Having examined the cutting experience of six among the 27 youths who narrated cutting and/or self-harm, it is evident that each has a highly distinctive profile while often invoking common themes of family relations and bodily experience, and we shall elaborate shortly a characteristic problematic of agency. Are these youths typical in any way, and if so typical of what? The challenges faced by many adolescents, certainly in the “Land of Enchantment” that is New Mexico’s self-description, are recognizable among these young people often in amplified form and complicated by additional factors that amount to extraordinary conditions both personal and structural . Their situations are often vulnerable and precarious, but there are various forms of vulnerability and precarity. They are, for example, not children who live “in the streets” like homeless children without families but children who are “in the system” with a trajectory back and forth from home to various settings of institutional care. These institutions vary along the axis of emphasizing what Hejtmanek has characterized as psychiatric custody and therapeutic process, terms that bear overtones of the carceral and the caring respectively. Indeed, conditions in some of the facilities where we interviewed study participants were sufficiently oppressive to count as just as much a form of structural violence as conditions of poverty, gender violence, and gang activity. Yet the larger scale politics of health care created another form of structural violence in the form of severe contraction of services under the regime of “managed care” that was ongoing throughout the duration of our project. Payment for both residential treatment and day treatment was approved with decreasing frequency, and the average length of covered stay decreased drastically. From the standpoint of CPH clinicians,vertical grow system this meant that patients were often being discharged to disorganized family environments which did not provide sufficient opportunity for their condition to stabilize or to less intensive levels of care for which they were not prepared .
Yet whether the experience leans toward the carceral or the caring depends not only on the character of the institution but on the different pathways into the hospital including through the police, the courts, physicians, families, and in some instances, volunteering. Once in the system, all are exposed to and inculcated with discourses of diagnosis, coping skills, and medication.5 Finally, although cutting is prominent among these youths who have been psychiatric inpatients, on the one hand not all of them are cutters and on the other not all cutters come to be psychiatric patients.What is critical in making anthropological sense of their experience is that suffering is not a barrier to interpretation and understanding because it partakes of the broader spectrum of human experience. Moreover, while we have a specific existential, ethical, and political concerns for the “extraordinary conditions” of this particular group of adolescent self-cutters who are psychiatric inpatients , their experience enacts and partakes of “fundamental human processes” and may highlight them in a way from which we can learn as much about the human condition as about a distinct pathological or cultural process. In other words, regardless of how troubled any one of them might be or appear to be, a careful look at their experience reveals the operation of fundamental human processes in a way that allows them to be seen not just as idiosyncratic individuals or representatives of a marginal category of afflicted subjectivity, but as having much in common with those who might more readily be classified as “typical.”With these considerations in mind, we must outline the range of issues that define the domain of cutting for these youths in treatment as a first step in understanding similarities and differences in their modes of bodily being in the world. Is cutting a learned behavior, and if so can it be called a “technique of the body” in the sense in which Mauss used that term? The answer is yes in situations where it is associated with the cultural complex defined by young people who define themselves as “emo,” “goth,” or “scene.” In this circumstance, the delicate cuts are, as one participant’s mother said, like a “badge of honor.”
There is indeed an element of technique evident in one girl’s report that while hospitalized another girl patient told her “you are cutting yourself the wrong way, you are supposed to cut down.” Particularly among SWYEPT participants, this learning could take place among peers in the hospital or residential care facility as well as at school or from siblings at home, and the mother of one of our male participants acknowledged that all three of her sons were “cutters.” Nevertheless, it is possible for cutting to be primarily a self-discovered practice, evident in one girl’s comment that “I was shaving my arm and I accidentally cut myself and I liked the way that it felt and that is when I started cutting. That is when I started purposefully cutting myself on my wrist.” These findings compare with a study of participants in online message boards that indicated a substantial group of cutters who had never heard of the practice before engaging in it, some even reporting they thought they “invented” it, not knowing they would feel better before they cut for the first time even if it was accidental, while a third of respondents had heard of or knew someone who cut before they began; self-learners typically began cutting at age 16 while those who learned from others began at age 14 . Cutting as an Emo technique is also most often associated with the apparently careful use of a razor blade and fits the model of “delicate cutting,” whereas among SWYEPT participants, there was in addition a range of implements used: fingernails, pencil, knife, toothpick, thumbtack, scissors, paperclip, binder ring, and broken glass. Using such a range of implements is not unique to these youths . Also in relation to Emo/Goth culture, cutting stands in relation to tattooing and body-piercing, the principal diacritics being that the latter are typically done by others and not by oneself and that the latter are often for performative display while cutting is typically concealed.Girls who wear “lots of bracelets” may be both adorning themselves and concealing the scars on their wrists. Placement is stereotypically on arms and legs, wrists and ankles, and one is inclined to interpret as more idiosyncratic instances such as those we recorded of poking under one’s fingernails, cutting one’s thumb, or cutting one’s stomach. Hodgson’s survey respondents often tried to pass by concealing their scars or created cover stories but sometimes also disclosed their cutting with an excuse for doing something wrong or a justification that it was a way to deal with emotional pain,cannabis grow rack but these disclosures did not include display as with stylized body modification.
