Healing Self-Injury

This topic comes from my thinking about recent posts on a list serv that I am on (yes, I am learning a bit about technology).  The people on the list are mental health and other professionals as well as trauma survivors, many of whom work in a professional capacity in some way.  The list is designed for people to share resources on trauma and trauma-informed care.

As often happens when the topic of self-harm comes up, the conversation became intense rather quickly.  At first I twinged when a doctor that I respect, who has done groundbreaking work addressing the impact of childhood traumas, used the word “cutter” to describe people living with SIV.  We weren’t people who sometimes cut, we were simply being described as “cutters.”  Rarely has that served anyone.  Yet this type of labeling happens often, whether in the mental health system, public conversations and articles and even amongst people who themselves self-injure.

The conversation got most intense for me when the posts about the term “self-inflicted violence” (SIV) got going.  People, mostly consumers (!), got really pissed at the term.  The term I began using over 20 years ago.  Some of these are people I know and respect, yet I felt myself whirling about accusations that people who live with SIV are not violent, that what we do to ourselves is not about violence but about coping and self-soothing and many of the other things that we already know….  It was as if the reason behind the action should mean the action itself is not violent.

I argued that the term SIV does not imply motive, it is only descriptive.  Of course violence is uncomfortable.  Of course sometimes I used SIV to prevent being violent towards another person.  SIV helped me survive so much profound pain and distress and disconnection… and it is still violent behavior.  My SIV was violence as an act of self-defense.  I prefer nonviolence.  For a long time I found a deep need for violence in the form of SIV.  I am relieved that I was not violent towards another person.  Besides myself.  I was violent with myself.  Physically, emotionally, mentally, spiritually.  Like many abuse survivors, I am not alone with that.  Now I am no longer physically violent and that is a relief.  I am working daily on the other ways I am still cruel to myself.  Life has never been better.

We all have the right to do with our lives as we will, for the most part.  We do not have the right to harm others (except in self-defense).  Some of the ways we bring harm are not illegal, nor necessarily violent.  I can call you an asshole, tell you that you are worthless.  That may or may not impact you.  It will likely hurt you if you are my child.  What if I say the same words to myself?  How many of us are actually comfortable with the way we “speak” to ourselves?

But I digress.  What really got me in my gut were the words a colleague that I consider a friend wrote.  In her post she wrote that if a psychiatrist used that term (SIV) with her, she’d have to slap him upside the head.  I sat back and said “wow.”  Being so upset at the use of the term to want to be violent upon the person who used it.  Of course this is a response to the great harm still done in the mainstream mental health industry as people are labeled and categorized and disempowered or blatantly hurt in many ways.  Many of the cruelest acts in the name of psychiatry happen to people who live with SIV.
But to threaten violence?  It was a great comment, as it took thinking about all of this to a whole new level.  I hope.

If I slapped you “upside the head” would that be an act of violence?   Would it matter why?
If I slapped myself upside the head would that be an act of violence?  Would it matter why?
What is the meaning of a knife in the hands of an assailant?  Of a surgeon?  Of an abuse survivor needing to cope?

These are questions that need many conversations.
The term “self-inflicted violence” is a strong and painful one.  So is what it describes.  And the most pain and turmoil come from what drives the need for the SIV to begin with.  This is all hard.  Judgment is not helpful, not from within or from others.  The word “violence” is descriptive, not judgmental, but many react to the word as if it implies immediate, profoundly negative, judgment.

It has taken great self-compassion to kindly accept the violences I have done to myself.  After all, they were acts of self-preservation at the time.  I am relieved that I was not violent towards others, and there were times SIV gave me the out to avoid that.  When options are limited and distress is severe, life is narrow and survival is a priority.  Without compassion and understanding, from self and others, it is even more difficult to risk change and expansion.  I hope that language, while we struggle with it, does not become a barrier to that process.

