The Navajo have many ceremonies that are designed to help them achieve a state of Beauty. For them, Beauty is not a manner of dress nor a way of appearing. It is a way of being. Their ceremonies help them to return to a state of balance, respect, and healing with the universe. They define this – balance, respect, and health – as Beauty.

The Navajo Unity Chant is a perfect example. (Navajo chants are not easily translatable into English. The chants are made up of “vocables” – sounds sung to drum beats that don’t translate well.) Here is a translation of the Unity Chant which communicates the power of the concept of Beauty in Navajo tradition:
You will walk in Beauty; the Beauty will walk before you; the Beauty will walk behind you; you will be surrounded by Beauty. We have beautiful things and now we must have beautiful minds; with beautiful minds we will have beautiful hearts; with beautiful hearts we will talk in Beauty. Those who speak with beautiful speech will lead the world to Beauty.

One Friday evening many summers ago, after a family weekend event, I was lying on my back on a grassy slope at the South Campus with a therapist friend. We were laughing together and comparing profound experiences from the two-day family weekend, and then he became very sober. He said he’d been thinking about innocence. To this day I don’t know why he decided to share his thoughts on that topic with me, but it had a lasting impact on how I think. He said he felt that people could reclaim the same innocence they once had as children. He felt that people who had been hurt deeply, people who maybe felt like their innocence had been robbed from them, forced from them, or taken from them could reclaim their innocence.

What he was saying was not that teenagers and adults could (or even should) become ignorant or childish again; he was saying that he felt that wounded people could become childlike again; that they could be in balance with the universe; that they could respect themselves again; that they could heal. He was saying, in essence, that people who feel like their Beauty has been robbed from them are mistaken – everyone can become beautiful again.

In the middle of the winter of 1863, 9,000 Navajo were forced to march about 400 miles to one of our nation’s first experiments with an “Indian Reservation”. They were compelled to march away from the lands between their four sacred mountains. They were forced to leave the spiritual protection of their homeland – something they had believed for centuries that they must never do. On a march that lasted weeks, they walked to Bosque Redondo in New Mexico – a million-acre reservation on a poplar-wooded curve in the Pecos River. To this day they refer to that forced march as “the Long Walk”.
The reservation at Bosque Redondo was a horribly planned location. The Navajo suffered disease and dehydration from drinking the putrid waters of the Pecos River. The first summer, their crop of corn was destroyed by worms. The rest of the winter they lived on meager rations from the army. The second year was the same. The third year a hailstorm ruined the corn fields. By the fourth year the Navajo simply refused to plant anymore.

Barboncito, a diminutive, thinly mustached Medicine Man, assumed the position of leader among the Navajo at Bosque Redondo. He kept the Navajo’s faith alive. Even though they were heart-sick because they were living hundreds of miles away from home, he encouraged them to remember their ancestral values and traditions by leading them in sacred ceremonies. He renewed their hope daily by advocating for them with the government and the soldiers stationed at the Bosque. In the face of enormous obstacles, his message was consistent – never, never give up.

By the summer of 1868 more than 3,000 Navajo had died – most of starvation. One third of those who had marched to Bosque Redondo had perished. General Sherman visited the failed reservation experiment in 1868 and was astonished at the misery and death he witnessed there. After an historic and emotional meeting with Barboncito, the general almost immediately authorized the Navajo to return to the sacred lands of their inheritance. Those lands are near what we call the Four Corners area of the west, where Utah, Colorado, Arizona and New Mexico all touch at the same point.

The Navajo were ecstatic to return to their homeland. In a caravan of natives that stretched over ten miles, they made the 400-mile walk home, this time willingly and joyfully.
As soon as they reached the Rio Grande and saw their beloved Blue Bead Mountain in the distance, many of them fell to the earth and wept . As they continued homeward, they spoke a healing chant, sometimes known as the Night Chant. Imagine their feelings as they spoke the Night Chant’s words, as their eyes gazed on their sacred mountains, and their feet crossed the boundary into their ancestral homeland:

In beauty I walk.
With beauty before me, I walk.
With beauty behind me, I walk.
With beauty below me, I walk.
With beauty above me, I walk.
With beauty all around me, I walk.
It is finished in beauty.

It is significant to me that they chose a healing chant at that moment. It is significant that they were homeward bound. It is significant that after all they had suffered they still believed that they could reclaim their balance and their respect. They believed that they could heal. They could reclaim their innocence. After all they had been through, they had preserved their way of being – they still had Beauty.

Like Barboncito, I believe that we should spend time reminding our clients – especially our adolescent girl clients – of the Beauty that surrounds them. Through the process of therapy, many of them learn balance. They re-learn self-respect. They heal. They reclaim innocence. They “return”, in many ways, to the way they were when they were more childlike. They walk in the way of Beauty.

