Fly on the Wall
Patty McCormick
Jane, Jan/Feb 2001
More women than ever self-injure and can't stop. Patty McCormick spends three days in a clinic that works.
A dozen young women sit in a circle, not making eye contact. After several minutes, Candy twists the bill of her baseball cap from back to front and wipes her palms on her jeans. 'I had really strong impulses last night,' she says. Though her delivery is tough, her eyes brim with panic. 'I want...' she aims the words at her lap. 'I want to get rid of my breasts. I hate them. Sometimes I wish I could cut them off.' She peers up, scanning the circle for reactions. 'I am an inanimate object. It doesn't matter if I hurt myself.'
[It is 1989. Candy is sitting in her high school math class when the soundtrack goes dead. People next to her seem distant, the teacher a million miles off. It isn't the first time though, she can't find her way back. Through her haze, she looks down to discover she's scratched her wrist raw with the wire from her spiral notebook. Soon, she's cutting herself every week, then every day.]
'It feels really good. I get turned on by it. I can't stop,' Candy explains, addressing a spot on the carpet in front of her. 'Self-injuring is my best friend.'
Many of the others - a former preschool teacher, a social worker, a veterinary assistant, a recent college grad, an artist - nod with enthusiasm, even reverence.
Karen Conterio, the group leader, leans forward. 'Your best friend?' she snaps. 'boy, I don't know what you guys look for in a best friend.'
Karents bluntness shocks the group. and that's the point. Here at Self Abuse Finally Ends (SAFE) Alternatives, the nation's only inpatient clinic exclusively for self-injurers (most other clinics lump them in with schizophrenics or hard-core psychos), there is no coddling. The program rejects common notions about how self-injurers should be handled - with restraints, sedatives and round-the-clock supervision. Here, in a comfy wing of a berwyn, Ill., hospital, patients have access to scissors, razors, knives and privacy. There's a firm belief that they, and only they, can save themselves. And it seems to be working: According to surveys of SAFE graduates, about 75% are still self-injury free two years after leaving. Wendy Lader, who founded the clinic along with Karen, claims that the success rate for other programs is around 15%.
'We try to keep things as realisitic as possible here,' says Karen. 'We don't want patients to find the child within. We want them to find the adult and move on.'
Which matters, since self-injury is not the teen phenomenon it's often protrayed as. Although self-injurers, who are mostly female, usually start hurting themselves at about age 14, most continue into their 20s and 30s. Many suffer from other disorders rooted in self-loathing, like anorexia, bulimia or substance abuse, and many are rape or incest victims.
It is estimated that up to 3 million americans injure themselves, double 1997s figure. There are a lot of reasons why women self-injure. Some do it to quell panic. Others say it's the only way they can feel. Mental-health professionals say it's a morbid form of self-help; self-injurers often tout the myth that endorphins - natures little opiates - are released when the body is hurt. But Karen has no patience for this. She wants the group to focus on the real-life consequnces.
'Does a best friend hurt you?' she continues. The room grows stuffy. The women push up their sleeves and shift in their seats. Scars - faint, raw, old, deep, artful, awful - are visible on arms, wrists, legs and ankles.
'So, tell me' says Karen, sounding more like a prosecutor and a therapist, 'What exactly has this friend done for you?'
Finally, Joanna, a 21 years old who looks like she belongs on a soccer field instead of in psych ward, speaks up. 'I got kicked out of school,' she says.
'I can't live at home anymore,' says Kait, the only teenager in the group. 'My parents are afraid of me.'
Marie whispers, 'I lost my job.'
[Marie, a social worker, gets chewed out by her boss and goes into a downward spiral of shame and panic. She digs her fingernails into her scalp until she bleeds. It is incredibly calming. Soon she is looking for other ways to get relief. She starts peeling the skin off the bottom of her feet - but usually one foot at a time, so she can still balance her weight on the other and keep her injury hidden.]
This disorder is hard to shake and stumps many. Some er workers have said to mistake severe cutting for suicide attempts. 'The average patient has been hospitalized 21 times before coming here,' Wendy says.
[Rachel is at the beach with her parents. They say nothing of the jagged scar that runs from her wrist to her elcow. instead they complain about her nose ring.]
At the other hospitals, grisly tales about self-mutilation are the staples of group therapy. But Karen and Wendy believe graphic talk glorifies and incites self-injury and don't allow it. Still, in private, the patients love to trade war stories.
