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Cutting: Understanding and Overcoming Self-Mutilation Paperback – September 14, 1998

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Editorial Reviews

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. --This text refers to an out of print or unavailable edition of this title.

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. --This text refers to an out of print or unavailable edition of this title.


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Product Details

  • Paperback: 269 pages
  • Publisher: W. W. Norton & Company; Revised edition (September 14, 1998)
  • Language: English
  • ISBN-10: 0393319385
  • ISBN-13: 978-0393319385
  • Product Dimensions: 5.5 x 0.8 x 8.3 inches
  • Shipping Weight: 8.8 ounces (View shipping rates and policies)
  • Average Customer Review: 4.0 out of 5 stars  See all reviews (103 customer reviews)
  • Amazon Best Sellers Rank: #71,108 in Books (See Top 100 in Books)

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Customer Reviews

Most Helpful Customer Reviews

16 of 16 people found the following review helpful By K. Anderson on August 23, 2004
Format: Paperback
What I found helpful about this book was the way Levinkron described how a patient should get help. It never occured to me that I should ask if a therapist/counselor/psychiatrist has had experience with self-mutilation or the importance of their medical knowledge and ability to treat a wound. Also helpful was his approach to how the cutter should heal. Levinkron understands that it is unrealistic to ask a cutter to stop cold turkey. Yet, I have never had a shrink who didn't ask me to. After reading Levinkron's book, I think I have a better understanding of how a cutter heals, and the importance of finding a good therapist/psychiatrist who can do that for me.

However, what disturbed me most about this book was the focus on female cutters. While I am well aware that statistics show most self-mutilators are female, I couldn't help feeling a little more lonely and isolated reading this book. It's really kind of a catch 22: Statistics show that most cutters are girls, so most therapists/writers don't worry so much about the guys. But many men won't come forward with their disorder, thus changing the statistics, because they don't feel there is an understanding of male cutters. I think this is an important issue, and that if somebody took the time to address it, many more males would be coming forth and getting help with their disorder.

That said, Cutting does have two (I believe) incidents of male cutters. But their stories are not developed and their scenarios are, at best, stereotypical and shovanist.

If anyone knows of any literature or anything else that addresses the male cutter, I would love to know about it. Thanks.
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24 of 26 people found the following review helpful By Janet Morris on January 6, 2002
Format: Paperback
This was the first book on self-injury that I got. I know that it isn't as good as A Bright Red Scream and Bodies Under Siege, which you must get if you cut or do other SI.
This book, however, is a good starter book. It is written by a therapist, Steven Levenkron, who has had to deal with patients who've done self-injury for many years.
He describes SI as the Anorexia of this generation. (He's written several books on Anorexia, too.)
This book has the basics of the whole SI world and is definitely worth the money you pay for it. So, I recommend all cutters and people who need basic information on self-injury get this book!
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20 of 22 people found the following review helpful By Happy Mother on January 3, 2006
Format: Paperback
After reading reviews that said Steven Levenkron was "arrogant," I had doubts about buying this book. However, I didn't find him arrogant at all - rather, he was calm, clear, concise, and very knowledgable on the subject. The book is rich with case studies, which I found very helpful to use as examples, as well as interesting on their own. Being a former cutter myself, I think he hit the nail right on the head when he described the reasons people cut, why people can't stop, and why it is so difficult to open up about it. Levenkron emphasizes that cutting is not a disease in itself: rather, it is a symptom of something larger, and that "something" must be addressed in order for the patient to be cured. Cutting is not necessarily a symptom of Borderline Personality Disorder, as was previously believed. It can coincide with an eating disorder, depression, anxiety, trauma, etc.

Another thing I found extremely helpful about this book was the section on helping people who cut. I bought this book to help someone I know who injures herself, and after reading this chapter in particular I feel much better equipped to approach her.

I thought Levenkron had a very gentle approach, and never placed blame on the patient or pushed them against the wall (so to speak) to force them to admit their problems. He is someone who I would have liked to see as a patient when I went through years of self-injury. I highly recommend this book to cutters, former cutters, people who want to know more about cutting and why it is done, and ESPECIALLY people who want to help a loved one who injures him or herself.
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26 of 30 people found the following review helpful By A Customer on August 10, 2003
Format: Paperback
this book, while sometimes helpful, is for the most part a series of anecdotes that merely show off levenkron's success as a therapist. it may well have useful aspects for the therapist seeking help on how to treat a patient, but even some of those are a little scary from a patient's perspective. it seems that although levenkron states things like "it took five years of therapy to get this patient through this journey" or what have you, he glosses over the length and concentrates on the many miraculous breakthroughs he makes.
if you are a teenage "cutter" or "self-mutilator" or whatever you want to call it, it may be more helpful than someone who is 29 and therefore out of his age group. i don't fit into any of his categories - i had a wonderful upbringing, was never abused and didn't start self-mutilating until i was 22. perhaps this is why the book seems so far-fetched to me. however, i do think his data-tracking skills are suspect.
i highly recommend marilee strong's "a bright red scream" instead of this book.
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17 of 19 people found the following review helpful By Bethany A. on September 16, 2003
Format: Paperback
I bought and read this book almost immediatly after it came out. To be honest, I had never heard of Mr. Levenkron before, but I was excited because someone had actually written a book on cutting--a "disorder" that at the age of 21, I thought I was the only person who suffered it. However, as I read it, I became angry and offended. Mr. Levenkron seems to group all cutters into one catagory--we are all from dysfunctional homes and also have eating disorders. This did not include me at all. As a result, I felt even more displaced. This was in 1997--before self-injury became the "affliction of the new-millenium" as so many people like to put it.
I wish I had a different non-fiction book about self-injury to recommend in place of this one, but I don't. And believe me, I have read extensively on this topic. Most of the books that I have read are one-dimensional or only suggested one possible route for cutters to get help. In fact, the only good book that I have read that deals with this subject is the novel "Cut".
It is distressing to me that this "problem" (and I don't mean to offend anyone for calling it that) is not being dealt with in non-fictional ways by anything other than speculative psycho-babble or fast-tracked memoirs that offer only one viewpoint that is supposed to encompass all those who self-injure (i.e. "Skin Game") In truth, to see a fair portrayal of self-injury, you're better off seeing an independant movie such as "Secretary" or "Thirteen" than reading anything that's out there right now. And as far as Mr. Levenkron, I hope he has realized that not all of us who cut fit neatly into his box. If we did, we'd probably all be cured by now.
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