For Some Troubled Youths, Pain Offers Escape

In the battle against their own bodies, everything is a weapon. Razor blades, pushpins, lighters, staples, paper clips.

With each cut, burn or scrape, a flood of relief washes over them. Relief from agonizing memories. Relief from years of sexual and physical abuse. Relief from inexpressible emotions.

But for teenagers who injure themselves, the relief doesn’t last. The depression always returns. And when it overwhelms them, they cut themselves again.

Until the wounds go so deep that the child inside gets scared. Or until somebody sees the maze of scars. If they are lucky, that is when the teens begin to learn how to live without cutting themselves.

Because the youths often hide their wounds, local experts aren’t sure how widespread the problem is.

But Ventura County doctors and therapists have treated dozens of self-injuring youths in the last year at local hospitals and residential treatment centers. And they say the number is increasing all the time.

The typical “cutter,” they say, is a young woman who begins at age 14 and continues until she is in her 20s. She is likely a victim of physical, emotional or sexual abuse, often by an alcoholic or drug-addicted parent. She may struggle with an eating disorder or a drug addiction. And she probably suffers from depression or obsessive behavior.

She cuts herself because she feels worthless. She thinks she deserves to be punished. She wants to show the world how much pain she feels. And she doesn’t know how to communicate her emotions otherwise.

Toni, an articulate 16-year-old, was one of four teenagers from the Casa Pacifica treatment center who described their horrifying journeys through abusive childhoods and tortured adolescence.

She started injuring herself four years ago because “so many things were going wrong” and she wanted “to let people know how much they hurt me.”

She said that as a toddler, her parents sexually and physically abused her. She had so much rage and pain and suffering inside, she said, that she cut herself. And it was a relief--temporarily.

“It’s kind of a high--like a drug,” she said. “And when you start doing it, it becomes a habit.”

At first, she scratched herself with her teeth and fingernails. Then she turned to sharp objects, and “the next thing you know, I was really digging in.”

That is when she started to keep her cutting a secret.

There is no chemical cure for self-injury, doctors say, but with the right combination of therapy and medication, teens can heal and can stop the cutting.

With help, they can learn to write down or talk out their feelings and turn to friends and family for support. And in time, their self-esteem can improve.

“The hope is to let people know they can get better,” said Dr. M. David Lewis, medical director of Anacapa Hospital’s family and adolescent program. “[With] therapy, the behavior does go away. If they continue in the therapy and the medications, the behavior does not recur.”

Emerging From the Shadows of Taboo

Self-mutilation isn’t new. People have been scarring themselves in rage and humiliation for decades, experts say. One Chicago program has specialized in such treatment since 1985.

But only in recent years has it attracted the attention of medical professionals who want to know why an estimated 2 million Americans are now burning or cutting themselves on purpose. And doctors are treating the self-destructive behavior, which for so long was misunderstood and misidentified.

If self-mutilation was once shocking and unspeakable, it is becoming less taboo. A few celebrities, including Roseanne and Johnny Depp, have admitted that they wrestled with the problem. Music groups, television shows and movies have touched on self-mutilation. And half a dozen books, including three published last year, have been written on the subject.

In one, “Bodily Harm,” self-injury is defined as the “deliberate mutilation of the body or a body part, not with the intent to commit suicide but as a way of managing emotions that seem too painful for words to express.”

“Kids who cut on themselves experience an intense and severe inner rage,” Lewis said. “There is a rage inside that is going on, and they cut on themselves because they get relief from it.”

Their behavior ranges from superficial fingernail scrapes to gashes with knives. “Cutters” usually target their arms, thighs and wrists, because those areas can be easily hidden. They burn themselves with cigarettes or lighters. They use their skin like a canvas, cutting words and images onto their bodies.

Some doctors fear that self-injury may spread among friends.

“It’s kind of like a behavioral epidemic,” said Dr. Richard Deamer, a Ventura-based psychiatrist. “Kids will share this sort of thing. You have one kid in school doing it, and soon you have three or four more doing it.”

Andre, 16, another Casa Pacific resident who asked that his real name not be used, carved “kill me” on his arms.

The wide-eyed, outgoing Toni scraped “slut” on her stomach. Another time, she cut a drawing of a boy on her forearm, then stabbed the picture repeatedly with a piece of glass as if it were a voodoo doll.

Mary, 17, still so withdrawn she stares at the floor and seems to hide in her own skin, started cutting herself at age 13, after being physically, emotionally and sexually abused for most of her life.

