Pain: When Pain Is All You Have (cont.)

Until recently, self-mutilators like Lauren and Heather were bounced from emergency rooms to mental hospitals with little hope for complete recovery. Mental health professionals simply didn't know what to do with them. Even today, says Levenkron, emergency room doctors sometimes dismiss them, suggesting that they'd rather treat "real" patients, or they simply treat the surface wound and send them on their way. But thanks to increased media attention (the teen drama Beverly Hills 90210 featured a self-mutilation story line), the disorder is finally coming out of the shadows. Now a combination of techniques, including psychotherapy, antidepressant medication, and stress-tolerance and stress-management therapies, are being tried and found to help.

Helping Those Who Are Hurting

At Lader's program, she and her colleagues take a "tough love" approach with their patients, refusing to treat them like potential suicide cases, and ignoring the scars (they don't want the focus to be a show-and-tell of the patients' wounds). Instead, they use talk therapy to help them learn to take responsibility for, and control of, their actions.

The program is a last stop of sorts: SAFE patients have been hospitalized an average of 21 times before they get to Lader; one recent patient had been in and out of hospitals 200 times for treatment of self-inflicted wounds. Despite the odds, Lader says the intensive program has a 75% success rate two years after treatment. "Cutting is a way to be temporarily distracted from real feelings," says Lader, "and we help [cutters] learn to put a thought between the impulse and the action, to learn to deal with their feelings without 'self-medicating.' " The program seeks to uncover the motives behind the self-injury; one technique the program uses is having patients reach for a pen instead of a blade and write about their feelings.

As treatment for self-injurers becomes easier to find, friends and family can play a more active role. If you suspect someone you know is a self-injurer -- say you notice a series of similar scars in various stages of healing -- don't just ignore it. "Be direct but empathic," says Lader. "React in a caring way by saying something like, 'I've noticed scratches (or scars) on your body. Did you make them? I'm worried about you and want to help you get help.' " Don't minimize their seriousness, thinking the whole thing is just a harmless fad and that the wounds will heal with time. "Self-injury was my way of telling people that something was wrong," says McEntire, herself a "graduate" of the SAFE program, "but now I use my voice."

Dana Sullivan is a freelance writer based in Reno, Nev.

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