'The last place made me wear mitts for a month,' says Joanna. From her backpack Joanna pulls out mesh thumb-less mittens with tight canvas wrist-straps and stiff plastic splints that make it impossible to grasp anything. 'They have to feed you and dress you, they have to wipe your butt.' Joanna turns the mitts over; on the underside she's drawn a hand giving the finger.
'I'm 33 years old, and they made me sit in a corner like a toddler' says Rebecca indignantly. 'I still managed to self-injure, though. I had to shower behind a clear plastic curtain - the nurse was right there, and I was using the soap dish to cut myself.'
The patients pooh-pooh some of the 'enlightened cures' of other institutions. 'One therapist told me to chop vegetables any time I felt like cutting,' says Rachel. 'Sure as if holding a sharp knife is just the thing to do when you feel like slicing your skin.'
'A shrink told me to draw on my arm with a red magic marker,' says Kait. 'He said it would be just as good as watching my blood flow.' She snorts. 'Yeah right.'
The conversation withers. Several of the women grab photocopied sheets called impulse control logs and begin scribbling. The logs are a unique aspect of the safe approach. Instead of acting on the impulse to self-injure, patients grab a pen. They must explain the feeling they were experiencing. They must use specific descriptions such as depressed, agistated, bored or frustrated. This can be difficult if you're used to short-circuting those feelings with physical pain. Then they have to figure out what they would be trying to communicate by self-injuring (I'm scared, I want attention). Finally, they record what they chose to do instead. Those actions come from a list of self-calming activities each girl has developed - writing, listening to music, exercising, calling a friend, taking a bath. The activities are uncomplicated and easy to do.
'We think that self-injury isn't a disease, it's a choice. We give them other choices,' says Karen.
After several minutes of intense writing, conversation begins around the day-room table again. People admit that the recent conversation made them want to self-injure.
[One day, Jessica arrives at the preschool where she works with blood soaking through her shirt. She has just put a deep gash into her forearm. The children run up to her, asking what happened. Jessica tells them that she got a flat tire. They are immediately skeptical - even a child can tell she couldn't have gotten a cut like that changing a flat tire.]
'I feel sad about worrying the children at my preschool' says Jessica.
'I am still furious that my parents didn't notice,' says Rachel. she holds up a poem that she's just scribbled down. 'I used to see my emotions coming out in my blood,' she says. 'Now i can let them out with words.' Despite the sadness in Jessicas voice or the anger in Rachels poetry, there is a feeling of relief in the group - or at least a sense that the worst has passed.
On friday morning, Joanna takes part in her last group-therapy session. She's worrying that she'll start cutting again when she goes home.
'What used to trigger you?' Asks Paulette, the group leader.
'Boredom,' says Joanna. 'I spend a lot of time alone.'
'Okay,' says Paulette. 'If it was boring before, it's going to be boring again. What are you going to do?'
Joanna reaches for her list of safe alternatives. At the top of a well-worn page is her favorite: 'Play with my dog.' she pulls out a picture of him. 'Two more days,' she says. 'I'll see him in two more days.' Joanna is well aware that she'll also have to confront the problems she left behind. She grabs an impulse control log. 'I'm scared about going home,' she says, and quickly fills the page.
Candy's going home soon, too. She smiles shyly to applause when she announces that she hasn't self-injured in the standard stay of 30 days. She decribes how she once got a sense of power from repulsing people with her scars, but now she is tired of pushing people away.
Still, she says she can't imagine giving up cutting for good even though she's licked substance abuse. 'I love how it feels,' Candy says. 'It's better than any drug.' She averts her eyes. 'I want more scars. Mine aren't big enough.' Later, though, she says, 'I want to stop. I really do.'
Wendy is unfazed by Candy's confusion. 'Some will do it again. But they tell us it's not the same. Once they analyze what they're feeling it doesn't give the same relief anymore.'
Friday night the women are sitting around the day room. A nurse says she's rented 'Erin Brockovich' for them. 'Nighttime is the hardest,' says Kait. 'There are no distractions. You just have to lie there with your feelings.'
Kait starts cleaning up, tossing soda cans in the trash, putting cd's in their cases, busying herself with the soothing constructive task. 'I used to walk into a room and scope it out to see what I could turn into a weapon,' she says. 'I learned to open radiators, break mirrors.' She looks around. 'now I just see a room.'
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