Breathing while drowning: Youth who self-harm

Looking at Lila Levine, a tall and slender 18-year-old with a heart-shaped face, you would never guess that she spent her adolescence trying to “put [herself] into oblivion.” Only her expressive Bambi eyes lend a hint, a sort of haunted clarity to them betraying her self-destructive past, which began with cutting at age 12.

“The most harm I’ve done to myself has probably been with substance abuse,” says Levine, who started using drugs heavily and hit the bottle once cutting “wasn’t enough.” “But the emotions behind cutting yourself and the emotions behind getting blasted are similar. There are feelings of disconnect from society, loneliness, not fitting in and needing to have something to solidify the pain that you’re feeling.”

She flicks her cigarette into the gutter as she thinks, rhythmically rubbing her palms on her thighs. It’s hard to tell if it’s the cold or nervous energy, but she apologizes all the same.

“When you’re cutting,” she says, “you have a physical representation of what you’re feeling inside, and you’re the one in control. Self-harm is a coping mechanism. It can be very calming.”

This may sound strange or downright crazy to those who haven’t heard the stories of self-harm. But Levine isn’t that different from the average teen. Various studies over the years have found that nonsuicidal self-harm, which most often involves cutting, self-hitting or burning, is common among kids in North America and has been for decades.

In 2008, the Canadian Medical Association reported that 17% of Canadian youth have admitted to nonsuicidal self-harm, the usual age they start being 15. This year, a paper in Pediatrics journal stated that up to 24% of teens and young adults use it as a coping mechanism, the act resulting in the release of emotional tension and natural endorphins that achieve the calming effect these kids crave.

In fact, recent research has indicated that the prevalence of this behaviour may be increasing, according to Vancouver-based therapist Dr. Aviva Laye-Gindhu, who specializes in youth and self-injury.

“It’s a really over-looked issue,” she says. “And a different picture than what [researchers and psychologists] have previously thought is emerging. There’s been a lot of media coverage about ‘emo kids,’ and what we’re realizing is that though there are self-harmers who identify with that group, there is a wide range covering different demographics, youth subgroups and socio-economic statuses.”

Says Levine, who now works as a youth representative for Vancouver’s teen-focused Leave Out Violence organization, it’s not just the archetypal eye-liner-smeared, attention-seeking kids who hurt themselves.

“It’s the guy who plays basketball, or normal kids who seem to be doing really well. It can be someone who’s living an outwardly successful life, but when they take their pants off you see that they have scars running up and down their thighs, and they’re hiding a piece of themselves.”

Misconceptions, stereotypes and biases abound in discussions about self-injurers—in the media, society, culture and even in clinical studies. For instance, according to Laye-Gindhu, researchers used to automatically assume that kids who self-injure must be suffering trauma from abuse. Now, their eyes have been opened by an increasing number of illuminating studies.

“As we ask more questions,” says Laye-Gindhu, “we’re seeing more and more youth who seem well-adjusted and don’t have traumatic family backgrounds engaging in self-injury. Though there’s that association, [these kids come from] invalidating environments where emotions aren’t expressed and they don’t learn how to regulate them.”

This stifling kind of environment and lack of emotional skills, teamed with overwhelming feelings of anxiety, anger or depression, can create youth who don’t know how to cope and rely on self-harm as an outlet for all that’s pent up inside. In other words, for kids who feel like they’re drowning, self-harm can help them breathe.

It can also be a cry for help, a way to feel alive when they’ve become numb to the pain or even a form of self-punishment. Feelings of self-worthlessness often plague kids who self-harm, says Levine, and they think, “I deserve to live this existence, because look at what I’m doing to myself. I don’t deserve happiness, because I hurt myself every day.”

Levine is no stranger to these thoughts. In high school, she wanted to be popular, but being the “tall, awkward” girl—5’11 at age 12—she didn’t have many friends and not much self-worth either. Half-white, half-Punjabi, and never knowing her Punjabi father, Levine says her image of beauty was skewed, prompting her to once cut her face so badly that she was hospitalized.

“I thought I wasn’t pretty because I wasn’t white,” she explains. “And I tried to pass for white for so many years, with light hair and contacts. I wanted to look like my mom and the women in the magazines, and it wasn’t until much later that I realized that I…” She seems to struggle, still, with saying she’s pretty the way she is.

Although Levine grew up in a “super strong and stable” family, she surrounded herself with bad seeds at a very young age, and when she was 14 or 15 years old, a family friend and “father figure” locked her in his basement and attempted to sexually assault her.

Speaking very slowly, like a girl creeping around landmines, Levine says, “That was kind of the starting point of me… going 110% into self-destruction. That was when my self-value was very low. But I lived through it and coped with it, in my own way.”

Jessica, Chantalle and Tanya, three active forum members on self-injury.net, a resource-based online community for self-injurers, have all used self-harm to cope with stress in their youth. Although each of their stories is unique, they share relatable commonalities that crystallize self-harm as a widespread phenomenon, not just the batty behaviour of an isolated group.

“I tend to let my emotions build up to a boiling point and then lose it,” says Jessica, 23, who started hurting herself at age 14 to cope with depression and anxiety. “Cutting lets me focus on the physical pain instead of dwelling on my emotions. Before I self-injure, I feel panicked or overwhelmingly sad, but afterwards I feel numb, which is what I aim for.”

Jessica, a victim of daily bullying from second to tenth grade, is now in the process of recovery from an eating disorder and years of chronic self-harm. Her first experience with it was both “scary and exhilarating.”

