Thursday, January 17, 2013

Self Harm and Self Abuse

CUTTING,

HAIR PULLING, PICKING AT SELF, AND RECKLESS BEHAVIOR


Bodily awareness and health are the foundation of human beings able to imagine what others are thinking and feeling; and imagining others knowing what they are thinking and feeling. People with secure attachments carry around this knowledge of being seen and felt by others.  Deficits in attachment can lead to a lack of an ability to feel seen or felt by the world around one. As a person with disturbed attachment moves through development they learn to focus on understanding actions in terms of their physical, rather than mental outcomes. Only action that has physical outcomes is felt to be able to alter the mental state in both self and others. Physical acts, like self-harm, re-enforce this strategy.  When feeling acutely invisible the person looks forward to a known sensation.  The build up, the ritual and the act change the way the person feels. 

By violating the physical boundary of her body with a needle or a knife, she dramatizes the very existence of that boundary.  This reestablishes a sense of her own embodied self-hood. In addition the stinging sensation and the droplets of blood produced by the delicate cutting provide her with concrete sensory evidence of continuing aliveness.  In her more vulnerable states the ever increasing draw toward the repetitive action to repudiate the lack of attunement she expects and receives becomes greater.  The person may also prove to himself he is alive by pulling his hair, picking at himself or reckless behaviors. During these activities he feels somewhat soothed in the moment of high distress. 

These are horrible secrets that they want everyone, and no one, to know.  One of the challenges in therapy is that the structures that foreshadow self-harm rituals are established quite young.  The defense against not being seen or felt is matured through many avenues of early play. Therapy needs to provide enough of a holding environment to allow the client to experiment with infantile acting out to get their feelings across. It is difficult to develop a light, playful attitude in the dyad toward these life-threatening feelings. As they don't feel punished for existing, they may create a communicative behavior that they consider, "good enough". This often takes years of weekly psychotherapy.