used to do it. You might be doing it on a regular basis. What I’m talking about is this: the emotional pain we cause ourselves by believing we are a bad person.

Whenever I ask a client to identify his or her strengths and weaknesses, it’s not unusual for the person to have a whole list of weaknesses, while the list of strengths might be very short, or nonexistent. In other words, many people believe there is a lot more about them that is bad than good. Some people are aware of this, and some are not, but whether one is aware or not doesn’t change the overall effect it has on the individual. As I’ve said before, it is virtually impossible to be reasonably happy while holding on to the belief that you are a bad person. Those two things are mutually exclusive.

When expressed in words, the thinking might go something like this: “Sure, everybody’s got their faults, and nobody’s perfect, but I’m really screwed up.” We tell ourselves that because of the way we think or feel or behave, there must be something seriously wrong inside. Makes sense, right? Why else would I do this weird behavior or have these bad thoughts, the ones no one else knows about? There is a blanket explanation that covers all our unsavory aspects: I am truly messed up. Damaged goods. There is something really wrong with me.

Here is a point I’ve made before, but which bears repeating – absolutely no one is born with this belief. It’s far too sophisticated a thought for a newborn to entertain. However, we can acquire this belief pretty quickly. Where does it come from? From parents, from teachers, from siblings, from kids at school, from any source that tells us we are different or weird or bad. Once that seed has been planted, it tends to flourish, and its roots go very deep. It’s like a weed – you can pluck it at the surface, but it just grows back. If you want to get rid of it, you have to dig it out.

Most anyone who does therapy or any other form of growth and change long enough will eventually come to a startling realization, that basically goes like this: I’m not as screwed up as I thought I was. This realization usually brings mixed feelings. On one hand, it’s good news. Hey, I’m not so bad! That’s good to know! On the other hand, the realization can bring sadness, the sadness that comes from understanding that a lot of pain I’ve felt over the years came from me. Why did we do it? Is it masochism brought on by self-hate? Is it another indication of how screwed up we are? Is it deliberate cruelty? No. It is none of those things. We do it simply because we don’t know any better.

If I or anyone were to say to someone, “Hey, you’re not as screwed up as you believe,” it probably wouldn’t make any difference. The response is usually, “Yeah, I know, I’m working on it,” which may or may not be true. You can’t force this realization on anyone. It comes from doing the hard work of therapy. When we see the truth of who we are, which is part of what doing therapy is about, we realize that a great deal of shame we feel does not belong to us, and a lot of guilt we carry was never ours to begin with. That doesn’t mean we are perfect, because we’ve all got our flaws. Some are insignificant, and some might need to change, but it’s very difficult to try to effect change in ourselves while we’re still in the self-punishment phase. The more we come to see the truth, the more we understand why we are the way we are. At that point, the “I’m screwed up” explanation can be seen for what it is, which is inadequate at best.

If you want to be happy, you have to get to a point of forgiveness, especially for yourself. Again: self-hate and happiness are incompatible. It’s one or the other.

There is a scene in the novel Hannibal, by Thomas Harris, in which the infamous Dr. Hannibal Lecter is talking to a former patient of his, a lesbian body-builder named Margot. In the scene, he asks if she remembers what he had told her on their first meeting, many years prior. At one point, they have the following exchange, the Doctor speaking first.

“What else did I tell you?”

“You said you were much weirder than I would ever be,” she said. “You said it was all right to be weird.”

Yes, Hannibal Lecter is a fictitious character who has a bad habit of killing and eating people. He is a psychopath. But there is truth in his statement. It’s all right to be weird. Most of our weirdness is small potatoes compared to those of a serial-killing cannibal. But hey, if Dr. Lecter can accept himself for who he is (which he does), then surely there is hope for all of us.

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