Mental health professionals: Misunderstanding self-injury since 1991

how I feel when I think back on my interactions with most therapists, shrinks, and social workers over the years

I feel like I need to start with a “not all men!”-style caveat here. Also, the misunderstandings I date to 1991 relate specifically to my own self-injuring; I have no doubt others have been having their SI misinterpreted for decades before that, at least. 1991 stands out for me simply because that was the year officials at my college quarantined me at night for two weeks to a bed in the Mental Hygiene clinic, partly because they didn’t know what else to do and partly because they only had to delay for those two weeks before I left for summer break.

So it was in 1991, while sitting in a motorized hospital bed in Mental Hygiene, that I was examined by a doctor brought in special for my quarantine–a doctor who glanced down at my injured arm and said, “Oh, those are just scratches! I was told there were cuts.”

I wish I could tell you that her tone implied relief, but what I heard was exasperation at having been called in on a Saturday morning for just scratches. And I really wish I could tell you that Dr. Mental Hygiene understood the risks involved in telling a 20 year-old overachiever that her cuts are only scratches, or that I was not the kind of overachiever who decided then and there that if ever I was to be hauled into Mental Hygiene again, I’ll by god show you I know what cuts are.

I also wish I could tell you that no one since has ever said to me,”Oh, I thought you said it was a cut! What you are describing sounds like a wound.” But that is another story, for another day.

I’m going to skip ahead here, passing over about ten years of many things, including “Find the truth your depression wants to speak!” and “If you ever cut again, I’ll terminate my services because you need to learn your actions have consequences.” Or else I’m skipping backwards here, passing back over another ten years of misdiagnoses and mis-medications and “You demonstrate excessive and inappropriate anger.” From 2000 to 2003 I worked with yet another Professional Someone: this time a licensed social worker and an intentional/unintentional expert in self-injury, a man who had set out to work with survivors of sexual violence and thus found himself deeply engaged with the community of cutters.

I liked D, and I trusted him. He was the first person who sat across from me on my patient’s couch with its inevitable end table inevitably littered with tissue boxes and said, “Cutting is just a maladaptive coping strategy.” He was the first one who let stand the words I myself chose to describe my injuries and who both openly shared his opinions and also welcomed my corrections when those opinions got it wrong.

The early 2000s was something of a watershed time for rapidly changing clinical interpretations and popular awareness of SI. The first memoir by a recovered cutter, Carolyn Kettlewell’s Skin Game, was published in 2000, as was the critically acclaimed YA novel Cut, by Patricia McCormick. Tracy Alderman’s compassionate self-help book, The Scarred Soul: Understanding and Ending Self-Inflicted Violence, finally became more readily available in bookstores than Armando Favazza’s egregious Bodies Under Siege, 2nd ed. (both published in the late ’90s). When my new therapist called SI “a maladaptive coping strategy” and nodded at me reassuringly, I nodded back: reassured not because he told me something I hadn’t already long known but because I had long known this–and it seemed finally others did too.

I liked D, and I trusted him.

And yet.

D’s training had occurred in the mid-’90s, a much less forgiving time period for people struggling with self-injury. “She refuses to grow up!” hollered our parents, as our therapists muttered ominously about “manipulative tendencies” and “frequent lying,” their pens forever hovering over the diagnostic checkbox for Borderline Personality Disorder. D never told me directly that he thought I was trying to manipulate him, or that I was lying about the motives behind my cutting behavior. He never used those words.

But I was aware of limits placed around what things I could say, what help I could ask for, how much of the desperation I felt that I could display. When I crossed those limits, the consequences felt severe and excessive. Abrupt cancellation of appointments. Demands that I drop my position–or else get out of his office. Once, lengthy confinement in a small room with padded walls before someone else finally agreed I could be let out.

No one ever said “manipulative.” No one ever said “liar.” But I realize now that the poisonous vapors of those words swirled around everything else we worked on. They hobbled every step of progress I made and stunted growth for all the change otherwise possible. They corrupted meanings of the words we did speak, words like hope and effort and cooperation. 

And trust.

Yes, especially the word trust.

Words for a Former Therapist

I pull my hands out of empty pockets and I push the burning coal that wants to be my beating heart deep down, further down, away from the knot that is my throat, out the bottom of the cage that is my bones. I bury the burning coal that wants to be my heart deep within my intestines and I smile with the face that is no longer my face and I say:


Yes if you humiliate me now it is surely because I deserve it. If you need to humiliate me now to find your own safety, if paying you to listen is not enough to make you willing to listen, I will heed your lessons. If I pay you to be trustworthy then surely you are trustworthy and if you make me feel that you do not trust me then surely I am not worthy of your trust and if I feel that it is I who does not trust you then surely I am wrong–

and anyway I have already swallowed the burning coal that wanted to be my heart. It is lodged deep within that inside of me that turns food to shit and I no longer hear it beating.

If you say that I can trust you then surely I do and so I trust you to know when humiliation is the lesson you need to teach that you will not be manipulated, not even by my truth that I see now was no truth, a once-truth that my grinning face will force down past the knot that was my throat, fully through the empty cage where the burning ember no longer beats. I will lodge my once-truths in the web that was my bowels and hope that my once-heart

burns them all to ashes.

# # #

“Misunderstanding Self-Injury…” is part of an ongoing memory project.
Additional installments can be found here.

10 thoughts on “Mental health professionals: Misunderstanding self-injury since 1991

  1. Two of my care-providers (one doctor, one therapist), sexually abused me. The poem so accurately speaks of how logic, guilt, shame twisted in me. What they did must have been my fault.


    1. I’m so sorry that happened to you. Have the sense from another comment you wrote (and a quick stopover at your blog) that you have since found mental health care support that is ethical and helpful? I certainly hope so!

      Trust can always get complicated in any situation involving huge power differentials — throw in the distortions that come from being raised in an abusive/dysfunctional family, and clients (or patients) often have no baseline guidance of what real “trust” feels like. One of many painful reasons why survivors of abuse or other trauma are at such increased risk of being re-victimized…

      Liked by 1 person

  2. Always pouring, never drinking! Always seeking, never finding. Always dying, never living. The power, pain and poignancy of your words brings tears to my eyes. I pray that one day you will find a good and firm place to stand on the ruins of those broken promises and self-serving “healers” and shout, “I am truly free!”


    1. After some time to think about your comment, I want to offer something of a corrective, because I don’t think most of the people I am talking about were “self-serving.” I’ve still got some anger, obviously–but I don’t want to undersell the difficulty of the work therapists do, or the human commitment that drives most people who enter these professions.

      Some of what I reference here was the result of people who were tired or aggravated for reasons that surely had nothing to do with me in that moment. Only one comment came from a person woefully unprepared for the work she was doing. My personal take-away from the (on-going) process of writing these things down is simply this: how very, very hard it is to truly listen to another human being. To sit still and open with that person in the space where she or he lives–and to listen with all that we are as that person describes her or his own fully unique and radical truth to us.


      1. Thanks for the corrective, AND the astute reminder to listen with great care. I’m reminded of an old (early 70s) album which carried this dedication: there are those who listen, and those who merely wait their turn to speak; this album is dedicated to those who listen.


        1. Hey there! 🙂

          Here’s another, similar saying (don’t remember source): there is a difference in listening in order to understand, and listening in order to decide how to respond.


        2. (To be clear, I meant a corrective to what I said, or to how I said it. Not to how you heard it–your feedback was a helpful insight into how I can come across!)


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