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The American Journal of Psychiatry, VOL. 157, No. 3

Book Forum: PERSONALITY AND ITS DISORDERS | March 01, 2000

Skin Game,

ARMANDO R. FAVAZZA, M.D.

Am J Psychiatry 2000;157:477-477. 10.1176/appi.ajp.157.3.477

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by Caroline Kettlewell. New York, St. Martin’s Press, 1999, 192 pp., $21.95.

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Many women who cut themselves ("cutters") seem to find some measure of relief by writing poems that are typically poignant, heart-breaking, visceral, and laced with bitter anger. Such poems derive from the horrific childhood physical and sexual betrayal and abuse that can be found in up to 60% of cutters. But what about the other 40%? What sort of stories do they have to tell?

Caroline Kettlewell, the author of Skin Game, is part of that other 40%, and, to my knowledge, she is the first to present a detailed personal account of cutting herself in which abuse and anger are supplanted by reasoned insight. Her astute observations and brilliant writing style keep the blood from spattering the pages. It is easy in this case to hate the cutting but admire the cutter.

This is the story of a bright girl who grew up in a Virginia boarding school for boys where her father taught. Her childhood was fairly normal; yet, she writes,

I needed to kill something in me, this awful feeling like worms tunneling along my nerves. So when I discovered the razor blade, cutting, if you’ll believe me, was my gesture of hope. That first time, when I was twelve, was like some kind of miracle, a revelation. The blade slipped easily, painlessly through my skin. As swift and pure as a stroke of lightening, it wrought an absolute and pristine division between before and after. All the chaos, the sound and fury, the uncertainly and confusion and despair—all of it evaporated in an instant, and I was for the moment grounded, coherent, whole. Here is the irreducible self. I drew the line in the sand, marked my body as mine, its flesh and its blood under my command. (p. 57)

Her family moved to Charlottesville, and her cutting, hidden from everyone, continued. In the seventh grade she

tried one night to cut deeper, torn between the anticipated thrill of a deep slash and the body’s organic mindless resistance to such assault.…To cut with conviction. To wound for the feverish beauty of the wound itself. I wanted blood—not the refined bubble of sundered capillaries, but a frantic spill, something beyond caution, beyond control. (p. 100)

I shall not take you through the frightful years of her life: the repetitive cutting, the anorexia, the failed first marriage, the psychiatrists, and the therapy. Rather, let us jump to about age 30, when she fell in love with a man of determined good cheer. She explained to him that her cutting, unlike alcohol or doing drugs, was not destructive. He replied that it was destructive because it hurt him. "I was surprised, taken aback, then, by the expectation implicit in his stubborn refusal just to let the matter slide—the expectation that true love obligated me to consider his feelings in the issue" (p. 167).

She married and finally came to grips with her longstanding depression. After treatment with an average dose of a selective serotonin reuptake inhibitor, the anxiety and unhappiness that had clouded and wasted the preceding two decades of her life were lifted. She stopped the medication, however, when she decided to have a child.

I went through my entire pregnancy feeling I was trying to pull off a sham, pretending to the part of the ethereal Madonna when I was wholly unqualified for the part. And yet, when my son was born into the waiting shelter of my arms it was as though the shape and structure of me had been made precisely to the purpose of fitting him. I was shocked by the fierce and immediate entanglement of this bond, that my son should become to me like a chamber of my heart. (p. 174)

She stopped cutting "only because I could afford to, because my need for it had apparently run its natural course…no matter how compelling the urge, the act itself was always a choice. I had no power over the flood tide of emotions that drove me to that brink, but I had the power to decide whether or not to step over it. Eventually I decided not to" (p. 177).

I have met with hundreds of cutters, and some have told me stories similar to Kettlewell’s. That, perhaps, is why I can still honestly offer hope to individuals whose lives have been overtaken by deliberate self-harm. Skin Game is a memoir and not an autobiography, so there is much about the author that is not revealed. Yet it is a solid book and a marvelous read. I, for one, am gratified that the author’s pen was mightier than her razor.

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ARMANDO R. FAVAZZA; Skin Game,. American Journal of Psychiatry. 2000 Mar;157(3):477-477.

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