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DVD - Interventions for Cutters Substituting Self Control for Self Mutilation
Cutters continuing education psychology CEUs

Section 18
Welcome Numbness vs. Pain & Arousal

CEU Question 18 | CEU Test | Table of Contents | Self-Mutilation
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs 

Self-harmful behavior functions to regulate and relieve intense feelings. Many women who drink, do drugs, binge, or cut themselves describe how their self-injuring activities help them cope with unbearable feelings. Some choices of behavior may seem more obviously suited than others to function as relief mechanisms. Alcohol and drug abuse, for example, would seem to provide relief from painful feelings more directly than an activity such as cutting, which for most of us causes rather than relieves pain. But for the woman whose symptom of choice is self-mutilation, cutting creates a powerful release from her psychic suffering. This kind of relief may feel like welcome numbness, whereas for non-TRS (Trauma Reenactment Syndrome) people, this form of self-harm would stimulate quite the opposite feeling, that is, excruciating pain.

Self-harmful behavior also regulates feelings in the opposite direction. Trauma in many ways creates a higher level of arousal in the victim. When the trauma is chronic, the pattern of persistent arousal can actually change the person’s biochemistry. Many adults who suffer from Post-Traumatic Stress Disorder have developed a craving or need for frequent experiences of excitement. The TRS symptoms, even while they may be serving a numbing function, can also increase sensations of excitement. I will describe this process in more detail later in this section; first, I will look more closely at the various ways in which TRS symptoms function to bring relief.

Unbearable Feelings
Drinking and using drugs are similar to the dissociative techniques used by the trauma victim to shut off the pain, fear, and rage experienced during the abuse. The abused child learns to evoke the numbing and disconnectedness necessary to endure the violations. The adult survivor, wishing to recreate this experience of escape, searches for other avenues to this state of oblivion. In a strangely paradoxical way, chemical abuse provides pleasurable sensations of excitement and at the same time induces numbness and a sense of being outside one’s own mind and body.

Women who drink or abuse drugs are most likely to describe their activity as a form of self-medication, an anesthetic against pain, rage, fear, disgust, intimacy, or any other feeling they wish to escape. June describes her drinking as if it were a lover who soothes and comforts her, distracting her from pain, loneliness, and disappointment.

June’s Stairway To Paradise
“I get myself sober and for a while it’s okay. But I never stop missing the anticipation, imagining I’m going to have a drink in another minute or an hour or whenever it’s going to happen. I’ll be feeling pretty much like I can get through the day sober, you know, but there’s still the feeling of being disappointed, kind of empty. I end up missing the feeling of anticipation almost more than I miss the relief I feel when I start to drink. It’s silly, but it kind of reminds me of when I was a kid and I just started going out with guys. I’d enjoy imagining how great it was going to be even more than I would enjoy being with the guy, even when I was having an okay time, you know?

“Then the other weird thing about it is there’s a point in time when I’m drinking and I’m not really sloshed or anything yet. And at this time I feel like I’m with a best friend or having a great time in bed or kidding around with my family- you know, those times when you just feel so good- but what’s weird is that it’s just me and the booze and we’re just us, just kind of flying or something. It’s hard to explain. I mean, I know that I shouldn’t be drinking, and I can even be telling myself I’m going to end up really sloshed and getting sick and making a jackass of myself, but at the same time I’m just feeling this great feeling. It’s what they mean by a rush, I guess.”

In much the same way, Lee conceptualized her cutting behavior as providing a sense of relief and pleasure. When she was abused as a child, she felt a powerful combination of pain, fear, and pleasure. Because she had no one to talk to about this complex experience, she began to experience herself as “bad” through her feelings of shame, but also as “special” and “powerful” because some aspects of the sexual episodes were positive, especially when she was aroused in pleasurable ways. Lee found it difficult to resolve her emotional and physical responses. It was as if she had betrayed herself by experiencing some “good” feelings. Her body became another enemy. Given the complexity of her response, it is not surprising that her self-abuse cycle, too, contains elements of pleasure, arousal, and a sense of power.

Some TRS women describe their self-harmful behavior as a means of either escaping the sensation of numbness or achieving it. The desire to break out of numbness and the opposite desire to attain it seems to be a goal common to many of the types of self-harm included in the TRS pool. Cutting is perhaps the type of self-injury most commonly associated with the sensation of numbness.

