Tuesday, July 28, 2015

Adolescent Cutting

No one seems to know why it is happening, but more and more American adolescents are engaging in self-injury, especially cutting themselves. True enough, boys do self-injure, but cutting is largely a girl’s activity.


Adolescent psychologists say there has been a sharp rise in recent years in the number of teens found to be engaging in self injury, mostly cutting, which usually involves using a sharp object such as a razor blade to inflict small cuts on the arms or elsewhere. The teens, both girls and boys, come from a variety of socioeconomic backgrounds and include good students and struggling ones. 

And also:

Cutting has become “the unfortunate coping strategy of our youth in the 21st century,” says Dr. Miller, of Albert Einstein College. In the past, teens often blew off steam in less self-destructive ways, such as talking with friends and family or unwinding in front of the TV, he says.

Based on recent research, she calculated updated figures for The Wall Street Journal and found that 9% of U.S. adolescents reported self-injuring in the previous year, and nearly 20% said they had tried it at some point in the past.

Children who do it often speak openly about it to their friends. After all, “cutting” has been destigmatized, and when you destigmatize bad behavior you tend to get more bad behavior:

Social media posts that feature cutting sometimes draw curious adolescents who want to try it, in what psychologists call a social-contagion effect. More teens also appear to be admitting to the behavior, or telling adults about friends who do it, because cutting has lost some of the social stigma it once had.

As for treatment, schools have been adopting Marsha Linehan’s dialectical-behavioral therapy, discussed (and even promoted) on this blog. See this link.

For now, I note this comment in the Journal article:

“One of the key mechanisms of action [in DBT] seems to be to give them replacement behaviors,” says Alec Miller, clinical professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine in New York and one of the authors of the DBT study, published in the Journal of the American Academy of Child & Adolescent Psychiatry.

I have often quoted Aristotle’s idea that the best way to overcome bad habits is to replace them with good habits, or, as Dr. Miller calls them: “replacement behaviors.” Seeing this concept at work in therapy is good news indeed.

As for why so many young people are finding it so difficult to deal with the stress of high school we can only speculate. I would note a point that the article, modestly, does not mention. The children who are caught up in this activity are pubescent. Since puberty is a monumentally important biological and social event, we should ask ourselves whether these children are having an easy or a difficult time adjusting to it. There’s more to the cutting problem than social media.

One has read that large numbers of adolescents participate in activities like sexting.  Those who do not are still obliged to live in a culture where sexuality is exposed and exhibited, sometimes through pictures, sometimes through words.

Children undergoing puberty need private time and private space to process and adapt to the changes their bodies are undergoing. Instead, they find that their sexuality, regardless of whether they have even sexted or discussed it, is constantly being discussed and exposed.

Privacy seems impossible. Even children who have not made the mistake of sexting feel exposed. They live in a world where sex is a ubiquitous presence. They cannot deal with it without help because they are simply too young to deal with it.

One should not imagine that children who sext images of their genitalia are going to emerge from the experience unharmed. And one should not imagine that a culture that purveys images and talk about sexuality all the time and that makes such material readily available to adolescents is not going to pay a price.

6 comments:

Larry Sheldon said...

When I was young (1945-1955 plus or minus) in the Los Angeles area, slitting wrists was pretty common as an attention-getter--messy but, word was, rarely successful suicide "attempts".

Ares Olympus said...

re: Children who do it often speak openly about it to their friends. After all, “cutting” has been destigmatized, and when you destigmatize bad behavior you tend to get more bad behavior.

I'm not convinced this is all out in the open. The article says 1/4 believed no one knew, and also one case "Ms. Brown says the worst part about cutting was disappointing the people who loved her, which is why she sought help from a therapist."
Fact: Most people who do it say cutting, while painful, makes them feel relief temporarily. Young people often do it secretly: In one study, nearly a quarter of adolescents who reported self-injuring said they were sure nobody knew or suspected. Some say the physical pain distracts them from emotional pain, or that it makes them feel more alive.

