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Treatment of Nonsuicidal Self-Injury in Adolescents
10 CEUs Physical Pain Stops my Pain - Treating Teen Self Mutilation

Section 24
Pain and Transcendence of the Self

Question 24 | Test | Table of Contents | Self-Mutilation CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, MFT CEU

Many contradictions exist in the experience of pain. When one experiences intense pain, one becomes acutely aware of physical existence and loses rational cognition. An individual in extreme pain may lose the ability to think or speak. Conversely, to be able to withstand pain is to transcend one's physical limits and become closer to a spiritual realm of being. Pain can both reaffirm an individual's physical existence and aliveness, and provoke a transcendence of this existence.

Pain as a potent vehicle of power and mastery can obliterate and recreate consciousness. Pain inflicted without consent negates the sufferer's integrity, but self-inflicted pain can bestow dignity and sense of self, and also provoke a feeling of connection with something beyond one's self boundaries. The sufferer experiences sensations that cannot be shared and that separate him or her from others, which may induce a profound awareness of physical limits and emotional solitude.'8 Conversely, pain may also provide an escape from one's separateness. A person in acute pain becomes oblivious to everything but the present moment and loses self-awareness and high-level thinking. Psychological studies of masochism reveal that a masochist uses pain to "lose awareness of his or her normal everyday self."19 Pain may be experienced as a loss of boundaries between self and environment that evokes a feeling of union with something beyond mortal earthly existence. If not experienced in this spiritual way, it may be experienced as being acutely in touch with the surrounding environment, and even identifying with the source of pain. This is especially true when people inflict pain upon themselves. They are simultaneously merging with, and differentiating themselves from the environment. Consenting to pain may provide a similar experience.

One of the motives for sadomasochistic activity is "loss of personhood," which is concurrent with the repair of a narcissistic fragmented self and alleviation of the accompanying emotional distress. This may be true for either the person who receives pain or who inflicts pain, neither of whom may have any kind of narcissistic disorder of the self, but wish to experience the psychological and physiological euphoria induced by their actions. Some individuals who practice sadomasochism claim that pain takes them or their partners into physical and spiritual realms of bliss. Commenting on the ability of pain to alter consciousness, one practicing sadomasochist says, "Your body releases endorphins and its better than any high I've obtained doing drugs."2' The same interviewee entertains the consideration that the euphoria produced by pain may be addicting. Research shows that the brain may block transmission of pain signals if other strong sensory stimulation (for example, sexual stimulation) is experienced at the same time. A discussion of ritualized acts of sadomasochism provides a fertile ground to explore the idea that physiological and psychological events can fulfill a need for confirmation of the self, while also providing an avenue to transcend the self. Although all acts of sadomasochism are unique, and no two individuals who practice these acts are moved by the same impetus, the idea of transcendence of the self is a useful tool to analyze the significance of acts of consensual sadomasochism, domination and submission, and bondage and discipline. All use the body, most rely on elements of ritual, and all seek to establish and break boundaries of the self, boundaries between the participants, and in some cases, boundaries between the participants and the cosmos. Abolishing these boundaries may result in Brena's experience of "ever-expanding states of consciousness of the body, the mind, and the soul toward the bliss of God-communion." Although the labels sadomasochism, bondage and discipline, and dominance and submission carry different connotations and imply different practices, I will use the terms sadomasochistic and sadomasochism as generic terms indicating activities that revolve around physically expressing a role-play of status disparity. Although not all of these forms necessarily involve pain, most involve some degree of physical discomfort inflicted upon the participant who assumes the subordinate role. The activities may or may not be sexual in nature.

In a provocative essay Jessica Benjamin examines sadomasochist interactions as both a confirmation and escape from self. Based on Hegel's discussion of the master-slave relationship, Benjamin asserts that acts of dominance and submission rely on interdependence between the dominator and the dominated for recognition. In her discussion of The Story of O, a novel that presents sadomasochistic scenarios in which the main character, O, submits to her lover's sadistic wishes, Benjamin concludes that "pain is the violent rupture of self-organization," while it is simultaneously an attempt to affirm a sense of self. "O finds a kind of substitute transcendence in losing herself to enslavement." O hopes that by submitting to pain she will be brought to life by the recognition of her torturer and through the awakening of her senses, but also hopes to lose her boundaries by experiencing pain.

"She…experiences her lover as a god whom she adores and cannot stand to be parted from. While God represents the ultimate oneness, the ability to stand alone, O represents the lost soul who is elevated by union with the ideal omnipotent other."

Similar to a sexual experience, O's union with another individual is intimately connected with body sensation in her process of self-definition and awareness. Benjamin's trenchant contribution is her analysis of submission to pain as a method of gaining recognition and self-confirmation. Although she does not mention the ability of pain to integrate the self via body chemistry, the physiological reactions to pain are relevant because of their ability to produce euphoria and feelings of narcotic wholeness and connectedness to others or the cosmos. Practitioners of Tantric sex rituals use prolonged pleasure for the same purpose. Individuals who endure the pain of nipple clamps, the discomfort of restraint, the sting of repeated whippings, or various other sadomasochistic activities may not experience severe pain, but may feel the effects of endorphins released in the body in reaction to prolonged discomfort. Individuals who experiment with erotic cutting, in which one partner cuts the other, or other extreme forms of sadomasochistic sex play, may experience more extreme endorphin thrills, and more intimate feelings of being connected to their partners. The clandestine and sexual pleasure that may accompany the activities may also provide psychological and physiological confirmation of identity as an individual, as part of a dyad, and as part of a secret community labeled deviant by mainstream society.

