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Cutting: Understanding and Overcoming Self-Mutilation, by Steven Levenkron
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A seminal work on treating self-mutilation, revised and updated with illuminating case studies and newly available resources.
Nearly a decade ago, Cutting boldly addressed a traumatic psychological disorder now affecting as many as two million Americans and one in fifty adolescents. More than that, it revealed self-mutilation as a comprehensible, treatable disorder, no longer to be evaded by the public and neglected by professionals. Using copious examples from his practice, Steven Levenkron traces the factors that predispose a personality to self-mutilation: genetics, family experience, childhood trauma, and parental behavior. Written for sufferers, parents, friends, and therapists, Cutting explains why the disorder manifests in self-harming behaviors and describes how patients can be helped.
- Sales Rank: #140478 in Books
- Published on: 1998-09-14
- Original language: English
- Number of items: 1
- Dimensions: 8.30" h x .80" w x 5.50" l, .53 pounds
- Binding: Paperback
- 269 pages
From Publishers Weekly
The psychotherapist whose books (including the novel The Best Little Girl in the World) have illuminated the nature and treatment of obsessive-compulsive disorder (OCD), anorexia nervosa and bulimia now shines the spotlight on another misunderstood behavioral disorder: self-mutilation. Levenkron begins by advising desensitization to the disturbing wounds, scars and blood-letting patients inflict upon themselves, redirecting focus toward the underlying issues. He likens cutting to OCD in that it is a compulsive act meant to relieve unbearable emotional pain, and to eating disorders in that it is a method of seizing control. Like anorexics, most cutters are girls, unable to express anger toward others, instead turning it against themselves. Levenkron is careful to explain that cutting is not the same as body piercing or tattooing, which reflect "adolescent trendiness," and that cutters are not suicidal, their wounds life-threatening only rarely and accidentally. Cutting is done secretly, "usually in a trancelike state," and "the act of creating pain... or drawing blood, is in itself the goal." Cutters then develop an "addiction" to this method of exchanging physical pain for emotional pain. With many examples from his practice, Levenkron provides clear and comprehensive information on the causes and effective treatments of this mysterious disorder, specific advice for therapists and an encouraging sense of hope for patients and their families.
Copyright 1998 Reed Business Information, Inc.
From The New England Journal of Medicine
Self-mutilation, most commonly by cutting or burning, frequently begins in adolescence and may continue for a lifetime if the behavior is left untreated. It can cause permanent scarring, blood loss, infection (including human immunodeficiency virus infection), and even death. It is also psychologically dangerous.
Self-mutilation can be visually shocking -- imagine a crosshatching of ugly red gashes on an adolescent's arms and legs -- and eerily silent, a dramatic symbol that takes the place of words. It has the power to move not only psychiatrists and other mental health workers, but also the members of the emergency room staff, who bind and stitch the wounds of "cutters" and assess the likelihood that such persons will commit suicide; plastic surgeons, who are asked to remove the scars but often find their questions unanswered about how the wounds that caused them occurred; and youth workers in all areas -- hospitals, schools, and juvenile and residential facilities -- who may be struggling with more than one child who cuts, often in recognition of and in competition with each other.
Levenkron understands the need for sharing basic information about this taboo subject as well as strategies for treatment. As a therapist who has worked with this problem for more than 20 years, he has much to offer. Levenkron is also a gifted writer who, with this book, adds to the growing genre of creative nonfiction in which personal narratives and many of the other devices used in fiction attract the reader's attention, and engrossing stories provide information about a complex subject in a medical or scientific field. Stories are one of the oldest means by which we pass along information. I believe that today, physicians are hungry for stories. Most of our journals are filled with extensive research studies, and the case reports -- our stories -- are rapidly disappearing.
Levenkron fills his book with stories. The lives of Kessa, Annika, and Dina, for example, are described in spellbinding detail. I first heard about the book from two of my adolescent patients, one a girl who regularly cuts her arms and another who mostly restricts her food intake but will cut herself occasionally. These patients liked the book but had some questions about it. They felt that the lives and problems of the people Levenkron describes paralleled their own and validated their struggles with cutting. Moreover, they grasped Levenkron's well-articulated and repeated message that getting better requires replacing cutting with a trusting attachment to an understanding person.
They were puzzled, however, by some of his comments about medications, which he suggests are merely agents to stabilize hereditary chemical problems. My patients, both of whom had used medications that resulted in less frequent cutting, understood that their problems were a complex mix of many factors and that medication, individual therapy, and family therapy were all working together to help them get better. They knew that their depression was more than a biochemical imbalance and that their cutting behavior was more than a problem with attachment.
I liked much about this book. The writing is strong, and Levenkron addresses many aspects of cutting that heretofore have been taboo and does not look away. He has a clear message for those who cut -- in order to get better, you have to develop a trusting attachment to another person -- and repeats it over and over again, interspersing supporting comments, and so, as in many self-help books, seems to say to the reader, "You, too, can do this."
