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Section 26
Self-Mutilation as Self-Initiation

Question 26 | Test | Table of Contents


Apprentices who wish to become medicine men in the Yamana culture of Tierra del Fuego undergo a rigorous training process of stripping away their egos and previous thought patterns. Part of this process is a systematic excoriation of their skin. The apprentices rub their cheeks with wood shavings over a period of several weeks, gradually wearing away the top layers of skin until the exposed skin is painful to touch. As the outer layers are tediously removed, deeper layers of skin, endurance, and consciousness emerge. The apprentice has transformed his body and penetrated to inner regions of his soul by symbolically abolishing the barrier between his inner self and the cosmos as he diminished the skin barrier between external and internal body realms. Shamanic lore contains many examples of paranormal powers demonstrated by withstanding pain and physical injuries that miraculously heal without scars. These events acutely confirm the shaman's power to mediate between spiritual and earthly existence as he controls his response to pain and the mutilation of his body. The skin as the fundamental binding of people's physical being is one of the most basic mediums with which humanity interacts with the environment as they absorb information and are perceived by others. Mary Douglas's theory of the potency of body barriers as symbols of boundedness and protection also illuminates the significance of breaking the skin barrier. Although mutilating the body by penetrating the skin is in no way itself an act of mysticism or spirituality, the motivations and repercussions of the act reveal a great deal about the yearning to recreate the ego and transcend the conditions of existence.

Shamans benefit from their acts of self-mutilation because they live within cultures that valorize their acts. What do private acts of self-mutilation, unsanctioned and even condemned by Western society, accomplish? A teenage boy carves the word hell into his forearm and holds a burning cigarette to his skin. A woman in her early twenties locks herself in the bathroom after a fight with her boyfriend and makes incisions on her stomach and legs with a razor. A patient in a psychiatric hospital severely slashes her genitals. A young man who is bored and lonely shaves his head and tries to pierce his nipple with a needle. Acts of self-mutilation exist along a continuum ranging from those we label as signs of mental illness to behaviors we consider acceptable and even fashionable. The act of self-mutilation brings together the elements of body narcissism, ritualization, and pain in an attempt to resolve an identity crisis. Self-mutilation may take many forms and be motivated by many emotions and circumstances, but ultimately it is an attempt to carve a passage from one state of being to another by cutting, burning, or excoriating the skin. In one form, self-mutilation is an attempt to reintegrate the self from a fragmented state of depersonalization akin to the function of bulimic purging. On another level, it is an attempt to garner attention from, and reintegrate into, a social milieu from which the individual feels alienated.

Chapter 2 discussed sadomasochistic acts as interactions in which ritualized control and body sensation confirm self-perception and identity, and feelings of emotional connection to a partner, and sometimes invoke a spiritual experience. Similarly, self-mutilators, like anorectics and bulimics, are struggling with self-esteem and identity and are attempting to establish a feeling of connectedness. Although some psychologists see this process as an attempt to establish a previously nonexistent ego, Heinz Kohut sees the process as reestablishing a secure ego. He describes the process as an attempt to "bring about the lost merger (and thus repair the self)."55 The pain of the body forces awareness of the wholeness of the physical self by sharpening awareness of body boundaries and limits. Discussing a self-mutilator, John Kafka explains that "problems of limits, the limits of her body, the limits of her power, and the limits of her capacity to feel-were of major importance in the analysis of [the] patient whose foremost symptom consisted of cutting herself and interfering with would healing."

The assessment of self-mutilation as an attempt to establish limits and overcome alienation from self and environment is supported by its correlation with eating disorders. It is also supported by the fact that skin-carving and other self-mutilatory acts are highly correlated with a history of incest and are described as part of a post-incest syndrome in which an incest survivor copes with traumatized emotional and physical boundaries. A person who self-mutilates as part of post-incest syndrome may be demonstrating rejection of the past invasion of his or her body, and simultaneously making a painful declaration of the ability to control his or her own body boundaries. As is the case with eating disorders, most of the individuals who self-mutilate are adolescent girls or young women. In a very simple way, self-mutilation, like self-starvation, is a plea to be witnessed and confirmed by others as proof of self-worth and autonomy. In the absence of the ability to perform structured, established healing rituals, the traumatized individual uses his or her body as primary material to self-heal. The individual symbolically and physically struggles to transform inner conflict into visible and feelable gestures. The act of self-mutilation often draws blood, symbolic of life and energy. As the blood crosses the broken skin barrier, the act of self-mutilation communicates pain and alienation. Self-mutilation is a powerful attempt to overcome distress, release inner tension, and enter a different state of consciousness. Individuals who self-mutilated as teenagers or young adults sometimes subsequently engage in sadomasochistic activity to achieve similar results.