In regards to treatment:
“One of the key mechanisms of action [in DBT] seems to be to give them replacement behaviors,” says Alec Miller .... DBT also teaches skills to help reduce the intensity of emotions or to distract from the urge to do self-harm. Holding ice cubes, for example, is often recommended.

What surprises me is the article only talks about self-abuse, while you might imagine bullying behavior as an outward expression. Its a lot easier to understand why and how someone can direct aggression towards another, but harder to see how it is directed towards self. And as a warped measure of maturity, a child might feel they are dealing with their emotional pain in a way that doesn't hurt anyone else, at least for those who keep it secret.

I imagine behavior like anorexia or maybe very much related, giving a sense of control and power over pain. And that can be more over-exercising as much as under-eating. I wondered if DBT recommended exercise, since I've know a number of girls who have "abused" exercise for stress and so it would be a dangerous substitute as well.

I admit I'm skeptical that there are "substitutes" to cutting whatever its "causes", at least not without looking at the full range of behaviors that offer something similer, to "feel more alive" etc. I imagine the irrational is overriding the rational mind, and so whatever substitutes can be found all contain varied degrees of risk.

Oh, and strangely I wonder about things like Tatoos and piercings, both rather painful experiences, while each actually leaving a permanent mark as symbol of a change, like a loss of innocence of any sort.

I'd never choose to get a tatoo myself, but if I had a child who was cutting, I'd like to be open to the possibility that they are trying to get a hold of some intractible pain, and perhaps if society had actual "pain rituals" of some sort, like that arise from tatoos, perhaps something like that might "ground" this dark urge into symbolic form.

At least that's the closest I can imagine, but on the other side, I'm sure I'd be concerned about a child's later regret. And there can be no answer except caution and saying no, but if a child already is doing self-harm, it might be worth considering?

In the rational world of civilization, none of it makes sense. But we do so many things that don't make sense, so the only "good" way through, so I've been told, is to ritualize them into something a little better.

Like E.F. Schumacher said “The art of living is always to make a good thing out of a bad thing.”

Anonymous said...

In my thirties I met a younger man on men's retreat who admitted to cutting in his past. He told me this involved making small cuts on his skin (in places that others would not easily detect) until he could see his own blood. Biographically this young man described an early childhood in which he received little or no affection from either of his parents. His mother was depressed and bedridden. His father was largely preoccupied with work and seemed to me to be hostile toward his son manifesting as emotional neglect rather than overt abuse.

priss rules said...

Kids cut themselves, adults lobotomize themselves.

http://www.city-journal.org/2015/25_3_snd-bias.html

Sam L. said...

"Children undergoing puberty need private time and private space to process and adapt to the changes their bodies are undergoing. Instead, they find that their sexuality, regardless of whether they have even sexted or discussed it, is constantly being discussed and exposed." Overwhelmed by sex in society and media, overwhelmed by sex-ed at school, they have little private time. Question: Has anyone studied the home-schooled for cutting? I have the feeling that they may not have this symptom, or not much of it.

Anonymous said...

If I had to point to a general cause of cutting, tatooing and other bodily insults, I would give a nod to the book "Spent". Can't remember the author's name, but he is a marketing psychologist. The book came out about 4 or 6 years ago. Very interesting.

Anyway, the take I got was that cutting (Or the like) is a non-verbal way of offering insult to the body and demonstrating the capacity to heal from the insult. What does that proveeip? Well, for young people with serious self esteem issues, it is a direct way of "advertising" that their bodies are capable of suffering insult and then ----- HEALING! That is a powerful message to the unconscious of others that they are indeed worthy of reproduction and are valuable persons.

In the end, we all want to feel safe and secure. We want to seek approval of otheres in spite of everything because it seems like the only means of survival. To be approved means that we will be helped when injured or sick or in trouble. This is as primal as it gets. Everything we do externally usually is to obtain or retain approval.