When Your Adolescent Patient Cuts

Cutting is a terrifying, but ever present phenomenon plaguing adolescents. Two in ten teenagers cut, and almost 46% of teenagers engage in some type of self- harm. As doctors, therapists, parents, and teachers we are baffled. This act of mutilation does not make sense to us. After all, our youth is fleeting and adults are desperate to maintain their health and vitality. Why would the young intentionally compromise their own?    

An expansive generational gap exists between adults who are trying to understand cutting and the children who are enslaved to it. The reason for this gap is not only generational, it is cultural. Let’s tackle the generational component first.  During the 70s and 80s, most children and adolescents spent their days outside, digging in the dirt, riding bikes, playing capture the flag, climbing trees, building forts in the woods, sleeping in tents under the stars, and only going inside when the street lights flickered on. Most kids walked to and from school. Unfortunately, the world has changed, and because of safety and supervision issues, these activities are now risky propositions. It is dangerous for kids to go anywhere alone.  Instead, a great deal of our children’s free time is centered around inside activities such as utilizing technology and participating in more structured endeavors focused on achievement. In essence, two anxiety reducing activities have diminished in our children’s lives: play and outside time.   

So, what do these things have to do with adolescents cutting today? The mind and body connection. Whether we like it or not, the mind and the body are connected and when this connection is healthy and strong, anxiety is kept at bay. When the mind and the body are at odds with each other, anxiety and depression flourish.  Intrusive and racing thoughts are all-consuming, and hopelessness and dread prevail as the leading emotions.  

On the other hand, when the mind and the body are connected, the person feels whole, centered and alive. The most obvious experience of the mind and body connection is what athletes refer to as “in the zone.” The body and mind function as one and movement is seamless, fluid, and optimal. Focus is astute. Traditional Eastern activities such as yoga and martial arts have become popular because these are the activities which help us maintain a healthy mind and body connection. Participation in sports and the arts are also activities that strengthen the mind and body connection. Essentially, any activity that the mind and the body intricately collaborate on is a mind and body activity. 

Play is an essential way children maintain the mind and body connection, because play requires participation from both the mind and the body. It is simultaneously creative and physical.  Experiencing and existing in nature also supports a healthy mind and body connection. Unfortunately, kids today do not play as much as previous generations, and they do not play outside nearly as much.  

In addition, the western culture seems to foster a separation between the mind and the body, which is the second explanation for the prevalence of this problem.  The medical model treats the body and not the mind. For example, an orthopedic surgeon doesn’t debrief a child after an accident, but they mend the child’s broken body.  Moreover, a psychologist doesn’t set a broken bone, but they support the client in processing the traumatizing experience. Basically, the mind and body are perceived and treated as completely separate entities. Another example includes how we operate day to day. Many of us go to work, sit at a computer and use our mind for 8 hours. Then, we go home and force ourselves to climb on a tread mill to exercise our body…. while our mind reads a magazine.  

Another example is the media. Pictures of isolated body parts are rampant, but the pictures do not include a depiction of the persons thoughts or feelings -- because if it did, it would not be a picture, it would be art.  The media treats the body as if it is an object.  

In essence, our children and adolescents exist in a culture where the mind and body split is prevalent, and many children and adolescents do not have the opportunity to reestablish it through play or playing outside. To add insult to injury, during adolescence, the body changes and feels foreign. Often, adolescents despise the way their bodies look, which induces deep shame. In addition, the developmental challenges adolescents face, such as identity formation, peer acceptance, and budding sexuality, are daunting and often cause stress and anxiety.  So, the mind and body  become dangerously estranged.   

When the split becomes cavernous, anxiety and depression intensify to critical levels. For example, say the adolescent is already trying to cope with a great deal of anxiety and depression, and they receive a negative sentiment from an acquaintance via social media, this can induce a level of shame and pain so excruciating, that is difficult for them to even breathe. In other cases, the mind and body have become so disconnected and distant, that the adolescent feels numb. Not feeling anything, which is the second most uncomfortable emotional state, feels like death.  

In either of these two cases, the adolescent not only feels horrible, they feel lost, psychologically. Any semblance of feeling whole, centered, grounded, and alive, as people do when there is a healthy mind and body connection, has vanished. This is when the impulse to cut becomes strong. In most of the interviews done with adolescents, they say cutting is almost like a drug. It provides an escape from their emotional pain, and relief -- Immediate relief.  

The majority of the adolescents interviewed report they don’t feel the first cut. Some report not feeling anything until the second or third laceration. This signifies the distance between the mind and the body. It takes a while for the mind to get back to the body. Yet, when the sensation of physical pain washes over them, they feel instant relief, and their emotional pain subsides for a few seconds. Why? Because they have brought their mind back to their body. Their mind reconnects with their body through the sensation of physical pain. The pain is real and it anchors them for a second. Their mind and body feel the pain together.  They are united. 

Unfortunately, this is a temporary and fleeting solution. It is also unsafe, and can be deadly if things go awry.  Yet, for some adolescents, it is the only escape. The only relief.  Like a drug, it becomes obsessional. Also like a drug, the shame and remorse that follow the act are unbearable. Thus, the cycle perpetuates itself. The shame and pain become intense and the only escape feels like cutting again.  

So, how do we stop the cutting epidemic? The first step is to avoid shaming or punishing the cutting behaviors. Teach parents to ask their adolescent to explain what they are feeling immediately before they have the impulse to cut, and attempt to empathize with their emotional pain. They can say things like, “I know you are hurting.” “I am here.” “You are not alone.” Have the parent try to understand and honor the adolescent’s pain. Next, ask the parent to be their child’s source of relief.  They need to be the one their child comes to for soothing and understanding when the pain becomes intense. Ask them to avoid telling their adolescent what to do—but ask them to simply listen with an open heart. Then, ask them to ask the adolescent to relinquish the objects they use for cutting. Secondly, invite the parent and child to find relief from that pain in another way. Ask them to do yoga together nightly or play catch outside. Taking a dance class together or kicking the soccer ball around are just a few ideas.  Having the parent enroll them in a martial arts class is another good idea. Any activity the parent can get the adolescent to participate in that connects the mind and body will help reconnect the two entities, so the adolescent feels increasingly whole, centered, and soothed.  Other ideas include, the parent playing the adolescents favorite songs softly in the background at home. Music is a natural anxiety buster and so is nature. Ask the parent to invite the adolescent to take the dog for a walk or go for a bike ride.  

If the parent or adolescent does not feel comfortable with these ideas, refer them to a therapist. They might need an outsiders help. If this is the case, it is ok.  It is typical and developmentally appropriate for adolescents to need support outside of the family. After all, the main developmental tasks of adolescence include identity formation (figuring who they are in relation to the world) and individuation. Both identity formation and individuation require a bit of differentiation from parents. Of course, this explains why most teenagers are mildly oppositional and rebellious.   

In essence, when a parent does not understand their adolescent’s perspective and feelings it creates a vulnerability in the relationship and in the adolescent.  Hopefully, no parent wants their adolescent to think exactly like they do. Having a child who has a strong and independent mind is critical for their success in the real world, and this requires that a parent surrender their own thoughts and feelings for a moment to try and understand their adolescent-- even if it is difficult and painful. Most parents would take a bullet for their child. Attempting to understand how they feel when they are in pain requires a parent feel the pain as well.  It is imperative. It is critical and it is worth the emotional investment. It may save their life.