As acts of reflexive sadomasochism, self-starvation, bulimic purging, and self-mutilation are not true rituals, but are often ritualized. The anorectic will spend hours lingering over a single egg she has allotted herself or cutting a piece of meat into a specific number of pieces before allowing herself to consume it. Bulimics will expend enormous energy planning binges and food abuse rituals and techniques. Acts of self-harm are also often ritualized. The self-mutilator will prepare and cherish select items to perform her deeds and sometimes follow exact procedures for cutting herself and caring for the wound. Because this ritualization is not communally supported, these acts are void of sanctioned spiritual foundation, and are diagnosed as deviant.

However, this does not deny that these self-mutilatory actions may be an attempt to achieve a feeling of connection akin to that provided by a cultural initiation rite. The ritualization of these actions points out the urgency of the need for structure and connection to something, even if it is to a razor or glass of tomato juice. Similar to the way in which the anorectic implodes her identity into her body and regulation of food intake, the cutter depends on her body and mutilating instruments as trusted self-objects that will bring her relief. Self-mutilators often describe their instruments of self-harm as objects of comfort and security. The ritualization itself is motivated by a need to order chaotic feelings and feel reintegrated into a structured psychological and social system. The pain of cutting oneself replaces the pain of disorder and fragmentation, and provides momentary self-definition, as will be discussed more fully below. The self-mutilator invests the cutting instrument, the act of cutting, and the pain of cutting with the potency to bring her into being, similar to the power participants grant ritual and body sensation in sadomasochistic interactions.

An attempt to ritualize behavior and codify identity on the body by self-mutilation is a poignant attempt to externalize internal distress. During the talking cure of a therapy session, the client expresses feelings verbally. The client "gets it all out." In an act of self-mutilation gesture replaces language. What cannot be said in words becomes the language of blood and pain. Although the gestures are often performed clandestinely, they are potent expressions all the same. David Napier calls ritual a "primordial link to others," and the reconciliation of food abuse and self-mutilation as secretive acts and yet as attempted communication rests on their potential to be witnessed. Rarely do the end results of these furtive acts remain permanently hidden from the view of others. The anorectic exhibits her emotional struggle and protest with her physical appearance, which is public for all to observe. Some anorectics enjoy displaying their thinness, as if the public attention their performance as hunger artists accrues nurtures them as food cannot." Habitual purging, and scars and lacerations from self-mutilation cannot be hidden indefinitely from others. Although some self-mutilators proudly flaunt their wounds, others carefully hide them. This attests to the potency of the message they inscribe upon the body. For many self-mutilators revealing the origin of their scars is an act of vulnerability and a risky attempt to establish connection and trust with the confidant.

The shame of self-inflicted wounds expresses a dark side of the social context in which they occur. Kaplan examines the complexity of ritualistic behavior and of labeling a behavior "perverse."

"[I]f we remember that every human being is susceptible to the longings, anxieties, and mortifications that motivate the perverse strategy, the possibility that our everyday submissions to tweezer, facial scrubs, and the like are normalized variants of perversion should not offend us but alert us to something important about shared human plight…[A] perversion, when it is successful, also preserves the social order, its institutions, the structures of family life, the mind itself from despair and fragmentation. For as horrifying as self-mutilation might be, the perverse strategy that empowers the behavior is aiming to prevent worse mayhem -homicide, black depression, utter madness."