“I had friends staying the night and everything was okay, but all of a sudden a wave of depression came over me and I couldn’t even focus on my friends,” she explains. Cutting her ankle with one of her mom’s razor blades, the wave broke and she felt better. But guilt and shame hang over self-injurers’ heads as a black and heavy haze, and Jessica is no exception.

“It hurts my family and friends to know that I do it,” she says. “They feel I shouldn’t have to resort to it and would rather have me talk to them about how I’m feeling. But that doesn’t always help. Sometimes I just can’t talk—I don’t have the words.”

Tanya, 27, who is now in the recovery process like Jessica, started self-harming at 15 to cope with the “intensity” of her emotions and a life-long battle with depression and mental instability. Although she grew up in a broken home, Tanya depicts her family life as “fairly normal.”

16-year-old Chantalle, a survivor of abuse, bullying and mental illness, began deliberately hurting herself at 14 to calm her anxiety and anger, but she says she’s exhibited self-harming behaviour since she was a child.

Although Jessica, Tanya and Chantalle differ in their attitudes towards their scars—in Chantalle’s words, “I don’t cover them because they’re a part of me”—they all concur that self-harm is deeply stigmatized in society, and kids who self-harm are not portrayed sensitively in the media.

“The media seems to be pretty ignorant,” Jessica says. “Most people just don’t get it. It’s not about getting attention or suicide, it’s just a way of coping. People need to have a better understanding, and that won’t happen unless the portrayal changes.”

“It’s slowly getting better,” says Chantalle. “But it’s still not accurate. We’re [constantly] made fun of and brought down.”

The perception of these kids as suicidal freaks is unfortunately still ubiquitous in today’s world, and the media reflects this. As Recovery Canada notes, self-harmers usually have no intention of dying. In fact, their behaviour is “a way to keep from killing themselves.”

And although kids who use self-harm to cope are “no more psychotic than people who drown their sorrows in a bottle of vodka,” smoke cigarettes or use other more socially acceptable forms of “problem avoidance,” the idea that youth would purposely hurt themselves to feel better is hard for much of society to swallow.

“A lot of ‘sanctity of the body’ is built into our Western culture,” says Laye-Gindhu. “So self-injury flies against that and our ideas about beauty and logic. It incites a lot of horror, and people seem to be pretty dismissive of it. Even though now there’s more awareness, people’s negative associations with it haven’t changed.

“I know when I first started doing research, there was almost nothing because nobody wanted to talk about it, and people were always shocked, like, ‘Why would I pick that to study?’”

“Let’s face it,” says Chantalle. “It’s not normal. You’re taught to take care of your body and not to do dangerous things. Then we get the religious side and how God wouldn’t want you to hurt your body because it’s a temple. We’re going against all of society’s norms and people don’t know how to react.”

Levine has experienced the stigma first-hand, refusing to hide her wounds and scars as a teen out of an aptly put mentality of “cutting off [her] nose to spite [her] face.”

“Cutting only made me more ostracized from my peers,” she says. “Whereas if you’re getting drunk, there’s camaraderie in that, so people accept you for it. Alcohol and drug use is glamourized and parties are fun, but cutting isn’t. People are afraid of it. And usually when you’re afraid of something, you hate it.”

So how should people react—namely parents, teachers, counselors and others personally involved with youth? Creating awareness is one avenue that can lead to harm reduction, but as with any complex issue, apparent solutions aren’t clear and sometimes lead to dead-ends.

“Anyone can discuss an issue,” says Chantalle. “But whether or not it’s helpful depends on experience and education, or else it’s going to leave a bad impression, get blown out of proportion or hurt those involved. People need to have an open mind.”

More than anything though, those who work with youth need to be empathetic, know how to listen and let self-harmers know that “they are loved and supported,” in Jessica’s words.

“A lot of the time we don’t even ask kids how they’re doing,” says Laye-Gindhu, who lists the most effective ways of helping as asking questions, being ready to respond and provide resources, being aware of our own biases, teaching healthy emotional functioning alongside academic curriculum, and recognizing the signs of self-harm.

These can include frequent scars, bruises or bandages, missing cutting and burning implements from the home and clothes that perpetually cover and hide, like long sleeves, long pants, wrist bands, etc.

One of the most current and ingenious harm-reduction tools available to self-injurers is the American “social-therapy” organization Project Toe. When a kid experiences that moment of panic or emotional overload that triggers them to hurt themselves, all he or she has to do is text the word “toe” to (331) 442-4863, and a “distracter” will reply with a question, comment or anything at all to distract them until their urge passes.

Although the project is still in beta form and unable to provide 24 hour service for now, this tool really seems to work, judging from the positive comments left on Project Toe’s Facebook and YouTube pages, like, “Tonight I felt like I was not alone in the world—thank you.” The organization has even launched a website that utilizes a live chat platform that works the same way as the texting tool.

The recovery process for each person is distinct, and for Levine it began with Leave Out Violence (LOVE), a space where she could speak openly about her problems and replace self-destruction with self-expression.

“Pain is healthy and real, but the ways you deal with it can be unhealthy,” she explains. “Now I express myself through art, and I rely on that to get out what I’m feeling. Instead of hurting myself and having that representation of pain on myself, I can have it on a piece of paper.

“I’ve learned that people appreciate me for who I am, and whether or not I’m cutting, I’m a valuable person. I still have a reason to be here.”

Photo by Sarah Wynne.