We have recently witnessed the dramatic rise and spread of self-injury, the deliberate, non-suicidal destruction of one's own body tissue, such as self-cutting, burning, branding, scratching, and more. In gathering data for our new book, The Tender Cut (NYU Press), we talked to a lot of people about their self-injurious careers: how they began, how it changed or developed, what maintaining the practice was like, and what drove or helped them to quit. People's length of involvement with self-injury varied enormously, depending on the reasons that drove them to the behavior, but we'd like to focus in this short post on desistance: how they quit it.
Some people, particularly teenagers who turn to it in response to "typical" adolescent problems of identity, friendships, maturation, and isolation, and who may feel themselves surrounded by an ocean of self-injurious behavior, move through the stages of starting to do it, rapidly escalating their involvement with it, and spinning out of it quickly. Their precipitating causes are painful but not drastic, and their lives may change as they form new relationships and get out of bad home and life situations.
Desistance is more difficult for those who become more deeply involved with the behavior, with people breaking free for reasons and at points in their self-injury careers that displayed certain patterns. The population winnowed down, with a gradually shrinking number of self-harmers from their teens to their twenties, thirties, forties, fifties, and beyond.
One of the strongest reasons people cited that drove them to cessation was quitting for others, an external "pull factor."People experienced a lot of pressure from friends and loved ones to turn away from this behavior. Some faced positive reinforcement and others were threatened with negative sanctions. Once, fighting cravings, Mandy reached out for support to her friend who helped talk her down from them. The conversation ended with her friend telling her that if she ever did it again, she would never speak to her. She felt so grateful for the emotional burden her friend took on that she quit:
"It is not that I'm afraid that she won't speak to me—I'm afraid that if I do it again, it's going to hurt her more. And it's such a private thing to begin with, to have them saying that they'll take care of you, you feel like you owe them so much, it makes them so afraid for you."
Other times people quit for themselves, being "pushed"out of deviance by their own involvement with it such as Jenny, who had always blamed others for her problems, but she finally took a really hard look at herself and decided this wasn't helping her. Once she did this, she was able to gather the strength to move on with her life. Quitting for one's self was often motivated by emotions. People quit because they were fearful they were going to get sent to the hospital, they were going to get discovered, they were afraid their friends would drop them, or their scars would show on a job interview. Jane felt guilty each time she cut, looking at her arm and not wanting to see bigger and bigger scars. After years of self-injuring, Hannah looked at all her scars and began to feel ashamed.
Life transitions often weeded out the population of self-injurers, with people quitting as they aged and went through the stages of life. Some quit when they moved from high school to college or when they graduated from college and got a job. Others fell away because they were in a serious relationship or they had children. As people aged, thus, the group of those still injuring got smaller and smaller.
People used a variety of techniques for quitting. Therapists helped some people break away by equipping them with other coping skills, giving them specific treatments or cognitive practices. Many individuals were helped by a variety of psych meds. Finally, people quit without therapy. Although the psycho-medical community promoted therapy, hospitalization, and drugs, these were not the only ways that people found the strength to quit. Chelsea, in a "cold turkey" quit, got the support that helped her recovery from her mother and on an online group called "sanctuary of love." Bonnie talked about the most helpful thing for her in quitting as learning was how to "surf the urge to cut." She described this as:
"It kind of comes in waves for me. I get these big tidal waves of emotion that rush through me and my first reaction for a long time was to cut, to make it stop. But now, if it's sadness, cry, if I'm angry, scream, if I'm ashamed, accept it. It's more about being mindful about whatever's happening to my body or my mind or my emotions at the time. But if I surf that urge, let it happen, it always passes. And that's actually been the most helpful for me."
Many tried, often repeatedly, to quit. Unsuccessful efforts, which ended in renewed self-injuring, could be called relapses. People rarely stopped self-injuring cold turkey, as Chelsea did above, but were triggered again and again. In fact, self-injury may resemble cigarette smoking in having such a large percentage of the participants in some active stage of trying to quit. "Slips" were one of the most common topics of Internet discussion, and were met with patience and understanding. The self-injuring career, then, was typically marked by people's phasing in and out, and they absolved each other of shame.
For some, the last quit was no different from any of the others, it just wasn't followed by a relapse. Those who built up to their exit gradually learned, along the way, how to manage their triggers better. For Matt, the trick to stopping was learning his "point of no return," coming to recognize the feelings that pushed him over the edge to injury. It took a series of major traumas to teach him these signs, but he then used them as a guide and tried to protect himself from such things. This awareness made it easier for him to get through the tough times. When he made it through one of these, he rewarded himself. The longer he was able to divert himself, the easier it got each time.
All in all, despite the tremendous feelings of benefit that self-injurers get from the behavior, people are able to desist over time and through their own initiative. Help in quitting can come from many places and range enormously in cost from the $30,000 a month specialty clinics to less expensive hospitalization or private therapists, to still cheaper psycho-medical drug treatment, or to support from friends, family, and/or online groups, which are free.