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Students' scars point to emotional pain By Patrick WelshWith school out and the summer officially underway, some kids are going to be forced to come out of the closet if they want to get into bathing suits, shorts, tank tops or other comfortable apparel. I am referring to the "cutters" closet, where kids who indulged in what psychiatrists call self-injurious behavior (SIB) have been hiding during the school year.
After about 30 years of teaching at T.C. Williams High School in Alexandria, Va., I thought that nothing teenagers could do would surprise me. But last month, a bright, sweet 16-year-old girl shocked me when she rolled up the sleeves of her black shirt and showed me the scars from burns and cuts that she had made on both arms. She and her fellow cutters — a group of about 20 girls and boys, most of whom, she said, have horrible relationships with their parents — often compare and discuss how their wounds came to be. Nancy Runton, the school nurse, said such behavior is becoming more common. Just weeks ago, a student rushed to Runton's office to report a girl who was sitting in class cutting her arm with a piece of glass. After Runton hunted the student down, she learned the girl had been cutting herself for more than a year.

The next teen disorderIn one way, there is nothing new about self-injurious behavior. Some orders of Catholic priests practice self-flagellation; groups of devout Shiites in Iraq beat themselves in religious processions. But these culturally sanctioned rituals are not the same as the pathological self-injury among today's adolescents. Psychiatrist Joshua Weiner, who has treated adolescent cutters in metropolitan Washington, says self-injury is "the anorexia and bulimia of the new millennium." And just as Americans were slow to catch on to the problems of anorexia and bulimia 20 years ago, Weiner says, we are just now beginning to understand the nature and depth of this phenomenon.Parents and educators can't afford to let self-injury creep into the American lexicon. If we don't act aggressively to understand and treat these kids, the suffering will continue, with incalculable costs to these adolescents and our society.
Fortunately, awareness is growing. More books are being written. Scores of Web sites discuss the culture of self-injury. Help is available. Yet no definitive studies have determined whether the attention being paid to SIB stems from a real increase in the behavior or a greater awareness. Weiner and other health professionals say it is a combination of both factors. Kaye Randall, a social worker in Greensboro, S.C., and co-author of the book See My Pain! says she has seen an enormous rise in teen self-injury in her practice during the past five years. She also has seen audiences grow at self-injury seminars nationwide. A school system in Mesa, Ariz., has had such a big increase in self-injury that it initiated programs to help its staff understand and recognize the problem.

Standing question: Why?Some of this behavior is temporary, often an attempt to get attention from peers or parents. Sarah Ball, a senior in my English class, recalls that in the eighth grade, several kids who would cut themselves "were rebellious types trying to project Kurt Cobain teen angst. ... Some of them gave it up by high school, but some ended up being hospitalized." Though self-injury has a social component, Randall cautions against believing that kids are just trying to belong to a group: "Cutting and other forms of mutilation become a coping mechanism ... a way of dealing with powerful emotions that they don't know how to deal with. It's as if they have a volcano inside, and that has to erupt. Cutting makes them feel calmer."
In the worst cases, the calming effect can make self-injury addictive. Some studies suggest that cutting releases endorphins (neurotransmitters in the brain that reduce pain) into the blood stream. The young woman who showed me her cuts and burns said that after three years of mutilating herself, she is trying to stop but sometimes "falls off the wagon and goes on a cutting binge." Weiner, who defines SIB as the intention of harming one's body without conscious suicide intent, says the act can be a form of punishment. "I had a girl who was such a perfectionist that she would injure herself when she didn't do well on tests," he says. "Some boys cut because they are worried that they are gay and feel guilty and want to punish themselves."I feel a little guilty myself, having been oblivious to the self-injury problem, but it is not easily confronted. Kids feel such shame that they hide their wounds. A common theme on the numerous Web sites is getting beyond the shame. Also, the behavior seems so unnatural that parents have a difficult time accepting it. Educators and parents must look for clues to self-injury — some visible in the summer sunshine, others well below the skin — and address them openly, with no shame. The bloodletting will stop when kids learn healthier ways to deal with painful emotions.

Patrick Welsh, an English teacher at T.C. Williams High School in Alexandria, Va., is a member of USA TODAY's board of contributors.


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