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In the last section, we discussed the consequences of badly executed hospitalization such as: a feeling of isolation; a discharge without being truly cured of the dilemma; and belittling the self-injurer.
In this section, we will examine why adolescents are so vulnerable to the guiles of self-mutilation. These reasons include: a drive for perfection; triggers from childhood; and the construction of identity.
♦ # 1 - A Drive for Perfection
She stated, "Before I self-injure, I am usually in so much pain emotionally. I feel helpless, hopeless, upset, and anxious. I really do not consider anyone around me. During the act itself, I feel completely numb, or I feel so much physical pain that I overpower my emotional pain. After the episode, I feel relieved, as if I have released some tension. My blood shows me I am still a human being." To account for her actions, Katie labels her self-mutilation as "delicate self-cutting."
Louise Kaplan describes the term of "delicate self-cutting" as an "innocent-sounding diagnostic label" that Katie uses to separate herself from the coarse self-injurious behavior of others. As you know, Katie is part of a rising demographic of girls that strive for perfection in their everyday lives. A comparison of this might be a client suffering from anorexia. As you know, the drive to be perfect becomes so strong for some girls that the pressure snaps their reality of what's healthy and good for them.
♦ # 2 - Triggers from Childhood
She stated, "When he would get drunk or had a hangover or withdrawal, he'd yell if I left one speck of dust on the floor. Whenever I would say things in family therapy meetings, my dad would take them out of the meeting and use them against me at home." These triggers caused Katie to arrive at puberty in a vulnerable and unstable state. Teens like her have trouble dealing with the stressors involved in puberty because of the weight these triggers add. To cope, Katie turned to cutting.
♦ # 3 - Construction of Identity
Adolescents who self-injure face this period with alarm. Often times, self-injuring teens arrive at this time period having been deprived of the ordinary gratifications of attentive parenting. Katie was one of these teens. Deprived of her father's affection, she became pseudo-mature and developed the character of the strong one in the family. Without a childhood, Katie could not celebrate adult roles and responsibilities because they reminded her of her inconsolable losses. Katie stated, "Self-injury helped me cope, but it also disrupted my life. It forced others to take care of me." In this way, Katie was compensating for her under-parented childhood.
On the other end of the spectrum, teens who are overparented lash out in dramatic ways to separate themselves from their overpowering parents. Lisa's boundaries were blurred by her mother's overly vicarious tendencies. Lisa, at 13, replaced her mother's perfect floral dresses with baggy sweatshirts and baseball caps.
She soon turned to drugs, alcohol, and self-injury at 15 to even further alienate herself from her impeccably dressed country-club mother. Her mother, Agatha, was horrified and repulsed at her daughter's behavior instead of wishing to help Lisa heal. Lisa stated, "My mother made me feel so claustrophobic, like she was smothering me. I felt that by hurting myself, I was breathing. It made me feel like I wasn't like her."
♦ Technique: "Breaking the Silence"
Lisa's relationship with her mother Agatha was heavily spotted with awkward silences which no one broke. Instead, Lisa and Agatha remained resentful and horrified of each other. To compromise for this, I had Lisa describe a situation in which her mother and she refused to talk when communication would have been key. Lisa filled in the silence with what she wanted to express and how she thought her mother would respond.
Lisa: Mom, I just got this new piercing.
In constructing this dialogue, Lisa finally saw why her mother had been so stringently careful in her upbringing. This realization helped Lisa to forgive her mother for her behavior. Her release of resentment aided Lisa in toning down her theatrical demonstrations of identity.
In this section, we discussed the reasons teens are so susceptible to self-injuring: a drive for perfection; triggers from childhood; and the construction of identity.
In the next section, we will examine how loathing one's body and a preoccupation with food can lead to self-mutilation. Also we'll discuss the differences between male and female self-injurers due to the way in which they vent their emotions.
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