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Secret Scars
Awareness -- and concern
-- rising over girls who cut themselves to relieve emotional
pain
by Molly Tanenbaum
Amanda's best friend in seventh grade was the one who
first told her about cutting.
Amanda, who asked not to be identified with her real
name, had a turbulent home life and didn't know how to
deal with her strong, negative emotions.
"I had told my best friend, and she told me she
cut, so that's what I started doing. She cut herself
because of the things that happened to her," Amanda
said.
She started by using a safety pin to make scratches
on her upper arm. She eventually switched to razor blades
and began cutting lower down on her arm and on her thigh.
"I had a boyfriend for 10 months, and we had broken
up, and it was really out of control. I started cutting
more and more," said Amanda, now a freshman at a
high school in Mountain View.
"It just made me feel better, the pain, I guess.
It kind of helped me take my mind off stuff," she
recalled.
Like Amanda, many who cut themselves, or "self-injure," use
the physical pain to cope with emotional suffering, said
Dr. Hans Steiner, a child and adolescent psychiatrist
and professor at Stanford University.
"They usually have tremendously strong emotions
that they're trying to control. It has a paradoxically
settling effect," he said.
Gunn High School psychologist George Green said he's
seen more self-injurers this school year than in previous
years.
It could mean that increasing numbers of students are
cutting themselves, he said, or that people are talking
about it more.
"Maybe it comes out in the open a little more with
adolescents communicating so much by text and MySpace," he
said.
Steiner has also observed self-injury become more common
among adolescents in the last few years. He said it often
appears in youth with other psychiatric diagnoses, such
as anorexia and bulimia, depression, bipolar disorder
and post-traumatic stress disorder. It is frequently
linked with sexual abuse in a person's past.
Self-injury statistics are difficult to come by partly
because there are few studies on the subject and because
self-injurers can be secretive about the behavior, Steiner
said.
"It's a private, shameful event so that makes it
tricky," he explained.
A 2006 study from Cornell University recognized this
lack of wide-scale studies on self-injury in American
youth, citing that studies from the last 15 years have
estimated anywhere from 4 to 38 percent of youth have
self-injured.
Palo Alto High School psychologist Wes Cedros said those
who cut themselves make up "a small percentage of
the students and it's almost entirely girls, very few
boys."
"But that doesn't mean it's not a concern for the
community," he said.
Though some boys also self-injure, Cedros said, they
tend to engage in risk-taking behavior -- like punching,
driving fast or drinking to excess "with the purpose
of not feeling, not caring what happens."
Despite its appearance, self-injury is not the same
as attempted suicide.
"Most people get confused," Steiner said. "They
see cuts, and they think kids are trying to kill themselves.
That's usually not what's going on. It's usually about
controlling emotions or expressing real, real self-loathing."
However, adolescents who cut themselves can go too far
and accidentally put their lives in danger.
The once-taboo and hidden topic of cutting has become
something many adolescents know about, whether they try
it or not.
"You always hear about it, like, 'Don't cut. Don't
cut,'" said Gunn junior Aurelle Amram, who thinks
educational, safety messages about self-injury can have
the reverse effect on some girls.
"They know about it, and they know it helps certain
people, so they try it," she said.
What used to be a private behavior is now finding increased
social outlets. Groups of young girls who try cutting
together are becoming more prevalent, Steiner said.
"When I was in training, this didn't exist as a
group phenomenon," he said.
One Gunn freshman said she recalled a couple of her
friends in middle school tried cutting when they were
together.
"I think they were curious," she said casually,
as if talking about experiencing a new type of music
or food. They didn't try it again, she added.
Graphic portrayals of cutting both online and in film
have contributed to an increased awareness about cutting.
Movies such as "Thirteen" and "Secretary" depict
young women driven to self-injury. Popular social networking
Web sites such as MySpace and Xanga provide a forum for
being open about self-mutilation.
Amanda wrote a poem about cutting on her MySpace page
-- which eventually tipped off her seventh grade teacher
to the problem.
Some maintain that self-injury Web sites, which range
from supportive forums to disturbing, graphic images,
can encourage harmful behavior.
Steiner said they provide "huge validation from
your peers about this thing being normal and good" and
some go farther than that and "glorify" self-injury.
"That didn't exist 20 years ago," he said.
Through that validation on the Web, self-injury has
even come to be associated with a certain, alternative
image, teens say.
"It's become part of pop culture," said Gunn
sophomore Maya Itah, who said it's easy to find "wrist-cutting
art" on the Internet where self-injurers are "showing
it off to people."
Her friend Danielle Edelman, also a Gunn sophomore,
said teens have come to think of cutting as "under
the general umbrella of 'emo' things to do."
The girls agreed that equating self-injury with image
was counterproductive to helping those who are actually
suffering.
"It makes the issue more trivial," Itah said.
Researchers, including ones at Cornell University and
Stanford University, are just beginning to study the
impact of self-injury Web sites, using work with pro-eating
disorder Web sites as a starting point.
"We don't know the long-term effects of these Web
sites," said Dr. Rebecka Peebles, an adolescent
medicine instructor and researcher at Lucile Packard
Children's Hospital.