Identity as a dialectic between being separate from others and yet recognized and confirmed by them is expressed by the psychologist Edward Podvall in an article about self-mutilation. Identity is "on the one hand, a mere reflection. . . of the impinging social and cultural forces, and on the other, being uniquely and idiosyncratically separate and private from other minds." The submission to pain highlights the private nature of self-awareness, while also providing a way to feel a connection with an external cause of sensation. In sadomasochistic interactions, inflicting pain and receiving pain are simultaneously private experiences and experiences that are witnessed and recognized by another. As the master or mistress dominates the submissive, he or she is assured of his or her sex appeal, self-worth, and self-mastery. The dominator regulates expression of his or her own desires as well as the behavior of the submissive. The subordinate participant functions as a crucial witness or "self-object" who confirms the dominator's self-control and power. Without a slave to manipulate, the master/mistress remains without an identity. Although widely considered deviant, the dominant-submissive play can be interpreted as a stylization of natural human desires to confirm one's own potency-as experienced by the dominator, and one's own importance in the face of a powerful force-as experienced by the submissive. When performed with affection and consent, human instincts of love and aggression merge as both partners willfully play out universal acts of domination, aggression, submission, and worship in a contained atmosphere. They confirm their own humanity as they exercise the will to choose their actions.

Many factors contribute to consensual acts of sadomasochism as ways to transcend the self and experience a feeling of cosmic connectedness. In an age when "safe sex" is a necessary precaution against sexually transmitted diseases, sadomasochism may carry an aura of danger, even though it can be practiced as safely as any other sexual activity, or perhaps more safely if body fluids are not exchanged. The feeling of transcending the danger of sex implies a transcendence of mortality and a god-like immunity to harm. As fashion theorist Valerie Steele points out, the fashions of sadomasochism and fetishism, leather, rubber, tight garments, garments reinforced with metal, heighten awareness of the body as bounded and purposefully controlled. As she claims, "Fetish materials dramatize the exterior (boundary) aspects of the body. Fetish fashion draws attention to the sexual aspects of the body, while simultaneously restricting access to it." Being snugly bound in a corset, rubber stockings, or thigh-high boots is a highly skin-erotic experience, as is being restrained in a leather collar, and ankle and wrist cuffs. The clothing adds to the transgressive fantasy of well-defined roles by making each participant feel literally physically defined and bounded, and therefore, safe.

When the interaction is ritualized, as it often is, the ritual may prepare the participants psychologically for a spiritual experience by gradually preparing a sacred atmosphere, a space and time set aside from the normal world of everyday life. As the participants don their special clothes and accouterments-for many of these rituals revolve around external appearance and special props or "toys"-they enter a different state of mind. Dressing, or being dressed by one's partner becomes a passage into an arena in which both participants must follow certain rules. Not only do these rules provide a comforting feeling of security and predictability, but because they encourage behavior that is not normally acceptable in other arenas they allow the participants the freedom to act outside of themselves. As the mistress or master assumes her or his typically elaborate and expensive gear and the slave accepts the slave collar, each individual enters a role. The master's whip and the slave's collar become masks that allow each to experience the "sacred awe" of both his or her own role and the role of the partner. The physical and psychological masks contribute to the creative disassociation from ordinary life. Like religious masks that facilitate altered states of consciousness, the masks of these roles allow the participants to transcend their own inhibitions and identities. As they experience the psychological and physical effects of pain and sexual pleasure, they may also experience themselves and each other as transcending their humanity. As they act out rituals of stylized domination and submission, and enter altered states of being, they may even experience themselves and each other as embodying universal forces traditionally labeled masculine and feminine, active and passive, Yin and Yang. Like the narcissistic use of a "self-object" to both create and transcend the ego, the participants use each other and each other's bodies to confirm and escape their identities and experience a feeling of integration with the cosmos. The experience of pain, the recognition by the other, and the escape from self culminate in what many practitioners of sadomasochistic activities describe as a spiritual experience.

The significance of pain depends on both its experience and its functional end result. Social institutions may inflict pain for utilitarian, symbolic, or expressive purposes. The disparity between pain that is culturally sanctioned and pain inflicted by an individual transgressing social norms, whether publicly or in private, is salient to the interpretation of acts of self-mutilation. This disparity will be explored further in discussion of specific acts of self-inflicted pain. To indicate the continuum between these two extremes, I will discuss how marking the body functions in cultural rituals and several acts of self-mutilation that illustrate the continuum between pathology and social acceptability.
- Hewitt, Kim, Mutilating the Body: Identity in Blood and Ink, Bowling Green State University Popular Press: Bowling Green, 1997.

Solitary Confinement and Risk of Self-Harm Among Jail Inmates

- Kaba, F., Lewis, A., Glowa-Kollisch, S., Hadler, J., Lee, D., & Alper, H. et al. (2014). Solitary Confinement and Risk of Self-Harm Among Jail Inmates. American Journal Of Public Health, 104(3), 442-447. doi: 10.2105/ajph.2013.301742

Personal Reflection Exercise #10
The preceding section contained information about pain and transcendence of the self. Write three case study examples regarding how you might use the content of this section in your practice.

When the self-mutilation is ritualized, as it often is, how does the ritual may prepare the participant psychologically for a spiritual experience? Record the letter of the correct answer the Test.

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