I wonder if the intensity of the conversation on the list serv has anything to do with the distance many survivors of violence keep between themselves and those who perpetrate violence.  Those of us who have needed self-directed violence to cope with our woundedness often bring great discomfort to others.  I wonder if being “associated” with the violent other, the “bad guy” is what is so triggering.  If that is so, then how will people heal from violence of any form?  How separate do we need to keep ourselves from each other?   I don’t write that lightly, I think it is an interesting question.

This post was a long time in writing as it brought out many questions in my mind.  It has been a rich, and not easy, time of growth and learning.  If any of you are still reading these posts, I’d be eager to hear your thoughts…

In the meantime I’m just glad that I don’t slap myself upside the head any more!

I was recently told, because I am not much of a web surfer (I only have dial-up access to the internet where I live) that there has been attention given in the mainstream press to “pro-cutting” websites.  You can guess most of the conversations centered on “How can someone promote that!” and “What can we do to stop this, it will make people want to do it” and “What is wrong with people, putting pictures of their cuts on the internet?!”

Sigh.  No, I’m not for promoting SIV.  But I’m not for bashing it either.  Why can’t people understand that it’s simple: if you trash people for something that is helpful to them (not only hurtful), if you withdraw yourself from them because of their SIV…. people will need to find others who understand.  That is why I started The Cutting Edge:  A newsletter for people living with self-inflicted violence in 1990.  1990!  For 18 years the newsletter, and now the web site has been intended to be a place where people can begin to understand SIV (their own and that of others) in a compassionate, nonjudgmental way.  Everyone wants to have a tribe, no? 

I remember when I was still smoking that people would tell me how bad smoking was for me, and that it was a waste of money, and all the other purely logical reasons not to smoke…   My smoking friends would understand better, but we did know that we were hurting ourselves and each other.  One of my dearest friends told me “Please don’t be so hard on yourself… it must help in some way and you will stop when it is time.  Please be good to yourself” And I did.  I think the same is true for living with SIV.
How come it is so hard for people to get the shame, blame and judgment out of this?
What do those of you who know the web think and feel?  Please teach me.  Thanks.

No, not another post about my horses!  This recent lesson came from a dog, not even one of mine.  I’ve been thinking about what I wrote in the last post, about how different our world might be if we were all aware of who amongst us has lived with Self-Inflicted Violence (SIV).  Well, at first I thought it was just a thoughtful question for me.  You see, though I am quite scarred, the scars are mostly faded and I’ve gotten quite used to them.  Sometimes I get a bit awkward when meeting new people, but not often.  When asked about them I choose to either make a joke or reply seriously about why my scars are there.  I’ve come a long long way on this journey of needing, then leaving, SIV.

I got quite an awakening two months ago.  I was on my way to spend four days traveling.  I was very excited as I had been hired to facilitate discussions on the film “between the lines” and do some teaching about SIV.  I think the world of the film and always appreciate having the opportunity to teach.  I’ve been consulting and teaching for many years and no longer feel as tense or uncertain as I used to.  I believe in what I am saying and carry the words of many of you in my heart when I speak.  It’s all good.

It was not going to be as easy as I thought, thanks to a St. Bernard named Padre.  I have three dogs that I kennel when I travel.  My dogs are familiar with this idea of going to “camp,” are tended to by friends, and I often go in and out of the place.  So when I went to drop off the dogs, there were no humans in the kennel.  But there was Padre.  A beautiful rescued St. Bernard whom, unbeknownst to us, had decided that his role in this new kind world was to work as the protector of the kennel.  He didn’t hear me open the door, but was lying inside the first room of the kennel.  When I stepped in he woke up and decided to do his job….
So, the next day I am driving to the airport feeling very vulnerable about the dog bite marks on my face.  They are fresh.  I am lucky that he has a lousy bite, but few could ignore the two rows of teeth marks on my cheek.

It had been a long time since I felt so vulnerable about a wound on my body.  I wondered how the people sitting next to me on the plane would react.  And the people who had hired me to do the work.  And those working in the restaurants and hotel.  And the folks in the audiences…. 

I ended up talking to the audiences about how it felt to be reminded of the vulnerability of living with wounds and scars.  I had the chance to remember my earlier, raw, surviving life and appreciate the journey I have been on.  It was a time of reflection, something I hadn’t bothered to do for a long time.  It meant a lot to me to sit with the memories, think of those who had touched my heart and soul along the way, and feel grateful.