With respect to severity, the continuum between delicate and deep cutting is significant among participants. On the mild end of the continuum, there are reports of scratching without drawing blood. Even dangerously deep cutting may be unintentional and, in the words of one mother, an instance of “going overboard” rather than aimed at serious self-harm or suicide. Likewise, even superficial cuts can be overdone, as in the report by one mother that her daughter had cut herself lightly with 63 times on various parts of her body. A final element of excess is the instance in which a boy carved his name in his leg and another in which a girl carved her boyfriend’s name in her arm. These are perhaps too conveniently expressive of gender stereotypes, specifically of the narcissistic boy and the infatuated girl.Onset of cutting can occur at quite a young age, and its duration varies as well. We have observed participants with only one transient episode of cutting, those in which it is habitual and compulsive and those who have had on-and-off periods of cutting with varying durations. This periodicity may occur either because conditions of stress may wax and wane or because the relieving effect of the cutting endures for a period of time before it in effect needs to be renewed.An instance of the former is a girl who, although she had been cutting herself periodically for several years, indicated that a recent episode was in relation to the conjunction of her grandfather dying and her boyfriend breaking up with her. A habitual instance is the boy who used a pencil or a toothpick as his instruments, though according to his mother he scratched but never broke his skin. He said, “Two months ago I started cutting myself. I just couldn’t stop cutting myself. I had the opportunity to do it, I couldn’t help it . . . sometimes it’s just no reason, other times, it’s just because I want to. It’s because I feel like it.” Notably, this boy indicated that the cutting did not make him feel better. The intentionality of cutting is complex, and as was the case among SWYEPT participants, cutting may be associated with other forms of self-harm such as head-banging, self-choking, bulimia, eraser burns, or drug abuse. The motivations typically reported for cutting in this study were depression, anger, frustration, stress, and tension. The intended results included relief, to feel good, to feel pain, to hurt oneself, and to see the blood. Notably, three of the participants reported that cutting did not make them feel better. With respect to integration of cutting into one’s identity as a mode of self-orientation, it was more common to hear that a young person “started cutting,” “cut myself,” or even “ended up cutting,” but there were instances of girls and a boy who declared either that “I am a cutter” or “I was a cutter.” The only other study of intentionality among adolescent inpatient cutters we have beenable to identify used the self-injury motivation scale II developed by Osuch, Noll, and Putnam , which taps factors including affect modulation, desolation, punitive duality, influencing others, magical control, and self-stimulation. The researchers found that the mean number of reasons cited for cutting themselves was 20 out of the 36 listed in the instrument as contributing to these factors and that 56% described their cutting as impulsive while 60% reported feeling emotional relief after cutting . Notably, males and females cited comparable reasons for self-injury, with a trend for females to use cutting for controlling negative affects more than males . Self-cutting is also not invariably linked to suicidality. Among girls who were SWYEPT participants, 18 reported suicidality, and 17 reported cutting; three of the cutters were not suicidal, and four of the suicidal girls were not cutters. Among boys, 14 participants reported suicidality, and 10 reported cutting; three cutters were not suicidal, and seven of the suicidal boys were not cutters. Moreover, cutting was by no means the only or the most common method for suicide attempts by participants. In this respect, we note the study by Gulbas et al.which expressly focuses on the relation between suicidal behavior and nonsuicidal self-injury among Latina adolescents in the United States.Gulbas and colleagues identify a series of factors relevant to both NSSI and suicide that correspond to features we found among the SWYEPT participants, including family fragmentation, conflict, physical and sexual abuse, and domestic violence. The relationships among these factors are complex and are found cross-culturally, though they tend to be more severe with suicide than with NSSI . Given the multiple challenges faced by our study participants in New Mexico, and the extraordinary conditions that define the contours of struggle for coherence in their lives, a focus on the specific act of cutting offers a necessarily limited but existentially critical insight into the nature of their experience. Without a doubt this requires attending to the question of children’s agency as a capacity with which youth are endowed, as we have invoked by citing childhood studies literature and in our analysis of individual vignettes. Childhood studies scholars embrace a concept of agency as a reaction against models of childhood with more structural and chronological substrates, allowing children to be recognized as meaning makers rather than passive recipients of action .