The evidence appears in neat, straight lines etched along a forearm, cross-hatches carved on an inner thigh, or cigarette burns around an ankle.
It might seem counterintuitive, but a growing number of adolescents practice self-harm in an attempt to distract their minds from emotional pain.
While self-injury can provide a perverse kind of comfort, discovering that a child is suffering raises difficult questions for families
Is it a suicide attempt? And why would cutting into one’s own skin offer any sort of relief? Monica Simpson found herself asking the unthinkable when she discovered cut marks on her daughter’s arms.
“Kids who are feeling so depressed and so numb say that cutting is one way they can actually feel something,”says Denver therapist Millie M. Riss, who works with adolescents at Greenleaf Counseling Center. “When people cut on themselves, the brain releases adrenaline, which helps biologically relieve pain. So, in the moment, it feels better.”
The tension is released and the outward scars might be healed, but the inner turmoil remains.
“I think the kids feel it offers relief but it’s also a sign that they’re not functioning well,”says Denver child psychiatrist Dr. John Peterson. Recent studies estimate from one third to half of American adolescents have engaged in some type of self-injury that was not a suicide attempt.
“We are hoping fewer people will dismiss self-injury as a ‘gesture’ and recognize the kids are hurting inside. If you think that this is just a defiant behavior that needs to be punished, that will guide you in the wrong direction,”says Peterson.
The T-shirts and posters bearing the message “To Write Love on Her Arms” carry a mission beyond a cool logo sold at Hot Topic and Zumiez stores in the mall.
What started as Jamie Tworkowski’s MySpace post about a suicidal friend who scrawled self-loathing into her arm with a razor has grown into an international fundraising and support movement with chapters on 15 college campuses. He titled his essay “To Write Love on Her Arms,”and sold T-shirts with the message to pay for his friend’s treatment.
That was four years ago. Last month, his Florida-based nonprofit received a $100,000 grant toward suicide prevention from Chase Community Giving, based on votes the group received through its Facebook fan base.
One of those fans is Caia Pattynama, 17, who created her own event on Facebook for “To Write Love on Her Arms Day.” More than 200 people responded.
Tworkowski says that’s just fine. “We don’t pretend to have cornered the market on hope, or encouraging people or investing in treatment. If we can inspire people, that’s exciting.”
To help teens and their parents understand self-harm, Caia, her sister, Kendall, 16, and her mom, Monica Simpson, agreed to share their story.
Home schooled until ninth grade, Caia identified with the dark-eyed, black-clad “emo” kids she met in her freshman year at suburban Denver’s Smoky Hill High School in 2007.
“I met a lot of friends who practiced cutting. It’s kind of popular — not that that’s the right word,” she says. “But I thought, ‘Oh, I’ll never do that. It’s like doing drugs, destroying your body.’”
But navigating the transition to a big public school and mourning the death of her stepfather darkened the shadows that had been gathering in Caia’s mind. She found that cutting seemed to relieve the stress she felt.
“I needed a way to cope. I thought, ‘It’s just on my arm. I can wear long sleeves, no one needs to know.’ It got to the point where I was doing it (cutting) every other day. My mom found out after about a week, but I kind of kept it on the down low. I told her it was a one-time thing.”
They went back to a therapist they had seen before, but Caia shut down. “I faked my way through it,”she says of her therapy sessions.
Her mom knew she needed help, but wasn’t sure where to turn.
“It’s like if your child came home and said, ‘I cut off my foot and I don’t need it any more and it’s no big deal.’ There’s no logical way to understand it,”says Simpson. “At that time, I did not understand it was not a suicide attempt. I had to call 911 and insist she was hospitalized. I did not believe that I could keep her safe.”
Caia spent five days in a psychiatric hospital that winter.
“I learned a lot,” she says. “But I went back to cutting when I got out. For me, five days wasn’t enough. Within those next couple months I realized, ‘Oh my gosh, I flunked my freshman year, alienated my mom and my sister.’ It was all hitting me, but something in me just didn’t want to fix all that. I started realizing I was on one extreme, and I could see the other side, but I just couldn’t get there. I got in a huge fight with my mom and went up to my room and cut. Mom knew what I was doing, she came up and got really upset.”
Her mom recalls the scene. “It really was a small matter that touched off this huge explosion. You don’t ask her about cleaning her room and expect her to carve cross-hatches all over her arms. I remember aching for her, just so sad, thinking ‘She’s terrified —how do I help her?’”
Caia went back to the hospital for two weeks in the spring of her freshman year while her mom researched treatment options.
“Putting me in the hospital was horrible for me, but it helped,” says Caia, who agreed to go to a therapeutic wilderness program — not a boot camp — for struggling teens.
Sending Caia to wilderness therapy was “by far the most difficult thing I’ve done in my life. All I knew was my kid was failing school and carving up her body,” says Simpson.
Peterson and doctors at the Denver Health Adolescent Psychiatry Inpatient Unit and the University of Denver are in the middle of a three-year study to learn more about self-injury and how to distinguish it from a suicide attempt.
“A little over 70 percent of the kids that are admitted here engage in some kind of self-injurious thoughts or behaviors,” says psychiatrist Peterson of his work with the teenagers in the 13-bed Denver Health psych unit.
“Families often feel very hopeless, at wit’s end: ‘Why is she doing this? We don’t understand this, how did we get to this point? What is the treatment?’”
Peterson and other mental health professionals answer those questions with coping, communications and problem-solving strategies that help the kids and their families learn to explain their feelings in a healthy way.
After the nine-week wilderness program, Caia spent her sophomore year at a therapeutic boarding school in Utah. She came home last August after 13 months in residential treatment, with a relapse plan and much greater insight into healthy self-control. “It was really addicting behavior, with all this emotional stuff underneath,”says Caia.
Family therapy helped too. “In all the ways we need to become healthy, we can’t point to our kids and say, ‘Fix yourself’ and not point that finger back at ourselves,” says Simpson, who also credits her younger daughter and older son for their part in the journey.
“The siblings are unsung heroes in many ways. They did not ask for this upheaval, they do not fully understand what their brother or sister is going through, they are often lost in the shuffle of a parent or parents trying to care for their sibling in crisis. They carry their own grief for the lost or changed relationships with their sister or brother,”says Simpson.
Returning to “normal” life hasn’t been easy for Caia. Stressed about school, she had a relapse and cut herself about a month after she got home. “I went straight down to my mom’s room and told her. She was really calm and cool about it, she was right there with me.”
This time, her mom felt empowered. “I told her, ‘You are really strong. I know this is hard. You did this, but you came to me and you are talking to me,’” says Simpson. “I am really proud of Caia. Every day she gets up and faces things that most people never feel. I know that in this process of recovery she has to make her own decisions every day.”
Caia calls herself a survivor. “Survivor is a really good word, not only in the physical aspect, but emotionally and spiritually, I came out of it really strong.”
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