Reviving Ophelia - Mary Bray Pipher [83]
I agreed that Penelope needed to learn to tolerate frustration and to control her impulses. She’d had almost no practice. I borrowed an idea from psychologist John Lehnhoff and suggested that she develop the almost nonexistent “hate it but do it center” in her brain. This “hate it but do it center” is something many girls need to develop if they are to meet their own long-term goals. I use this phrase to discuss the difference between immediate versus long-term gratification of needs. Often what hurts in the short term is ultimately rewarding, while what feels good in the short term is ultimately punishing. This concept is hard for adolescents to grasp, but important for their growth into adulthood. Only when they have a “hate it but do it center” can they work in a systematic way toward goals.
For her next assignment, I suggested that she record and report her victories—denned as times she handled frustration in a mature way.
I felt good when Penelope left. I planned to do a kind of awakening therapy with her that involved building her a value system that was more nourishing than the one that had failed her. I wanted her to discover that relationships could bring joy and that the world is full of riches that have nothing to do with money. I hoped I could get her parents into some marital counseling.
But a week after our session, Penelope again tried to kill herself. Her parents had refused to buy her something she wanted and she’d swallowed pills. This time her doctor hospitalized her at an expensive private hospital. I never saw her again.
In my first ten years as a therapist, I never saw a client who mutilated herself. Now it’s a frequent initial complaint of teenage girls. Girls deal with their internal pain by picking at their skin, burning themselves or cutting themselves with razors or knives. This trend is particularly disturbing because most young women who have this problem think they are the only ones. As more young women came to my office with this problem, I asked myself why this is happening now. Why are young women choosing, even inventing, this at this particular time? What cultural changes have fostered the development of this widespread problem?
Just as depression can be described as anguish turned inward, self-mutilation can be described as psychic pain turned inward in the most physical way. Girls who are in pain deal with that by harming themselves. There are obvious explanations: Girls are under more stress in the 1990s; they have less varied and effective coping strategies to deal with that stress, and they have fewer internal and external resources on which to rely.
In my experience, behaviors that arise independently and spontaneously in large numbers of people often suggest enormous cultural processes at work. Eating disorders, for example, are related to the pressure that our culture puts on women to be thin. Self-mutilation may well be a reaction to the stresses of the 1990s. Its emergence as a problem is connected to our girl-piercing culture.
Self-mutilation can be seen as a concrete interpretation of our culture’s injunction to young women to carve themselves into culturally acceptable pieces. As a metaphorical statement, self-mutilation can be seen as an act of submission: “I will do what the culture tells me to do”; an act of protest: “I will go to even greater extremes than the culture asks me to”; a cry for help: “Stop me from hurting myself in the ways that the culture directs me to” or an effort to regain control: “I will hurt myself more than the culture can hurt me.”
Once girls begin to cut and burn themselves, they are likely to continue. Inflicting harm on the body becomes cathartic. In the absence of better coping strategies, hurting the self becomes a way to calm down. With time, the habit of inflicting harm on the self becomes more ingrained, so the sooner young women seek help the better.
What is the treatment? Ideally, we will change our culture so that young girls have less external