ASK THE THERAPIST
by William A. Henkin, Ph.D.
Copyright © 1997 by William A. Henkin
<Q> Recently you answered someone's question about abuse in an SM relationship. My question is about a different kind of abuse, or maybe it's about a different kind of relationship. And it really isn't about SM, even though I am. My lover, who has been in therapy and on medication for depression for many years, recently confessed to me that the scars on her arms and legs did not come from being ritually abused in a cult when she was younger, as she had once told me, but were really the results of cutting on herself. Apparently before we met she had a long history of cutting herself until she bled, which would make her depression feel better, she says. She told me the truth because she thinks she might start cutting herself again. Now, I'm all in favor of honesty in relationships, and 20 years in the SM community has given me some understanding of the uses and pleasures of pain, but I have to admit her confession gave me chills. Why would someone do this to herself? Does it mean she's crazy, or her depression is getting worse? Should I tell her therapist? Is there anything I can do to help her? In short, I'm troubled and confused and I don't know what's going on.
<A> It's not surprising you're troubled and confused, and I admire your bravery for trying to learn something about your lover's experience. Your lover apparently has engaged in what's come to be called Self-Inflicted Violence (SIV), which is a subject relatively few people really know much about, even though studies have estimated that in contemporary America about 14 people in every 1000 do it.
In brief, SIV is the practice of cutting, burning, striking, or otherwise "hurting" or "doing violence" to oneself, often in a somewhat ritualistic fashion. People who engage in SIV often say it helps them relieve intense emotional distress, allows them to experience their feelings more deeply than they otherwise could, and even enables them to feel "alive" when they otherwise feel relatively more dulled to their experiences. What it does not do, they say, is add to their pain: instead, SIV is a practice they use to manage pain. Just as many people respond to physical injury with powerful emotions such as anger, grief, and fear in order to mitigate their physical pain, so it appears that for some people some forms of emotional injury or its recall can be so intense that they seek physical sensation strong enough to mitigate or distract them from their emotional distress. This is not the same as the ritual scarification, piercing, or other body decoration celebrated in other cultures, or that people involved with the modern primitive movement engage in, or the cutting, piercing, and branding some SM Masters and Mistresses use to claim their human property, or the various body modifications still other people use to reclaim their own bodies and experiences, any of which you might read about in publications such as Body Play and Modern Primitives Quarterly or Piercing Fans International Quarterly.
As a pain management strategy SIV seems to be employed preponderantly, though by no means exclusively, by women, and seems more often than not to be a sequel to severe childhood trauma or neglect. In this capacity it may accompany such other behaviors often seen in abuse survivors as head banging, eating disorders, depression, anxiety, and the abuse of alcohol and other drugs. Because it is still poorly understood, and also, probably, because it often frightens people who are unfamiliar with it, SIV tends to be stigmatized more than its counterpart behaviors by therapists as well as by people who suddenly find it in their lives.
It is frequently difficult for people who do not have the experiences of early trauma to understand how what looks like self-inflicted pain or harm or even mutilation could ease stressful feelings, but certainly some people in the SM communities are aware of how they achieve similar effects from intense stimulation, even if what they do is erotic and often involves other people.
It can also be difficult for observers to understand why people don't just stop SIV. But without a more effective way to manage the pain, or a way to relieve its cause, stopping SIV is no simpler than stopping any other form of self-relief, from binge eating to abusing drugs to compulsive petty theft to watching television for hours in a semi-trance.
Although I discourage doing therapy in the dungeon, as anyone knows who has read my SM book or attended SM classes I have taught, I also know that people in persistent or intense pain will use just about anything to try to obtain relief. And as some people might use SM to address a deep personal concern, so others might use SIV. In this way, even when it frightens or otherwise upsets observers, SIV can function like any other form of brief tranquilizing agent: the person cuts herself and, in a sense, sees her anxiety flow from her in the blood she lets. In relieving her stress she may become tired, fall asleep, and wake up, or her response may be more immediate; SIV does not solve her underlying problem, but usually she is, for the moment, free from the psychic pain that compelled her action.
While the motives for SIV seem to have their origins in early childhood trauma and neglect, the practice of SIV ordinarily begins in adolescence or early adulthood and is often stress-induced. In the psychotherapeutic world there is no single agreed-upon approach to treating or working with SIV, but stress reduction and alternate coping mechanisms seem to head the list of successful interventions for people who want to stop. Sometimes medications help reduce the compulsive feeling that may precede SIV, and psychotherapy often seems to help through the talking, writing, drawing, sand-tray, dream, and related work that centers around exploring whatever traumatic history may underlie and trigger the SIV behavior.
I offer this little essay on SIV as background to help you with your question about why your lover might cut herself. The fact that your lover has engaged in SIV does not mean she is crazy, though it does suggest she may have had some deeply painful experiences in her past. If she thinks she may begin to cut herself again after not doing so for awhile she may be feeling more depressed or more anxious than she has been, and she might want to seek assistance or relief in that regard: reducing or eliminating the stress might head off her cutting.
But you are also involved, as your letter indicates. Apart from being confused, how do you feel about your lover's activities? How do you feel about the fact that she hasn't told you about her SIV till now? It is fully as important for you to take care of yourself as it is for you to help your lover take care of herself.
Incidentally, if you want to chase down some additional information about SIV, one rather academic book that's available on the subject is Bodies Under Siege: Self-Mutilation in Culture and Psychiatry, by Armando Favazza (Baltimore: Johns Hopkins University Press, 1987; second edition, 1996). There's also a self-published survivors' SIV newsletter that's worth a look, which is The Cutting Edge, edited and published by Ruth Mazelis (P. O. Box 208119, Cleveland, OH 44120).
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