Monday, December 7, 1998; Page C03
  Copyright 1998 The Washington Post Company
 

 A BRIGHT RED SCREAM

 Self-Mutilation and the Language of Pain

 By Marilee Strong

 Viking. 232 pp. $24.95

  This is not a book, or a review, for the faint of stomach. It is the story of "cutters," meaning people (most often women) who use razors, knives, glass edges or needles intentionally to wound themselves. "They may also," writes Marilee Strong, "burn their skin, bang their heads, punch themselves, break their own bones." More common is the simple, ghastly incision in the arm.

  What is ghastly to others, however, has a very different meaning to those who cut themselves. (Strong says this may be as many as 2 million Americans each year, though the figure is not explicated.) "Melanie," a 16-year-old Californian who has cut her wrists with a razor, burned herself with cigarettes and carved words and pictures into her skin, bears a particular scar that illustrates the book's interpretive theme. By heating a disposable lighter and pressing it to her flesh, she created a scar in the form of the happy-face icon. "Making yourself hurt to feel good is a really wicked and deranged thing," she says. "But to me, it's normal."

  How is it that self-wounding can "feel good"? "To intentionally injure an organ as vulnerable and delicate as the skin," Strong writes, "seems to go against everything we know about our biologically innate tendency to increase pleasure and avoid pain." But according to a line of thinking that begins with the esteemed psychiatrist Karl Menninger in the 1930s, self-injury can also be a product of the survival instinct. Cutters, Strong argues, disfigure their skin as a way of declaring, to themselves and others, that their souls are in anguish.

  The background goes something like this: In the wake of trauma -- especially in early childhood -- we often dissociate, or separate ourselves, from our moment-to-moment feelings. (Awareness is multilayered: A simple demonstration is to think of the watch on your wrist or the socks on your feet -- you felt them before reading this sentence but weren't fully aware of doing so.) Extreme dissociation can be extraordinarily useful, say, for a young person sexually abused and far too fragile to bear the weight of that horror. But, eventually, chronically diminished awareness takes its toll: If you're forever numb to pain, then pleasure or even satisfaction will also elude you.

  Cutters, whose behavior is clinically described as "repetitive self-mutilation," typically have a background of physical or sexual abuse, illness at an early age, or parents who are depressed, alcoholic or in some other way not nurturing. While they use numbness as protection, it quickly gets so that they feel, in the words of a 19-year-old student at an Ivy League college, "like a walking corpse." Taking sharp objects to the skin -- and watching the blood flow -- is a way of feeling alive: It is apparently doubly satisfying to watch the wound heal; cutters describe a feeling of calm -- approaching ecstasy -- the intensity of which directly corresponds to the pain of the cut. And so many of them escalate from nicks to incisions to carvings.

  If the phenomenon is not well known, it's partly because so many cutters lead productive lives. The great 18th-century scholar Samuel Johnson, apparently tormented by the idea of his own sinfulness, compulsively hit himself, scraped his fingers with a penknife, and bit and picked at his skin. Princess Diana was another famous cutter. "You have so much pain inside yourself," she told the BBC in 1995, "that you try and hurt yourself on the outside because you want help." Among those interviewed in Strong's book are a schoolteacher and a physician.

  Strong labors to present a hopeful, constructive view of cutting. She sharply distinguishes it from suicide and relies heavily on the work of psychiatry professor Armando Favazza, who writes that cutting is a "morbid form of self-help" and that "scar tissue is a magical substance, a physiological and psychological mortar that holds flesh and spirit together."

  But such observations are tempered by Strong's equally clear view that cutting is a pathology, or at least indicative of one. Cutting is a symptom of larger problems, but those problems are often difficult to identify, let alone treat. Medication and psychotherapy are sometimes helpful, as are cognitive therapy and an experimental treatment called eye movement desensitization and reprocessing. (Another recent book on the subject, "Cutting: Understanding and Overcoming Self-Mutilation," written by therapist Steven Levenkron, dwells on how a cutter can help herself with long-term therapy.)

  "A Bright Red Scream" concludes with a laudatory chapter on SAFE (Self-Abuse Finally Ends), a treatment center that takes a stern approach and expels patients who continue to cut. SAFE's philosophy, a sensible one, is that cutting is a mask over a trauma that needs to be identified and let out in a healthier way. And so a book that seeks to justify, defend and understand cutters' behavior concludes with a wish that all of us can understand: that cutters bind up their wounds in other ways.

  By Joshua Wolf Shenk, a writer living in New York.

  Copyright 1998 The Washington Post Company