What the Cutters Feel

By Tamala M. Edwards/Chicago

Cathy Collins' first memories are of knowing that she was adopted. The hardships of childhood--the difficulty of communicating with her parents, the cruelty of other children--all fed her belief that she was unwanted, her sense of being alien and unreal. She began abusing drugs and alcohol as an adolescent, but by freshman year discovered a better release. Using a knife or a razor, she would methodically slice open her arms. "A main part of it was to know I was real," she says. "With the blood flowing down my arms, I was real."

For the past decade, Collins, 31, a Belvidere, Ill., health-care worker, has been hospitalized at least once a year for the self-injury that scars her arms, legs and stomach. Her boyfriend of eight years left her, saying her self-mutilation made him miserable; most of her friends have dropped her. A few months ago, she cut herself so badly that she was soaked in blood at the end of a five-minute ambulance ride. "But I didn't want to die," she explains. "What people didn't understand was this was my way of staying alive."

For many of these years, Collins continued to feel like a little girl alone, the only person with her problem in a Ken Kesey world of psych wards. Now the problem of "cutters" like Collins has come out into the open; some are calling it the "anorexia of the '90s." An estimated 2 million Americans purposely cut or burn themselves, break bones or otherwise mutilate themselves. That figure may even be low, say many experts, judging from the growing number of reports from hospitals, schools and therapists. Karen Conterio and Wendy Lader started S.A.F.E. (Self-Abuse Finally Ends) Alternatives, the nation's only in-patient center for self-injurers, in Chicago in 1985. "We used to be able to check the calls on our hotline number once a week. Now a staff member has to do it every day," says Lader. "We're getting 700 calls a month."

The disorder made its first major public appearance three years ago, when Princess Diana confessed that the strain of her marriage had caused her to throw herself down the staircase and cut herself with razors, pen knives and lemon slicers. "You have so much pain inside yourself," she said in an interview with the BBC, "you try and hurt yourself on the outside because you need help." Says Steven Levenkron, a pioneer in the study of anorexia and author of two books on self-injury: "It feels like an epidemic, but it's an epidemic of disclosure. And I credit Diana with that." One sign that the malady is fully emerging into the daylight: it has been the "disease of the week" topic on recent episodes of the teen-oriented TV series 7th Heaven and Beverly Hills 90210. And now come two major books: Bodily Harm (Hyperion) by Conterio and Lader, based on their successful treatment program, and A Bright Red Scream (Viking), in which journalist Marilee Strong provides a compelling tour of the trauma and science of self-injury.

Both books chronicle how disturbingly misunderstood the malady has been. Sufferers have traditionally been met with disgust by doctors, who find their self-injuring offensive. Therapists are often unwelcoming too, mistakenly labeling such people suicidal or dismissing them as "borderline," a catchall category for manipulative, difficult patients with intractable disorders. In reality, the authors say, cutters are people frozen in trauma. More than half of self-injurers are victims of sexual abuse, and most report emotionally abusive or neglected childhoods, the strains of which send them into an emotional grave. "To me, it wasn't the self-injury that was shocking but the things that brought them to this point in their lives," says Strong. Typically, at some point in adolescence, they happen to injure themselves. Not only does it not hurt but the blood seems to voice their pain and also take it away--a "bright red scream," as one self-injurer told Strong, of all they can't communicate. "It's like the old movies where someone was hysterical, someone slapped them and they sighed thank you," explains Levenkron. "We all understand the physical can mediate the emotional."

Contrary to the stereotype, self-injurers are not all middle-class, teenage-to-twentysomething white women, an image reinforced because the behavior is often linked to another affliction common to that group, eating disorders. Self-injury is prevalent in all races; minorities are simply less likely to get psychiatric treatment and thus be counted. More surprising, an estimated 40% of self-injurers are men. They are often overlooked because they tend to dismiss their injuries as the product of macho outbursts.

In their book, Conterio and Lader challenge the orthodoxies of conventional treatment. Typically, patients are placed in restraints, given high doses of sedatives and kept away from sharp objects. Instead, Conterio and Lader opt for tough love. They refuse to view or discuss scars with patients who enter their five-week program. They push injurers to take responsibility and control in counseling sessions, using an aggressive "Why would you do that?" approach worthy of Dr. Laura. It's a method they say has decreased serious recidivism 75%. "We help them earn back their self-respect," says Conterio. "There's a difference between caring for someone and taking care of them."

But Bodily Harm is not meant for the layman. Instead, it's more a workbook for the initiated, complete with checklists and common Q&A advice for injurers, their family and therapists. Strong's effort, by contrast, is a richly reported and achingly well-written account that benefits from a reporter's storytelling skills. As she profiles a range of injurers--from Andrew, a star chemistry student at a British university, to Fran, a wealthy suburban New York matron--Strong deftly crafts not a freak parade but a sad march of the familiar.

She weaves her anecdotes together with science--for example, a Harvard study finding that severe trauma may alter both the chemistry and structure of the brain and other body systems meant to handle stress. And she chronicles the problems that researchers have, even today, in getting institutions to take the problem seriously. Two scientists at the National Institute of Mental Health, for example, were stymied when they attempted to undertake a groundbreaking study of the connection between childhood sexual abuse and adult disorders such as self-injury. "We don't do that kind of research," the researchers say they were told by NIMH officials, as funding for the project dried up. Strong doesn't advocate a particular therapeutic approach--though, like Levenkron, she prefers coddling to the tougher tactics of Conterio and Lader.

For Collins, those tactics seem to have been successful. On her last day at S.A.F.E., her voice is strong and her dark eyes shimmer with hope. "I don't believe I'm cured," she says. "But I feel like I have a choice not to do this. And I have a choice now to let myself feel."