*Navajo information taken from Hampton Sides’ book Blood and Thunder

As we talked, she unwound tape from her forearms – tape she had wrapped around paperclips pressed tightly against her skin, hidden under the long sleeves of her sweatshirt.  She handed me the various bits of metal she was planning to use to harm herself again later, and we talked of her reasons for wounding herself.

All of her reasons boiled down to pain:  the emotional pain caused by the shame she suffers for decisions she made in the past; the emotional pain, “burning through her veins”, as she described it, due to the abuse she suffered at the hands of someone who should have been safe and trustworthy.

Her solution to assuaging her emotional pain was to distract herself from it by self-inflicting physical pain.  Physical pain is something she can control. It is straightforward; it is easy to understand; it demands attention NOW.  Ironically (and effectively), it helps her to numb out and forget.

As we talked, she allowed her words to spill out, like a trickle of water that has filled a deep basin over time, and has just crested the lip of the reservoir.  She surprised herself.  It seemed as if she couldn’t stop the flow of ideas and emotions.

Ways Girls Self-Harm

Favazza assigns self-injury into three types¹: compulsive self-injury, episodic self-injury, and repetitive self-injury.

Compulsive self-injurers hurt themselves repeatedly in a day, and typically use some kind of ritual.  For example, a girl who cuts herself may store her razor blade in a special box on her nightstand, or keep it with her in a backpack, purse, or pants-pocket, wrapped in tissue paper.  She may cut at a designated time each day (like immediately after Algebra class) and may find she can’t sleep at night without first cutting herself.

Episodic self-injury occurs every so often, and is typically more secretive.  The self-harmer would likely not identify herself as a “cutter”.  Girls who only hurt themselves every so often tend to be reactive to some precipitating event, like breaking up with a boyfriend or failing a test at school.  Girls suffering from Major Depression or Anxiety disorders (like Panic Attacks or Generalized Anxiety Disorder) seem to be more susceptible to episodic self-injury.

When a girl begins to self-harm over and over, so much so that it seems like (or becomes) an addictive pattern, we refer to it as repetitive self-injury.  Young women who struggle to control their impulsivity have difficulty ceasing self-harm once they experience it soothing their emotional pain.  One 14-year-old cut herself on her stomach, right along her waistline, so that she could interfere with the wound throughout the day by moving her body against the waistband on her pants.  The pain kept her distracted from her parents’ pending divorce.

Prevalence

As you can imagine, due to the nature of the topic, many people are not forthcoming about their self-harm.  Accurate numbers about self harm are difficult to obtain².  Recently, however, key studies in Europe and the U.S. shed light on the prevalence of self-injury among young people.

In a massive, highly coordinated study³ spread out among seven countries in Europe, researchers found that teens engaged in high rates of self-harm around the age of 15.  In four out of the seven countries more than 30% of girls that age had harmed themselves.  We now know what we long suspected:  Girls are more than twice as likely as boys to cut their wrists and thighs, and to scratch or pinch themselves so hard that they leave a mark or bleed⁴.

Both studies found that most self-injuries go unaddressed.  Girls don’t tell their parents or therapists, or even their doctors, about their self-injury.  This is concerning, as self-injury is a highly treatable problem.

In the U.S., New York researchers found that almost 10% of college students surveyed had purposefully cut or burned themselves at least once. When researchers opened the definition of self-injury to include head-banging, scratching, and hitting (in addition to cutting and burning), one quarter of the 1,200 students surveyed responded that they had self-injured in one or more of these ways⁵.

A 2006 survey⁶ of over 3,000 Northeastern University students revealed that 75% of students who harm themselves had harmed themselves more than once.  Girls were more likely to self-harm repeatedly.  The Northeastern University survey corroborated the seven-country European survey in that the average age of the first experience self-harming was between 15 and 16 years old.

Why Girls Self-Harm

Why do girls harm themselves?  I think it will be helpful to get the answer straight from those who did it, rather than from stuffy researchers in white lab coats.  A few years ago I posted this question on Facebook for some of my former clients.  Consider Carin’s answer:

“I think you have to figure out the TYPE of attention the person is after . . . .  Because I didn’t want people to know I cut. I was very embarrassed by it. I went to great lengths to hide it. However, I did want attention. I wanted people to know something was wrong and to somehow see beneath the facade that I put up. There are people who cut for obvious attention– they do it then show their friends, etc, but you have to remember people like me who did it as a way to get attention but not directly.”

Many girls felt like self-harm became addictive over time.  This corroborates research which suggests that cutting the body releases endorphins⁷ that provide a mild “high” or “rush”.  Here is Betsy’s reason for cutting:

“I found it addictive. In the midst of it, I wanted to do it even without a clear ‘reason.’  I LOVED buying/stealing new razors. I thought about it all the time. Some of that might have been a way to get attention, like you said, Susan, but I also think it can be addictive just like losing weight/not eating/purging is addictive in those with eating disorders.”