My face is healing.  There might be a scar or two left.  They will join the others, self-inflicted and otherwise. 

Thanks Padre.  Didn’t think I would be saying that!

As I’ve spent a lot of time sitting on airplanes lately, I’ve had many opportunities to sit with my thoughts as well as fellow passengers.  I‘ve been thinking about what Erin wrote in her comment on the last post.  She wrote about the pity she sees on friends’ faces when they notice some of her scars.  And she said how lately she feels like SIV (Self-Inflicted Violence), or the coming out about it, is furthering the gap between herself and other people.  It made me remember how quickly SIV, including scars, can create distance between people.
The wounds and scars of SIV that are made visible to others can either alienate us or bring us closer together.  Learning about the SIV of someone you care about can be confusing, frightening, repelling, or people might feel pity or want to avoid the issue entirely.  For some people SIV is taken as a sign of severe mental illness.  For others, especially the young, SIV is often perceived as “pathetic attention-seeking”.  Perhaps this would change if the public, and the mental health community, had exposure to people who have healed from the need for SIV.  People whose scars are old and faded.
What if those of us who are scarred  ”came out?”   How would it change how we feel about ourselves as well as how others feel about us?  Would it increase understanding amongst most people or not?  Over the 18 years of The Cutting Edge newsletter I had the privilege to listen to many people who lived with SIV.  Most of them kept their SIV secret.  The newsletter traveled to many countries and I learned about SIV in the lives of a great variety of people.  Women, men, girls, boys, poor, rich, people with doctorates, people who struggled to read, people of many races and cultures, all ages, many different abilities and interests……….  What we all had in common was the need for SIV.  We were in pain, struggling, and the connection we created through the newsletter brought us into community with each other.  With such stigma and misunderstanding in the larger world, the newsletter was a place of refuge for many of us.  It was rare to have a space where you could be honest, feel understood, and give compassion to others you felt a common bond with.  It was a rare place where your voice could be heard.  Unfortunately it is still rare for people to have a safe place where they can feel accepted and understood about their self-injury.
I’ve taught many workshops and classes on the topic of SIV over the past dozen years or more.  At first I was surprised how often, when teaching mental health or substance abuse professionals, someone in the class would find me and privately let me know of their struggle with SIV.  They had almost always kept this secret and feared for their careers and professional certifications should the SIV become known.  These are valid fears.  How sad, terribly sad, that those who were charged with helping others feel so threatened.  Where is their safe place to explore and heal?
What if we realized that the therapist, the doctor, the cashier at the store, the firefighter, the veterinarian, the man who picks up garbage, the professor, the teacher, the car mechanic, the cook in the kitchen, the corrections officer, the nurse, the artist, the farmer, the people that intersect with our own lives….  are scarred from SIV?  I’ve known people in all these roles who have lived with SIV.  There are many more.  What if all could be open about this?  How would life change?

When I started The Cutting Edge newsletter in 1990 it was to stay in touch with other people, those I had met when I first began creating spaces for people to talk about living with Self-Inflicted Violence (SIV).  I had instinctively known that finding others who lived with self-injury would bring me hope and understanding, qualities that were rarely given by those who didn’t struggle in the same way.  Eighteen years later we created the web site, then this blog, and I kept writing about the power of relationship to heal.  Many of the posts to this blog have emphasized this, even recent writings about the power of relationships with nonhuman animals.  Yet I recently realized that I haven’t written about one crucial relationship, the one we have with our very “self.”  That is what I want to begin to explore in this post.  I’ll be interested to learn what you think about this…

One of the many joys of working for the Sidran Institute is a commitment that we share to “practice what we teach.”  The basic beliefs of our work come from Risking Connection, the manuals and training that address how trauma impacts people and how to promote healing.  While the information and experiences provided in these trainings and manuals is extensive, we do have a “shortcut” way of getting to the point of what it is all about.  We use the acronym “RICH relationships” to simply remind ourselves of what the ground of healing looks and feels like.  “R” stands for respect, “I” for information, “C” for connection, and “H” for hope.  These principles are the base of healing relationships.  My work has, for several decades, been focused on creating space that promotes connection and hope, provides information to those who live with SIV and those who care about them, based on mutual respect.  So I’ve written often and repeatedly about how to do this in the context of our relationships with one another.