What troubles me is that this book is not written solely for people struggling with this problem, but also for a wider audience -- health professionals, therapists, friends, and parents -- and for these readers its main goal is to define good treatment of self-mutilating behavior. Here there are problems, and Levenkron's perspective is limited. From my own 20 years of experience with such patients and their families, I know that developing a trusting relationship with a qualified, knowledgeable person is an important part of the work. But there are other aspects of treatment to consider: the way medication can work with therapy to decrease symptoms, the way various life stresses can aggravate the condition, and the roles of individual, family, group, and cognitive therapies. The treatment of self-mutilation is complex, as are the factors that contribute to the behavior and the coexisting disorders and symptoms that present with the behavior. And for people who cut, as for anyone, not all depression merely reflects a hereditary chemical imbalance.
As a psychiatrist, I am disinclined to become involved in turf wars with psychologists and other mental health professionals. It has often been my experience that psychologists can describe and capture what psychiatry is and what it does better than psychiatrists can. But Levenkron's perspective seems biased. When he tells the story of the family of a girl who is referred to a psychiatrist because the previous therapist is overwhelmed by the serious nature of the girl's behavior, he says that the referral leaves both the parents and the child feeling "rejected, lost, and hopeless about obtaining successful treatment." Levenkron goes on to note that patients who are referred to psychiatrists feel that their problems are overwhelming to their initial therapists and too severe.
Yet Levenkron makes no recommendations for how to work with such fear. He does not suggest, for example, that a psychiatrist and therapist could work collaboratively on a case or that a patient could be referred to a psychiatrist and not be led to feel that his or her situation was hopeless. Instead, he reinforces the viewpoint that an adolescent will see himself or herself as a "psychiatric freak" if such a referral is made. Certainly not all patients who mutilate themselves need to see a psychiatrist, but psychiatrists are uniquely trained to work with patients with severe problems in which psychological, biologic, and social issues play a part.
I must recommend this book with caution. It is well written and engaging, and it educates the reader about a subject on which too little has been written. However, it does not provide a fully integrated perspective on treating self-mutilation, nor does it describe the many problems that frequently accompany this behavior.
Reviewed by Lynn Ponton, M.D.
Review
“Casts an eye on the emotional pains behind a dark adolescent practice.” (Salon)
“Levenkron understands well the need for sharing basic information about this taboo subject as well as strategies for treatments. As a therapist who has worked with this problem for more than twenty years, he has much to offer.... Well written and engaging, [Cutting] educates the reader about a subject on which too little has been written.” (New England Journal of Medicine)
“Clear and comprehensive information on the causes and effective treatments of this mysterious disorder.” (Publishers Weekly)
Most helpful customer reviews
7 of 7 people found the following review helpful.
Dated and Too Situationally Specific
By Kara Stenberg
The book is well-written and approaches this difficult subject matter with respect and dignity. There are plenty of case examples, including conversations, to give an idea of some of the mindsets of patients who self injure.
However, reading this book nearly 20 years after its publication and having experience in the mental health community it is apparent that a lot of progress has been made in understanding the subject of cutting and self-harm since the book was written. The case examples tend to be on the extreme end of the spectrum; I didn't feel the book covered a wide enough spectrum of "levels of mental health" in clients who self injure. In particular I noted an obvious lack of examples of adults who self-injure. The book focuses on teens and older children coming from rather intense backgrounds, which felt overly specific and seemed to ignore (or present a total ignorance of) those who self-injure as a whole as we are aware of this issue today.
While the author attempts to break down the taboo barriers in the discussion of self-harm and cutting, (and admittedly, there are still many in the mental health community who struggle to adequately support or help those who self-injure) the subject almost comes off as sensational due to its focus on the extreme.
There is still useful and well-grounded information in this book. As I said, the author led the charge at the time in understanding self-injury and presenting it as a treatable issue. Just keep in mind that in comparison to what we know now in the present day, the information comes off as a bit narrowly focused.
1 of 1 people found the following review helpful.
Better suited for friends for female cutters and friends or families of cutters.
By Brandon P. Isaacs
I have to agree with some of the other reviews, if you're a male cutter you're probably not going to get much value out of this book.
Personally I think this book would be ideal for the loved one or family member of a cutter trying to develop some understanding of what's going on.
That said I honestly just found most of this book to miss the mark for me. The psychology described in the book would probably describe 70% of cutters but absolutely missed the mark with me. I was really hoping to find some answers or insights to this book but frankly I found it tiresome and tedious to read through. I can't fault the book for being bad or misinformation, but I can't say that I did not enjoy this book and did not have a positive experience with it.
0 of 0 people found the following review helpful.
Direct and To-The Point with Compassion
By C. Ramirez
This book is very direct and to-the-point while being compassionate and non-judgmental - a perspective that I very much appreciate. The narratives that describe actual people who have experienced the practice of cutting are very helpful. I found the probable causes and explanations for self-cutting useful and applicable. This book explores not just the person who is experiencing the self-cutting, but the social and family dynamics as well. Be prepared to self-reflect if you are a family member who is close to someone who is experiencing self-cutting. I highly recommend this book for family members and therapists alike.
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