Several times a day, she hid to slash or scrape herself. With time, she had to cut deeper and harder, because her skin was layered with old scars and had lost most of its feeling. Every time she carved into herself, she said, she felt “less stressed.”

Now, after years of intensive therapy, she remains fragile. Fragments of metal are still buried in her arms, hidden by an intricate pattern of old gouges and scars. And sometimes she can’t fight off the urge to hurt herself again. Just two weeks ago, she scraped her chest with a razor blade.

“I think somebody else is going to hurt me,” she said, “so I hurt myself first.”

But she cuts herself less often now. And when she does, it’s less severe.

Common stresses, such as a new school, a boyfriend’s rejection or parents divorcing, may provoke teens to cut themselves.

But the behavior is rooted in childhood trauma or abuse, experts say.

An Expression of Anger, Depression

“They have a rage and anger and nowhere to put it,” said Pat Pope, a clinician at Casa Pacifica, “so they turn it in on themselves.”

They cut themselves to cope with emotional pain, much in the same way people turn to drugs or alcohol, she said. Their physical pain deadens their emotional pain. But doctors say that self-injurers don’t feel pain like others do. They disengage from the act of cutting, almost like they are watching it from afar.

Abused adolescents also cut and burn themselves out of self-hatred. They see themselves as “bad” and “worthless,” and cut themselves as a form of punishment.

When Mary had a good time, laughed, smiled or simply enjoyed being a teenager, her urge to cut herself intensified.

“I didn’t deserve to do fun stuff,” she said. “I had to punish myself.”

For many, self-mutilation is a cry for help. And sometimes it is a way to punish their parents.

Andre, who is muscular and nervous, said he cuts himself “so people can see how bad I’m suffering.”

For almost six years, he said, he was sexually abused by his baby-sitter, who lived with him and his mom. When he turned 13, he started cutting himself. “My family didn’t love me,” he said. “I wanted them to see how depressed I was.”

After his mother found out, she locked up sharp objects. And she stayed up all night. “My whole family was afraid of me and afraid I was going to do it again,” he said. “My mother always slept with one eye open.”

The adoptive mother of one of the Casa Pacifica teenagers said that sometimes trauma runs both ways. “It was very frightening at first,” the mother said. “I didn’t understand it. I mean, how many of us can?”

While some teenagers do try to kill themselves, doctors say self-mutilation differs from attempting suicide.

“It provides temporary relief from anxiety and depression,” psychiatrist Deamer said. “They don’t want to die. They just don’t want the emotional pain.”

Teens say that before cutting themselves they feel sorrow, guilt and frustration. While doing it, they feel happy, peaceful and satisfied. And afterward, they are depressed and feel like they have to do it all over again.

Doctors say the behavior may be addictive because endorphins are released in the brain when people cut themselves. Those chemicals dull pain and produce a “high,” which often lasts a few hours.

Doctors worry not only about the emotional impact of self-injury, but also about the physical effects. Fresh surface cuts on open wounds and burns can cause infection and scarring, and deeper incisions can lead to nerve damage.

Learning Other Ways to Handle Stress

At Vista Del Mar Hospital in Ventura, therapists help the adolescents develop healthy ways to deal with daily stress and take responsibility for their actions. They encourage the youths to keep a journal of how they feel. They also teach them how to turn to friends and counselors for support.

“We want them to learn coping skills so they can deal with difficult problems,” said Dr. Blake Darrington, a program director in Vista Del Mar’s adolescent unit.

At Casa Pacifica, therapists occasionally place severe self-injurers on safety watch, where somebody stays with them around the clock until the threat abates. In some cases, nurses will examine the youths several times a week, checking for abrasions and scrapes.

Casa Pacifica’s Pope encourages self-injuring teens to take it one day at a time. “Success isn’t about stopping [immediately],” she said. “It’s about decreasing the severity and increasing the time between episodes.”

Youths who want to cut themselves will, she said. While one teen was in a mental hospital, he sliced his face with a plastic fork.

Andre said he used to hide razor blades, pencil sharpeners and pushpins in his mouth so he could cut himself whenever he wanted.

For some teens, stopping the behavior cold is too difficult to imagine.

“I want to do my cutting, but then I don’t,” Mary said. “I saw how bad it affected people around me. But I can barely go a week without doing something. If I don’t, it builds up too much.”