Yet I missed something!  I forgot to apply these principles to the relationship I have with my self.  It has taken me some time to question myself about my attitudes about who I am, what I do/don’t do, what I believe about myself….  While I often think about creating hope for others and for our relationships with each other, I rarely have thought about my own hopes, and where I draw personal hope from.  The same is true for respect.  Do I respect myself?  As much as I do my friends?  How do I know what it is to feel respect for myself?  How do I see my journey with SIV through the lens of respect?  If I was my own best friend would I be treating myself any differently?

Am I connected with myself?  I know when I feel connected to another person, do I know when I feel the same with the person I am?  I often catch myself paying much more attention to the feelings and conversations of others and not notice my own.  Not all that “rich” of a relationship, is that?

So that’s my beginning of this conversation and exploration.  How do you feel about yourself?  Your life with SIV?  Do you respect yourself?  Have hope for yourself?  Feel connected to your “self”?  What do you believe about yourself?  An inquiring mind wants to know….

So I had believed that this part of my life, focused on teaching about trauma, self-injury, and healing, had ended.  No formal good-bye, still taking on work, but letting go in my heart and spirit.  I had thought, after over 20 years of this work, that we had accomplished at least part of the goal of changing awareness about the roots of self-injury and how to create opportunities for healing   So I started moving in a different direction.  My life this past year became quite focused on horses and I have been challenged, inspired, and deeply moved by that journey.  One of my last posts was about Pocket, the horse that a friend and I rescued, who has deeply changed both of our lives this past year.  Now there is another, second, horse in my life.  Harriett arrived in a circuitous way after the death of a friend who used to tend to her.  It’s been a busy time.  Let’s just say that I’ve become quite good with a shovel.

Yet now I am so glad that I didn’t dismantle this blog, nor the web site.  Couldn’t make myself do it and am grateful that it is still here, like a trusted friend.   I get to come back and start writing again.  I offer you fresh eyes, renewed enthusiasm, and a tender heart.

Why?  Two reasons.  First of all, I’ve been made keenly aware that there is still a great deal of misunderstanding and pain about SIV in our society, including the mental health community.  While there are pockets of sanctuary, there are still many people truly suffering from being judged, misunderstood, controlled, pathologized and mistreated.  Many are greatly harmed by this.  There is still much work to be done.  I tend to be an optimist at heart but now sit in the reality that I was overly hopeful about the evolution of understanding about SIV.   I am not ready to walk away yet, I just didn’t know it.

Second, a beloved friend, a young woman I cherish and respect, let me know that she and her family are in turmoil because she is cutting.  Of course I am sad that she needs SIV for now.  I love her and her family.  So we have begun talking and having adventures, planning and scheming.  We have two powerful forces in our lives: SIV and horses.  I have my journey to share about healing from the need for SIV, while she has her healing path to create.  We both find light and excitement, peace and comfort when we are around the horses.  These two passions, one so painful, the other so joyful, have brought us together.

And the journey has led here.  We want to share our journey on this blog, and invite you to return here to expand our small circle of healing.  I have been brought back to the roots of what is most important to me – people I care about, our passions, and the journeys we can share together.  It feels like coming home to a place that is familiar, but new as well.  I am eager to start the conversations.  More soon….

Lately I’ve been hearing from people that they feel alone, misunderstood, and isolated because those around them are so reactive to their self-injury. I think most of us have experienced this at some point, no? Some of us are ashamed of our need for SIV, others proud and protective, some simply accepting of it. Living with SIV challenges many relationships, including that which we have with ourselves. And it often challenges our relationships with others intensely.

