As Jessica recalls the scene in the car, her mother began to cry and said she would do anything to help her. As soon as they got home, Linda got on the phone and started setting up appointments. “It was exactly what I needed,” Jessica says. “She gave me the support I needed to begin my recovery.”
Recovery was a long process, however. Jessica entered both individual and group therapy and took medication for what was diagnosed as clinical depression and bipolar disorder. “But then she would feel better and take herself off the medication,” Linda says.
Israel, who is a psychiatrist, says teens as well as parents can be resistant to the idea of medication if depression or a mood disorder is diagnosed. “I often hear kids say, ‘I don’t want to have my mind controlled by medicine—I like my edge,’ ” he says. “So what I say to that—especially for kids around here, where there’s a lot of interest in science—is that just as electrons have different energy levels and orbits, [medicine] increases the time that kids are in their best state. That stability frees them to develop their own inner resources.”
A 2004 study published by Cornell University in Ithaca, N.Y., found self-injurious behavior most often begins in early adolescence. Cecilia, a soft-spoken 14-year-old from Rockville, says she began cutting herself in eighth grade, after her emotionally troubled younger sister attempted suicide and was hospitalized.
“It gave me something else to think about,” she says. In contrast to her more dramatic sibling, Cecilia describes herself as a low-key person who “doesn’t like a lot of people crowded around me or looking at me.”
She recalls seeing an episode about cutting on the teen soap opera Degrassi, but was not really thinking about the TV show on the September day when she began idly scratching her arm with a safety pin. After a while, she stopped and began to cry—not because of the pain or fear that she would seriously injure herself, but because she worried about adding to her family’s troubles.
“I just wanted to keep out of my parents’ hair so they didn’t have to worry about me,” she says with a sigh. “First they had one bad kid, and now they had two.”
Cecilia didn’t cut herself again until January, after her sister was released from the hospital and life at home became stressful again. Finally, she confided in a therapist who had come to their home to work with her sister. The therapist recommended that Cecilia be hospitalized, and it was there, she says, that her cutting worsened. Although inpatients were not allowed to have sharp objects, she quickly learned how to fashion one from a broken plastic utensil. Cecilia’s hospital roommate told on her, and she was watched even more closely.
The next few months, for Cecilia, were a blur of repeated hospitalizations and outpatient treatment. She missed most of the second half of eighth grade. But despite her almost desperate efforts to find or fashion sharp objects (her parents by this time had locked away knives, scissors, even thumbtacks), she says her cutting was never an attempt to kill herself. On the contrary, “it made me feel better.”
Goodman says cutting is often an attempt to get through the moment, rather than a suicidal gesture. However, because self-injuring teens are emotionally fragile, she says, “it is crucial to ask whether a recent episode of self-injury was a suicide attempt.”
Although some teens appear defiant or even exhibitionistic about cutting—writing about it on Facebook, for example—all the young people interviewed mentioned feeling shame. “You become very secretive and fake with everyone you love,” says Christine, the Kensington girl, “which just adds to the guilt and the feelings of why you need to cut.”
Warning signs, according to Goodman, include wearing bracelets, watches or wristbands that are never taken off; wearing long sleeves even in summer; or making excuses for not putting on a bathing suit or going to the beach. When cuts are visible, a teen may dismiss them as cat scratches, even if the cuts are suspiciously straight and parallel.
Often, self-injurers seem to be simultaneously hiding and crying out for help. Max, 22, an athletic and genial former football player from Silver Spring, says he never fit the “emo” stereotype. But in the winter of his freshman year in college, he cut his face with a paring knife after a longtime friend rejected his romantic overtures. Although the cuts soon healed, he couldn’t get the girl out of his head, and a few months later he made deeper wounds in the same spot. “I just wanted it to be visible, so that everyone would know I was hurting,” he says. “But I ended up lying and saying I got hurt playing football.”
After spotting the girl at a party with another guy, he got drunk and slashed his wrists, this time hiding the scars with an athletic sleeve. “The rush [of cutting] only lasts a few seconds, so you have to keep doing it,” he says. “Not only was I hiding the problem of not being able to get over the girl, but I was hiding another of self-mutilation.”
One day, when his friend dropped by to borrow something, he felt he couldn’t stand the secrecy any longer. He pulled off the sleeve and showed her his wounds. “She was pretty shocked,” Max says. “She knew that I liked her, but not that I was gashing myself over it.” He says they’re still friends, although they never talk about that day.
Max decided to seek psychological help, realizing he probably had needed it for years. “Starting in middle school,” he says, “I tried for the longest time to tell my mom and dad I was depressed, but they just wouldn’t buy it.”
Experts who work with teens agree that adolescent self-injury is highly treatable when parents, teachers and mental health professionals work together. Walt Whitman High School counselor Jenny Higgins says that while Montgomery County does not require parents to allow schools to be in contact with a student’s therapist, “those who do allow it get the best wraparound support for their child.”
“It’s important for parents not to feel defensive or like a failure,” Israel says, “but to feel that [cutting] is a danger sign that needs to be looked at with understanding and the intention of solving it to make it better.”
Goodman has provided symposia and seminars to mental health professionals, teachers, parents and teens on the subject of self-injury. She says the revelation that a teen is cutting should be met with concern and as much calm as a parent can muster, and professional help should be sought as soon as possible. Recovery, she says, doesn’t happen quickly; it is a process that can take months or years. “Life is not a race, and a successful recovery is rarely a straight line,” she says. “Just as a teen learns how to cut, each self-injurer needs time and strategies to learn how to stop.”
Alternative coping strategies can include everything from art and journal-writing to snapping a rubber band or holding ice cubes instead of cutting. Recovery is accomplished, Goodman says, when teens can identify and express their feelings in words.
And for recalcitrant teens who stonewall an individual therapist, a weekly group therapy meeting can melt their resolve not to talk. “They come into a group of peers,” Goodman says, “and you can’t get them to stop talking.”