How Self-Harm Provokes the Brain Into Feeling Better

May 6, 2017

Cutting brings relief because emotion and pain criss-cross in the brain. Can we untangle the circuits and stop self-harm?

Here’s what I remember about the first time I cut myself: I was mad. As a writer, I wish I could come up with something more literary, such as: ‘The cuts provided a route through my skin for the emotions to escape.’ Or maybe: ‘I used it to translate emotional pain into physical pain.’ Or even, perhaps: ‘I engraved my suffering into my skin, turmoil writ large for all the world to see.’

These are, to some extent, true. But that’s not what I was thinking the first time I picked up a pair of scissors and slashed at my thighs. Mostly, I was pissed off.

I had argued with my mom over something so banal it has long since disappeared into the dustbin of memory. And, in a fit of adolescent fury, I stormed into my bedroom and slammed the door. Blind with rage, I picked up a pair of scissors and turned them over in my hand. The next thing I knew, I was staring at tiny pearls of blood on my leg. The fog of anger had lifted.

I quickly patched myself up, rather shamefaced. The scissors were old and the blades were dull, so I had done minimal physical damage. Then or now, I couldn’t explain what had come over me. I vowed never to do it again. Within two weeks, I had broken that vow.

Over the years, I’ve tried to explain self-injury to my therapists, my parents, my friends and, most recently, my husband. Everyone has the same plaintive question: ‘Why?’ Mostly, I just shrug my shoulders and mutter: ‘Dunno.’ I don’t tell them that I am asking the same question of myself. I don’t enjoy the process, nor do I like the scars. It’s shameful and embarrassing. I desperately wanted to stop, but one thing kept getting in my way: after I cut, I felt better.

Although I have written extensively about my mental health history – I have a psychiatric rap sheet that stretches as long as my arm – I rarely mention self-injury. Depression, anxiety, anorexia, even suicide attempts – all of those feel infinitely more explicable than the recurrent pull of the razor. I am not alone in my shame or my struggles. A 2006 study in Pediatrics estimates that nearly one in five college students have deliberately injured themselves at least once. Approximately six per cent of young adults will injure themselves repeatedly. Although death caused directly by self-injury is relatively rare, even occasional self-harm dramatically increases the risk of suicide attempts and completed suicides.

Why so many of us keep hitting the self-destruct button still isn’t clear, but a new era of studies in psychology and neuroscience offer a richer picture of why, for some of us, feeling bad means feeling good.

Blood is a powerful force. We speak of blood ties and land that has been consecrated by blood. We spill blood to cure disease and to appease gods. Long-standing disputes between groups of people become blood feuds. Blood – and the injuries sustained to obtain it – has long been a symbol of both war and religion. Christians drink wine during Holy Communion that represents the blood of Christ, which was spilt to redeem our sins. Mayan priests opened their own veins for a blood sacrifice for their deities.

Self-mutilation is just as ancient. The historian Herodotus writes of the first King Cleomenes of Sparta, who went insane and was placed in the stocks in the fifth century BCE:

As he was lying there, fast bound, he noticed that all his guards had left him except one. He asked this man, who was a serf, to lend him his knife. At first the fellow refused, but Cleomenes, by threats of what he would do to him when he recovered his liberty, so frightened him that he at last consented. As soon as the knife was in his hands, Cleomenes began to mutilate himself, beginning on his shins. He sliced his flesh into strips, working upwards to his thighs, hips, and sides until he reached his belly, which he chopped into mincemeat.

The first clinical reports of what would now be recognised as self-injury appeared in the late 1800s, in Anomalies and Curiosities of Medicine (1896) by the American physicians George Gould and Walter Pyle. They write of ‘needle girls’, young women who repeatedly injured themselves by inserting sewing needles and pins into their skin, or otherwise cutting themselves. They summarise the case of one 30-year-old woman from New York like this:

On September 25th she cut her left wrist and right hand; in three weeks she became again ‘discouraged’ because she was refused opium, and again cut her arms below the elbows, cleanly severing the skin and fascia, and completely hacking the muscles in every direction. Six weeks later, she repeated the latter feat over the seat of the recently healed cicatrices [cut marks]… Five weeks after convalescence, during which her conduct was exemplary, she again cut her arms in the same place. In the following April, for the merest trifle, she again repeated the mutilation, but this time leaving pieces of glass in the wounds. Six months later she inflicted a wound seven inches in length, in which she inserted 30 pieces of glass, seven long splinters, and five shoe-nails. In June 1877, she cut herself for the last time. The following articles were taken from her arms and preserved: 94 pieces of glass, 34 splinters, two tacks, five shoe-nails, one pin, and one needle, besides other things which were lost – making altogether about 150 articles.

Gould and Pyle classified this ritualistic self-harm as a form of hysteria, and the women who engaged in it as deceitful and attention-seeking. In fact, until the early 2000s, most of the clinical literature classified self-injury with more severe psychiatric disorders such as psychosis and borderline personality disorder, a state of inner chaos and instability, especially where relationships are concerned.

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