Relationships with other people can be difficult when they learn about SIV. I am incredibly fortunate as I have many deep and delightful friendships with people who do not judge my scars. Yet true friendships take time and mutuality to evolve, and not all are wanting to do this when they meet a scarred person. Yet there are all sorts of relationships. On a recent conference call, when I was answering questions about SIV, we shifted into an excited conversation about the powerful healing influence many of us have experienced from relationships with companion animals. This is one of my favorite topics to talk about and it turns out that there were quite a few people like me on the call. We talked about how cats, dogs, birds, horses, and other animals provide us with an opportunity to connect with a living being that does not judge, that responds to us with sincerity, and that we are responsible for tending to. I’ve learned a great deal about who I am, and who I want to become, from life with my dogs and cats and, the past 5 months, my horse. I have learned about power, responsibility, vulnerability, tenderness, trust, living in the moment, taking risks, and having fun (I used to be much too serious). They have all been catalysts of healing for me, in ways that no clinical intervention could begin to touch. I have changed in my depths, and these relationships have challenged me to grow in the relationships I have with my own kind, humans. I wonder if this is true for you as well?

I caught my eyes filling with tears on my way to the barn this morning to tend to the horses. Not tears of sorrow, but of tender overwhelm. The horses have taught me so much, and challenged me to risk and grow in many new ways. They may be huge in size, but they are prey animals, not predators, and so they know fear. And they know trust. And I have learned deeper levels of calm and understanding and attentiveness from them. These are qualities I am learning to apply in other places as well, most importantly with myself and the people around me. For now it is time to walk the dogs, then play with the cats, and spend the evening with dear friends. All of whom celebrate this healing journey with me. None of whom look twice at my scars. I hope this blog is such a place of acceptance too.

Ah, finally liking this computer again.  The past weeks, actually months, have been full of frustration for me as I’ve experienced computer glitches.  Then a crash.  A big one.  Oops.  So, for anyone who has e-mailed me in the past few months and hasn’t heard back, please try again (my home e-mail is rutamaz@eohio.net).  My ISP is a small local company and could not give me access to my old e-mail from a remote computer.  I had to wait and hope this computer could be fixed.

And it has been, so I am excited about being back in touch (in the next few days please look at the web site, as there will be new postings of prose and poetry, really wonderful stuff).   I am not all that comfortable with computers or the internet as a whole.  Some of my problem is that I’m intimidated about learning computer skills.  Most of my problem is that, most often, I’d rather be cooking for friends, walking dogs, hiking in the woods, or even shoveling out my horse’s stall…

Recently a friend challenged me to get more interested in the internet and explore what is out there regarding SIV.  I haven’t begun to do this whole-heartedly yet (my challenge is that I have dial-up access, which is very slow), but I’m interested in learning about what is out there.  I’ve previously explored clinical sites that discussed “self-mutilation” and didn’t find much different than what I had seen in books or articles.  But what my friend told me about was the existence of “pro-cutting” web sites.  Have you found these?  What are your experiences and thoughts about this?

I’m wondering if the misunderstanding and intense efforts to control those who feel the need to self-injure has brought about a protective reaction is some folks who live with SIV.  I neither argue for nor against SIV, to me it “just is.”  Therefore, SIV can be understood and we can create opportunities for people to heal from needing SIV, if they want to.  I’ve certainly read a whole lot about how “horrid” and “pathological” SIV is and have written many times about how many coercive psychiatric practices, as well as bigotry and misinformation in the general public, have caused great harm.

But the idea of promoting SIV is a new concept to me and I am interested in what people are thinking and believing.  Is this a celebration of SIV?  Is this a way of finding comfort with people who understand?  Where can I learn more?  Anyone out there want to let me know what they think?  I’d appreciate hearing from you!