Drinking and drug abuse are often used to escape feelings of pain and despair. A young drug addict described her drug use in this way.
“Sometimes I’m just hurting so bad, thinking about how things are in my life. I’ll be thinking how my girlfriends keep leaving me, how I can’t seem to get my shit together, how I don’t have money for the right clothes or for the CD player I keep on wanting to buy. Then I’ll be thinking next about something someone did to me—you know, a long time ago. I get so sick and disgusted when I think about it that I just get to hurting worse and worse. Can’t even concentrate on the tube. Can’t call a friend ‘cause my phone’s been cut off again. All I can think about is how bad I hurt and how bad I want to just chill out and feel nothing. Just nothing. That would be so nice.

“So I decide to get a little buzzed. You know, nothing drastic, just a sweet little high. So I go down to this place where somebody’s always got some kind of shit. Either I pay one way or I pay another, depending on whether I got money. Then I get this good buzz on, you know. I let myself do a little more shit and then I get to that place where I’m feeling nothing. Beautiful, awesome nothing. Next day I feel disgusted with myself but I know I’ll do it again the next time I get those bad, bad feelings.”

At first glance, Nancy’s medical forms of self-harm would seem to have little connection to any form of relief or release. Listening to her story, however, reveals that the emotional sequence is not so different from June’s or Lee’s, although the process is substantially more delayed. Nancy talks about her terrible anxiety and fears. Behind the fear is also considerable grief and sorrow for the struggle her life has always been and for the loneliness she can never quite escape.

Nancy In Never-Never Land
“I was having iced tea with Natalie yesterday after tennis, and she was talking about a party she and Jack went to. Anyhow, she said that so many of the women there were obviously second wives and how fabulous they looked and how young. She said to me, “Nancy, you and I are just lucky we have hung on to our husbands, because, dear, we just could not compete with what’s out there.”

“Now Natalie is quite a good-looking woman, a very youthful forty-five. Hearing her talk about both of us that way threw me into a real tizzy. If she thinks we can’t compete, then she’s seeing my age as clearly as I do. I try to get Chip to tell me what he thinks, of course, but the man is just a dear, sweet liar, because he always tells me I look like a hot butterscotch sundae with a cherry on top, our little code for when he wants sex. Anyhow, I can’t trust him to tell me how I really look.

“This conversation got me thinking again about the eggplant and oat bran diet I’ve been on for three weeks now, and I’m positive it’s not working. Then I thought again about the new surgeon my friend Ginger found who is supposed to be the best in the field for tummy tucks. I don’t think I can do another tummy tuck yet, because I just had one last year. But maybe this man does good buttocks tucking. My ass is just disgusting, no matter how many times I work out each week. Maybe I’ll call and see how soon I could get it done. Everyone says that it is really, really painful. But you know what they say- “no pain, no gain.”

“I wonder if I could get it done at the hospital where I was last year? The nurses there are so sweet. I remember how the last time I really didn’t even want to come home, they were so sweet to me. I’d better call and get this all scheduled before the eighteenth, when Chip wants me to go to that party at the new CEO’s place.

“But then he’ll probably go to the party without me, and that could be a little risky. Oh well, I’ll just have to go to the damned party and look like shit. But I’ll schedule that surgery right after the eighteenth.”

The centrality of anger in the TRS woman’s emotional system is never to be underestimated. Although anger is a difficult, if not forbidden, emotion for many TRS women to express, some can be impressively bold in their symptom-induced anger. Some women, for example, can get openly angry only if they have been drinking. Others use their self-mutilation to express rage. Women with eating disorders have extremely complicated ways of using their self-harmful behavior to release anger, as well as to suppress it. For example, Karen eats cake she does not even like when she gets angry at work. Then she vomits what she has stuffed down her throat, an indirect expression of her rage.
- Miller, Dusty; Women who Hurt Themselves: A Book of Hope and Understanding; Basic Books: Massachusetts; 1994

Nonsuicidal Self-Injury

- Virginia Commission on Youth, Collection of Evidence-based Practices for Children and Adolescents with Mental Health Treatment Needs, Nonsuicide Self-Injury, 2017

Personal Reflection Exercise #4
The preceding section contained information about patterns of relief and arousal in self-injuring women. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 18
How is Nancy’s addiction to plastic surgery similar to other patterns of self-injury? Record the letter of the correct answer the CEU Test.

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