In his book, Cutting, Steven Levenkron lists anger, self-medication, trading emotional pain for physical pain, guilt and shame, exhibitionism, and comfort as reasons for cutting.  His most important contribution to the literature about self-harm, early on, was his view of how attachment issues infuse almost every part of cutting⁸.  Additional reasons girls engage in self-harm are listed below:

• Increased Attention
• Cope with emotional pain in a physical way
• Addiction to the “rush” of self-harm
• Dissociate from something scary or overwhelming
• Acceptance of other “cutters”
• Pre-suicide gesture
• Cry for help; expression of inner turmoil
• Art – to some, blood is beautiful
• To punish self or loved-ones
• A form of religious worship to expiate guilt
• To feel again, to drive away apathy
• To sense if self is real
• Sexual pleasure
• Impulse

Provide Options to Replace the Self-harm

It is imperative that we provide other options for young women who are hurting themselves, yet have expressed a desire to stop.  New habits and new coping skills provide a line of defense against self-injury, especially when the girl is feeling lonely.  Melissa said,

“I know it helped me to learn other coping mechanisms and use them. Find other ways to get out your feelings, a way that works for you. Some people like talking. Some like music or art, journaling etc. You have to find what works for you. And a lot of times it doesn’t feel as good as cutting, which may seem like the best quick fix, but if you get through to the person that in the long run it makes problems worse, then getting through it in a different way is more acceptable.”

Here is a short list of options for replacing self-harm, some of which I’ve found to be better than others⁹:

• Relaxation techniques
• Try not be alone (visit a friend, go shopping, etc.)
• Listen to music
• Go for a walk
• Write in a journal
• Learn to confront others respectfully/make your own feelings known instead of keeping them inside
• Take up a sport (a form of exercise can help you release tension)
• Work with paint, clay, play-dough, etc.
• Draw a picture of what or who is making you angry
• Instead of harming yourself, try massaging the area you want to harm with oils or creams
• Go to church or your place of worship
• Wear a bracelet or something that will fit on the places that you injure.
• Break the object that you use to self-injure as a way to show that you have control over it
• Write the phone number of a friend on your wrist
• Play some kind of musical instrument.  Even if you don’t really know how to play, picking out tunes is a way to concentrate and help get rid of the urge to harm yourself
• Yoga
• Allow yourself to cry.  Getting the tears out can make you feel better
• Make a list of reasons why you are going to stop cutting.  Carry it in your pocket or tape it to the bathroom mirror.  Every time you get the urge, read the list to remind yourself why you shouldn’t

This article is brief by necessity.  Suffice it to say that if we have established a physical environment that is safe and we have a healthy, affirming relationship with the young woman, we are off to the right start.  If she trusts us enough to show us her scars, tells us how, when, and why she cuts, and she begins to explore the deeper issues that plague her, we are close to helping her stop self-injury.  Providing her with a slew of new options that work for her helps assure that success is right around the corner!

References:
¹Favazza, A.R. 2nd Ed. 1996.  Bodies Under Siege.  Baltimore: The John Hopkins University Press.
²Cornell Research Center on Self-Injurious Behavior in Adolescents and Young Adults; http://www.crpsib.com/whatissi.asp#common
³Deliberate self-harm within an international community sample of young people: comparative findings from the Child&Adolescent Self-harm in Europe (CASE) Study; Nicola Madge, Anthea Hewitt, Keith Hawton, Erik Jan de Wilde, Paul Corcoran, Sandor Fekete, Kees van Heeringen, Diego De Leo, and Mette Ystgaard
⁴Whitlock, J.DL., Eckenrode, J.E. & Silverman, D. (2006).  The epidemiology of self-injurious behavior in a college population.  Pediatrics, 117(6), pp. 1939-1948.
⁵Whitlock, J.L., Eckenrode, J.E. & Silverman, D. (2006). The epidemiology of self-injurious behavior in a college population. Pediatrics, 117(6), pp. 1939 -1948.  http://pediatrics.aappublications.org/cgi/content/full/117/6/1939?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=self+harm&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
⁷Purington, A. and Whitlock, J.; ACT for Youth Upstate Center of Excellence’s Research Facts and Findings; August 2004, pg. 2; www.actforyouth.net
⁸Cutting:  Understanding and Overcoming Self-Mutilation, Steven Levenkron, M.S., © 1998 by Lion’s Crown, Ltd., W.W. Norton and Company, New York.
⁹Many ideas for this list came from: http://www.mirror-mirror.org/selfinj.htm