"People report learning a lot of behaviors on these
sites. That's a big concern with young, vulnerable kids
going online," she said.
But the school psychologists at both Gunn and Palo Alto
High Schools say there are benefits too.
"One the one hand," Green said, "they
learn more often about cutting and some of them may imitate
it. And on the other hand, it's more apt to be disclosed
to adults."
Amanda no longer cuts or scratches herself, but it took
going through two counselors, several months of therapy
and getting worse before getting better.
Eventually, because a teacher had seen Amanda's revealing
MySpace page, and because the cuts on her arms were not
easy to hide during physical education class, the principal
at her school called Amanda's mother, Sharon (whose name
has also been changed).
"I lay awake all night trying to figure out what
in the world I could do to make this better," she
said. "That's the problem with being a mom: You
want to fix everything, but sometimes you can't."
She sought out a counselor for her distressed daughter.
This counselor proved ineffective.
Becoming more desperate, Sharon eventually found Dr.
Tonja Krautter who practices in Los Gatos and specializes
in self-injury.
Krautter said she gets 10 referrals a week from all
over the Bay Area. Responding to the lack of research
and resources for mental health professionals on self-injury,
Krautter also travels to schools and counseling centers
to provide trainings.
"People don't know how to intervene with this issue.
No one knows how to support them," she said.
Two weeks ago, she trained a group of 20 counselors
at the nonprofit Community Health Awareness Council in
Mountain View. She has also come to nonprofit Adolescent
Counseling Services in Palo Alto, which provides on-campus
counseling at Palo Alto schools, and to Stanford.
With self-injury, the faster a person gets help, the
better, Krautter said.
"People get addicted to the release of endorphins,
so faster intervention means preventing the addictive
process," she explained.
Therapy for self-injurers is generally two-fold: giving
teens alternative, safe behaviors to deal with their
emotions instead of injuring themselves, and addressing
underlying personal issues that cause the teen to cut.
"She made me realize I could do all these things
instead of hurting all my friends," Amanda said. "I
would just try to go to sleep and listen to loud music.
I actually got a punching bag."
When she thinks back on seventh and eighth grade when
she was cutting herself, Amanda reflects on how cutting
led her to a descent toward more extreme injury and feelings
of depression even though it gave her immediate gratification
at the time.
"You start doing it more and deeper because eventually
what you're doing doesn't work. It doesn't affect you
as much. When you do it, you feel even more depressed,
just looking at your arms. You think things are so bad,
and you're in the dark not seeing the things that are
out there that are really good," she said.
Now, she feels like a different, healthier person.
"I'm really good," Amanda said, with clear
relief. "After you stop, you feel so much happier
and have so much more energy and everything. I'm so much
better than I was back then."
School psychologists in Palo Alto advise students to
tell an adult if they think their friend is self-injuring.
"The way it's going to be brought to light most
often is by friends of the student," he added.
One Gunn sophomore said she and her friends know that
one girl in their group self-injures.
"You can see fresh cuts every day. Any emotional
pain she goes through, she cuts herself to relieve it," she
said.
She added that her group used to worry about the girl
and question her behavior, but they stopped after a while.
"Nobody asks her about it anymore. I don't think
she realizes that she has a problem. She never talks
about it," she said.
They haven't told anybody because they don't want to
make her angry.
But telling a parent or an adult at school will be better
for the friend's health and safety in the long-run, psychologists
say.
"They really need to understand they're not betraying
that person by telling a responsible adult," Green
said.
Steiner advises parents to initiate open dialogue with
their children, not just about self-injury but also about
other hard subjects that face kids and teens today.
"The main tip is that you should always talk to
your child about difficult topics, so when this rolls
around, it's not difficult to do," he said.
"Your job is to essentially stay open to all these
things. And you're always going to have one essential
response: You're going to bring help to the situation.
Not rage, fury, threat of destruction."
Philippe Rey, executive director of Adolescent Counseling
Services, advises parents to educate themselves about
the types of Web sites and other messages out there related
to self-injury.
"Listen to their music, read their magazines, watch
their TV shows with them and ask questions. There's so
much on the Internet about adolescents' life and experiences," he
said.
Sharon said she often volunteers to drive Amanda and
her friends places so she can learn what the teenage
girls are talking about.
"It's really important to listen," she said. "They're
going to talk, and you can hear."
It may be difficult to know if a child is self-injuring
because it can be kept hidden for a long time, Green
said, but a sudden drop in grades could be a good reason
for a parent to check in with the school about a child's
overall wellbeing.
"It might have nothing to do with an issue like
this, but it would at least be an excuse to have the
school take a look," Green said.
Rey said Adolescent Counseling Services has held self-harm
support groups in the past and provided parent education,
but "not to the extent that we would like to do."
A tense discussion last month on the Palo Alto Weekly's
online community forum, TownSquare, between concerned
parents, teens and school counseling services signaled
to Rey that more needs to be done in Palo Alto about
self-injury.
"It sounds like this community needs to be educated,
so we're looking into putting in some parent education
groups or lectures about this topic," Rey said.
He said these might happen sometime in spring of this
year.
Staff Writer Molly Tanenbaum can be e-mailed at mtanenbaum@paweekly.com.
Printed with permission by the Palo Alto Weekly
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