Since the last post was an expose of some of the worst that is written about people who live with SIV, I thought I’d balance it by writing to you about my most beloved resources.  I’ve made the mistake of presuming that everyone is aware that these exist, but it’s been a long time since I’ve mentioned them.
There are two publications that I always recommend to people who ask me for resources.   The first one is a book, Self-Injury: Psychotherapy with People Who Engage in Self-Inflicted Violence, written by Robin Connors (copyright 2000 by Jason Aronson).  I know, it sounds like a boring clinical text.  It is meant for clinicians, but it is not boring and I think anyone and everyone should read it.  Robin Connors approaches the topic of SIV in the kindest and wisest way of any clinician I have ever met or read.  She explores the reasons people turn to SIV, how it serves them, and how to create connections that promote healing.  Not only does she not promote coercion, she advocates against it.  She explores the power of emotions, the impact of trauma, and the centrality of relationship in the healing process.  Not only is the content rich and filled with understanding and hope, but her writing style is warm and inviting.  For example, one of her subtitles is: “Presence as the Heart of Intervention.”  This book is primarily an example of the healing potential that can occur in relationships between people who live with SIV and clinicians who are willing to treat us with dignity, understanding, mutuality and support.  It is a thick book, over 400 pages long, and written for clinicians, yet I think it can serve everyone.  People living with SIV will feel understood and validated.  People looking for helpful therapy can find an example of how it can look here.  Clinicians can find remarkable guidance and wisdom.  Family members and friends of those who self-injure can gain understanding and awareness for themselves in the chapters that address the challenges therapists face when working with folks who self-injure.  I wish this book was available in every library and that it was required reading for anyone in a helping profession.  It recently came out in paperback, so I hope it is less expensive than it used to be (though I must admit I’d never regret spending a good chunk of money to get it).

For those not interested in such a thick text, and especially for folks looking for solutions for their own SIV, I recommend another publication, Understanding Self-Injury: a workbook for adults.  Co-authored by Kristy Trautmann and Robin Connors, the second edition was published in 2004 by Pittsburgh Action Against Rape (PAAR, 81 South 19th St., Pittsburgh, PA 15203).  This 63 page workbook is the most useful “self-help” resource I’ve found.  It helps people living with SIV explore the reasons for their SIV and discover alternatives to self-injury in a very respectful and encouraging way.  The authors acknowledge that SIV does not simply go away, and focus more on self-understanding rather than “making SIV stop.”  They help people feel understood and validated wherever they may be.  I think this manual is a wonderful resource for people of any age and would be helpful for anyone interested in the topic as well.

So, here are two resources I find very hopeful and encouraging.  Are any of you familiar with them?  What do you think?  Other resources we should be talking about?

I recently read an e-mail from a beloved colleague that I must share with you. Recently I’ve been saying that I sense a shift in understanding about SIV, that perhaps people who live with self-injury will no longer be so demonized. Well, I’ve learned that I am, once again, a bit too optimistic. The article she sent me to read verified this.

This article, which came out in the Times on line (United Kingdom) on Dec. 16th, 2009 contained the quote in the heading of this post. This quote was deep in the belly of the article which was focused on women as perpetrators. At best this article intended to point out that women, and not only men, can be predators of children. The author suggested that this is apparently a new concept to many, including those in the criminal justice and mental health professions. So I thought this might be a useful piece.

I was wrong. Instead of looking at the impact of childhood trauma through the lenses of victims as well as predators, considering boys and girls as well as men and women, the author vilified women. And, most upsettingly to me, she vilified women who self-injure. So now women living with SIV (women labeled anorexic were inc luded in the description of self-harm as well) can be presumed to be predators, and also have their SIV interpreted for them, as “sexualized acts of aggression”.
What a damaging and cruel thing to say, especially as the person saying this is a therapist. Here we go again. People living with SIV have long lived under the curse of being labeled “borderline” and I didn’t think there was a worse label than that. But perhaps this tops it. What do you think?

How to survive and create healing environments when so many consider people living with SIV as deviant and potentially dangerous? How to challenge this brutal stigma? How do we find compassion for ourselves and each other?
We can keep finding each other, and supportive people in our lives (whether they have lived with SIV or not) and we can learn that we are survivors, that we are strong, and that we are capable of enormous courage and kindness. We can be living examples that we are not what someone else has judged us to be. We can continue to connect through our words, our art, and our presence here and on the web site and in our homes and communities… until the change that we can imagine will come true.