Katiewas a seventeen-year-old studen whose family moved from Mexico when she was five.Her father was an engineer who made a good income working for a chemical company.They loved in an affluent community in which her father was very sensitive to the anti-hispanic feeling.Most Hispanic men there were day laborers,gardeners,and caretakers;he always dressed well,to avoic being confused with them.Katie's mother was depressed.When she took her children(Katie's three older brothers and two older sisters) to school,the other mothers initially assumed she was their nanny.If they spoke to her,it was to patronize her.She had to continually explain that she was a resident of the community,not a imported maid.
Katiewas born seven years after the last of the five childen-an accidental pregnancy.She was given over to the care of the maid the family had brought with them from Mexico when they immigrated to the United States.Katie was a cheery,outgoing child,spontaneous and noisy.Her father was often embarrassed by her behavior in public places,especially in resaurants. He would demand that she quiet down, then hit her in public.
He continuously told her that she was a disgrace to the family.As time went on, her brothers and sisters began to treat her with the same contempt.Only the maid remained on her side;the rest of the family called Katiedisloyal.They said she made the family look bad in public and chided her for preferring the maid over them.As a resultKatie felt emotionally exiled from her family. She hated herself, believing her accusers.
In herfreshman year of high school,she cut her left wrist.She was hospitalized at a nearby psychiatric hospital for attempting suicide.While in the hospital,she developed a pattern of head-banging in fits of anger.She would also smack the backs of her arms against the corners where two walls met--untill she was given powerful tranquilizers.Katie was on tranquilizers when she was discharged from the hospital;she stayed on them for a year.
After that year,her therapist thought it was time to taper off her medication.But within two months she began to cut herself,mostly on the wrists.She was hospitalized repeatedly for a week at a time for these so-called suicide attempts.
WhenKatie entered her sophmore year,she developed a pattern of excelling academically for the first three-quarters of each semester,then withdrawing to her room and not attending her final exams.She had been expelled from two schools when she came into treatment with me.
She was likable,dressed in bright colors,and quick to explain to me that deep down she understoof she was smart and a good person.She spent her first several months of therapy describing her past.When she was upset by something she had said,she would immediatly change the subject.If i asked her to return to the subject,she would tell me that it was too overwhelming for her,but that she would come back to it at a later time.
Durring one session,Katie reached into her pocketbook and took out a small object.She had been spaking about one of the occasions when her father had hit her and humilated her in a restuarant.Her mood became subdued and trnacelike.
Thats when she took out the pair of childrens scissors,looking like a toy,with its bright green plastic handles.As she absentmindedly placed the open scissors on her forearm,i relized she intended to cut herself.I pulled her hand away and wrestled the scissors from her,flinging them on the desk behind me at the other end of the office.Katie grabbed my arms.She was fighting me,through still in a trance state,repeating, "I need my scissors,"When she finally relized that i did not have her scissors in my hands,she scanned the room and spotted them on my desk.She spent the next hour trying to get past me to the desk.It was clear that getting to cut herself was her only was of stopping the pain and anguish she was feeling.No amount of talking on my part helped.Exhausted by her effort,she finally fell asleep in her chair.
Katieattempted to do what most cutter avoid;she tried to cut herself infront of someone else.This was an ability she had developed durring her stays at psychiatric hospitals where there is no privacy. There were other ways in which she was diffrent from most cutters.She made very broad scars,longer than normal,and placed her cuts as high as the shoulders and chest.She detested these scars and asked a plastic surgeon to remove them.He refused after the apperance of new scars,telling her he would only deal with them once she had been cured of damaging her skin.
Katiehated the results of her self mutilating behavios,but she was inevitably drawn to it for the relief it brought.She would talk about her cutting episodes,but when i asked to see the scars,she was suddenly shy.She selected the largest and told me how disgusting she thought it looked.I asked to see the most recent.She rolled up her sleeves past the elbow,and showed me the gauze pas held on with adhesive tape.She removed the tape with a sudden jerk as most people do,to minimize the pain,grimacing at the pull of the material.
I commented, "You dont like all pain then?"
She shot me a critical look. "Its never about liking pain.If I liked pain,then it wouldnt help.I hate it. Thats why it helps."
"What does it feel like then?
"I feel terrible.I have to make my feelings go away.I use very bitter medicine to make them go away.If im lucky,I got away,too.When i do it,theres only the place on my skin that im looking at.Theres nothing-no thought.I start to cut.It hurts.I cut a little deeper.It hurts alot.I move the blade.It hurts much more.I start to bleed.The blood means ive hurt enough to chase away all other pain.Its over.I can take a nap after i finish looking at it and cover it with a bandage."
Katie's solution,or "bitter medicine" for her pain was indicative of her despair about the possibility that other people could be a source of support or saftey for her.As the family scapegoat,she had learned to hate herself.She didnt feel entitled to succeed in school or to seek comfort from others when she was sad or upset.Like other disorders that result from failed trust relationships and attachemnts-eating disoders,obsessive compulsive disorders,alcoholism,drug dependance-a behavior or a substance is used as a coping mechanism for the pain of the original wound.Self mutilation is just the most bizarre and paradoxical example,in which pain and self damage are used to bring about relief,safety,and security.
The self mutilator is very sensitve to her emotional pain,but even more then that,she is despairing of the trustworthiness of others.She prefers to be the one in charge of the pain she experiences and the feeling of numbness it leaves with her.