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Mental Disorders

by Marilee Strong
Penguin USA, 1999
Review by Kathryn Walker on Apr 16th 2001

A Bright Red ScreamI am not a cutter. I do not self-mutilate. However, self-destructive behavior while not something I engage in to the extreme is not completely foreign to me; I have been known too drink to much, sleep too little or work too hard.

I never begin book reviews with personal revelations. However Marilee Strong's A Bright Red Scream is so emotionally powerful it forces its reader - it forced me to position myself. Strong, describes the phenomenon of cutting and self-mutilation with an overwhelming degree of compassion. Strong does not allow you, the reader, to assume an objective or clinical distance. She brings you into the lives, into the intimate details and the pain of those who engage in self-injury.

A Bright Red Scream opens by debunking the myths, which surround self-mutilation. Self-mutilation, one learns, is not suicidal behavior; it is not para-suicide. Furthermore self-mutilation is not a simply an exaggerated death instinct or a will to harm oneself. Rather in self-mutilation one can identify a dialectic of pain and healing. Self-mutilators harm themselves in order to heal themselves. In self-harm a deeper emotional pain is eased. In watching blood seep out of the body, self-mutilators purify themselves. In witnessing physical healing, self-mutilators find the only type of healing accessible to them. Fifteen year-old cutter Lindsey describes the life affirming aspects of self-mutilation: "If I'm, suicidal I want to die, I have lost all hope. When I'm self-injuring I want to relieve emotional pain and keep on living. Suicide is a permanent exit. Self-injury helps me get through the moment."[p32]

Strong locates at the heart and root of self-mutilation Post-Traumatic-Stress-Disorder (PTSD). PTSD has long been associated with the trauma experienced by soldiers in war. Abram Kardiner first identified the disorder in shell-shocked veterans of World War 1. However it was through studies of Vietnam War veterans that intensive research into PSTD began. It was not until 1980 that PSTD was recognized by the Diagnostic and Statistical Manual of Mental Disorders. PSTD offers a shift in perspective in the study of mental disorders. Rather than, in a typically Freudian sense, describing disorders in terms of an internal conflict between various components of the psyche. PSTD traces mental disorders back to traumatic experiences and external events. Thus self-mutilation can be understood in terms of traumatic childhood experiences.

Sexual abuse experienced by children is an extremely traumatic experience and one of the most common roots of self-mutilation. Other types of abuse, emotional and physical non-sexual abuse are also extremely traumatic and they too can set a foundation for self-mutilation. Often in abusive situations children learn how to dissociate. Dissociation is a common feature of people that self-mutilate. Often self-mutilators harm themselves in order to overcome dissociation and to feel something. Other times self-mutilators, dissociated in the very act of self-harm, cannot even feel the physical pain they inflict.

Self-mutilation viewed as a response to PSTD, can be understood as an attempt to reenact the trauma. Freud named the reenactment of trauma the 'repetitive compulsion' and understood it as an attempt to gain mastery over the trauma. More recent theorists understand the reenactment of trauma as an involuntary attempt to integrate the traumatic experience.

The significance of childhood abuse in the phenomenon of self-mutilation is overwhelming. Strong recounts the power of childhood abuse and its ability to cause a variety of severe mental disorders in adult life. For example childhood sexual abuse is a more likely to cause schizophrenia than two schizophrenic parents. Strong remarks on the current biological-genetic bent of current research into mental health and notes the problems encountered by researchers Frank Putman and Penelope Trickett of the National Institute of Mental Health. Despite the powerful effects of childhood sexual abuse, research money is not direct to research into the effects of abuse. Rather research money is poured into the hard sciences, into biology, genetics and neuro-chemistry. Thus a bias is created -economically. The flow of money, not the exigencies of the actual phenomenon, determines the most important cause in mental disorders.

Of the self-mutilators described in A Bright Red Scream many are women. In addition to engaging in self-mutilating behavior many of these women also have eating disorders. The connection between self-mutilation and eating-disorders is profound, rooted in childhood experiences and a relationship to pain. Strong comments that the coexistence of self-mutilating behavior and eating-disorders is not surprising as each is a way to reenact childhood trauma and as each uses the body to work out psychological issues. In fact Strong suggests that the two behaviors are so similar that eating disorders can be understood as a type of self-mutilation. In both of these behaviors a profound alienation from the body and hatred towards the body can be discerned. The connection between eating disorders and self-mutilation in emphasizing the peculiarities of these experiences of the body also points to desires to control the body, dissociate from the body, speak through the body, and deny the body.

The phenomenon of self-mutilation raises the ancient philosophical question regarding the relationship between the mind and the body. In the 17th century Rene Descartes, resurrecting ancient scholasticism, established a rational philosophy focused on the mind. Descartes effectively severed the mind from the body. He then with some snake-oil style philosophical maneuvers attempted to band aid the split in the mystical regions of the brain, but the damage had been done and Western philosophy has since been engaged in attempts to understand, negotiate and repair the mind-body split. Strong points out that in self-mutilation the intimate connection between the mind and the body can be discerned. She writes, "The body is, indeed, the temple of the soul. Cutters are living proof that when the body is ravaged, the soul cries out. And when the soul is trampled upon, the body bleeds"[p88].

A Bright Red Scream discusses trends such as piercing and tattooing and addresses the presence of self-mutilation in popular 'alternative' culture. Thus the question of the relationship between the 'pathological' and the 'normal' is raised. Furthermore it is demonstrated that the phenomenon of self-harm exists along a continuum. Thus self-harming behavior while it may shock, is also often something with which we can identify.

Strong's presentation of self-injury while emotionally trying is not pessimistic. In fact Strong in her discussion of treatment and recovery presents hope. For example at the SAFE program, an in/outpatient program designed for self-mutilators, we are introduced to thirty-two year old bulimic and cutter, Roxanne who is learning to replace self-injury with other behaviors and to incorporate more positive thoughts into her life. Roxanne comments on the affirmations that the program has taught, "You don't have to believe them…but I try to believe them for a whole day. The more I say positive things, the more I feel that they are part of my life"[p211].

Beyond being an extremely illuminating and informative analysis, A Bright Red Scream, presents a sympathetic, emotional, personal encounter with self-injury. Strong abandons the cold objectivity of science but in doing so loses none of the insight. A Bright Red Scream is a testimony to the power of an inquiry that dares to engage with its subject matter. Marliee Strong's investigative sensitivity in A Bright Red Scream is proof that an observer who is willing to listen presents an observation that speaks.

Kathryn Walker is a doctoral student in York University's Social and Political Thought program. Her work is focused on the relationship between moods, rationality and politics. Kathryn is also part of the j_spot editorial collective.