 If we return to the Western preference for wholeness of the body, what Bakhtin calls the classical body, which is self-contained and separated from profane connections with decay, death, birth, or procreation, we understand the extent of the self-mutilator's transgression. Her "perverse strategy" is an act of making her body "grotesque" in Bakhtin's term. Her body is no longer smooth, and unmarred, but is a body in the act of transforming. Her blood shed connects her to the primal forces of life and death, as well as to her ancestors and other humans. As she spills her blood she is no longer separate from the external world but physically and emotionally spills out into it. By violating the Western value of the classic body, the self-mutilator is staving off the more extreme transgression of isolation, an emotional state of disassociation, and perhaps redirecting verbal or physical violence which she consciously or unconsciously would like to direct toward someone besides herself. In other cultural contexts this might be considered a heroic act, or an act of passage to adulthood in which one reconfigures oneself and one's actions as an adult. As a private act of anguish, devoid of sanctioned cultural meaning, it is diagnosed as pathological. If an individual feels unable to help remake his or her world as part of a community, he or she remakes the self.

Referring to "symbols that formally dissolve oppositions- joints, the pineal body, the skin, autoimmunity," Napier asserts that these physical elements "become the focus of a culture's social and mental balance, a battleground on which its toughest intellectual, moral, medical, and ethical issues are either compounded or solved." The proliferation of literature and diagnoses of eating disorders in the past three decades, and the recent public awareness of self-mutilation proves Napier right. In 1985 the Phil Donahue Show aired a show on the topic of self-mutilation. The show received thousands of letters in response Since 1985 self-help groups and hospital programs have formed to combat the phenomenon of self-harm. Public attention and fascination with body alteration, including masochistic and perilous acts, indicate a desire to analyze not just the neighbor's daughter who has dwindled to 82 pounds but American cultural identity as etched on the body. In spite of the proliferation of ways to self-define-perhaps because of the plurality of ways and lack of a cohesive communal structure for many individuals, the body has gained new importance as the ground upon which to stake one's identity. Faced with a multitude of choices and the exigency to declare oneself an autonomous outstanding individual, staking out the body as the primary territory for identity makes sense. As family and social milieus become precarious, individuals seek physical sensations of pain and pleasure to self-define and awaken an awareness, of themselves as bounded individuals. The body remains a constant, controllable element with which to attempt communication and mastery of the self.
- Hewitt, Kim, Mutilating the Body: Identity in Blood and Ink, Bowling Green State University Popular Press: Bowling Green, 1997.

Self Harm in the United States: What we can Learn from National and
State-Level Medical Datasets

- Classen, Cindy, Self Harm in the United States: What we can Learn from National and
State-Level Medical Datasets, National Center for Health Statistics 2012 Data Conferece, 2012.

Personal Reflection Exercise #12
The preceding section contained information about self-mutilation as self-initiation. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
A Rare and Complex Case of Non-suicidal Self-Mutilation
in a Patient With Schizophrenia

- Khanna, A., & Agustines, D. (2023). A Rare and Complex Case of Non-suicidal Self-Mutilation in a Patient With Schizophrenia. Cureus, 15(1), e33269. https://doi.org/10.7759/cureus.33269

Peer-Reviewed Journal Article References:
Frei, J. M., Sazhin, V., Fick, M., & Yap, K. (2021). Emotion-oriented coping style predicts self-harm in response to acute psychiatric hospitalization. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 42(3), 232–238.

Smith, D. M., Wang, S. B., Carter, M. L., Fox, K. R., & Hooley, J. M. (2020). Longitudinal predictors of self-injurious thoughts and behaviors in sexual and gender minority adolescents. Journal of Abnormal Psychology, 129(1), 114–121.

Snir, A., Apter, A., Barzilay, S., Feldman, D., Rafaeli, E., Carli, V., Wasserman, C., Hadlaczky, G., Hoven, C. W., Sarchiapone, M., & Wasserman, D. (2018). Explicit motives, antecedents, and consequences of direct self-injurious behaviors: A longitudinal study in a community sample of adolescents. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(4), 255–266.

Turner, B. J., Helps, C. E., & Ames, M. E. (2021). Stop self-injuring, then what? Psychosocial risk associated with initiation and cessation of nonsuicidal self-injury from adolescence to early adulthood. Journal of Abnormal Psychology.

QUESTION 26
How do self-mutilators describe their instruments of self-harm? To select and enter your answer go to Test.

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