Maria responded by cutting on herself. In this instance, we have a patent metaphoric and literal alignment of psycholinguistic and palpablebodily expression. These events have created major emotional and psychiatric challenges for Maria. When Maria began the study, she had been admitted for a suicide attempt and ongoing postpartum depression. Prior to being admitted, she had an eating disorder, along with self-harming and abusing cannabis for two years. Her SCID diagnosis shows mood disorder due to a general medical condition, postpartum major depressive disorder, brief psychotic disorder related to postpartum depression, separation anxiety disorder, PTSD, alcohol abuse, cannabis dependence, and an eating disorder.For Maria, cutting was an intended if fraught means of communication in the face of the emotional pain of abandonment. This was not the first time she cut; her practice began at age 11 following the sexual assault by her mother’s boyfriend. In the narrative excerpt above, her motivation was explicit and her logic clear when her father proved unresponsive to her telephone call. In semiotic terms, cutting was a concrete bodily hurt that stood as a sign, the object of which was her emotional hurt, and the interpretant of which was her need for emotional connection. Along with bulimia that resulted in weight loss and “attention from guys,” it formed a complex related to self-esteem and the need for intimacy from males in the context of a close but troubled relationship with a mother marked by alcoholism. Though cutting proved ineffective in communicating with her stepfather,rolling flood tables it was apparently effective in a negative sense by addressing her emotional pain.

In this sense for Maria cutting was anagentive practice and bodily technique operating in tandem with bulimia—one technique to take away pain and the other to gain attention—against the background of multiple interpersonal traumas. Finally, she was able to evaluate bulimia as something that worked, but in a bad way. Secrecy and isolation are themes for her even though her mother and aunt discovered her actions and initiated a trajectory of consultation with a school counselor leading to hospitalization; in fact, Maria had already spoken to the counselor before this event without telling her mother. It was her mother’s contact, however, that led the counselor to suggest treatment. Maria insisted that she had not cut herself since leaving the hospital. Dana was a 12-and-1/2-year-old Hispanic and African American girl who lived in a small town south of Albuquerque with her adoptive parents, younger brother, maternal uncle, and the uncle’s fiance. Dana was adopted with her brother Jordan at the age of five. She had five younger siblings with whom she still had contact. Dana and Jordan were originally placed with a family in Las Cruces, but they were sent to their current home because that family only wanted Jordan. Their adoptive parents suspected a history of sexual abuse because Dana would “play with herself” when she first arrived. Dana was diagnosed with ADHD at the age of five. She reported having depressive feelings since the first or second grade, even having suicidal ideation in the third grade. She was placed in Treatment Foster Care in a nearby town for one-and-a-half years, from the third through fifth grades when she threatened to kill herself. When she was eight years old, she threatened her adoptive mother with a knife, which led to TFC for another one-and-a-half years. She narrated that the change was positive for her initially, but that her depressive feelings intensified later on. In February 2008, Dana began being more aggressive to her adoptive parents, cutting herself and writing threatening letters. Her parents decided to send her to a respite for the weekend; in response, Dana threatened to physically hurt her father and was taken to the hospital by the police.

After returning home, Dana was better able to control her anger; however, this did not last—she engaged in behavior prohibited by her parents, stole from her school and from her parents, and was eventually suspended. Dana had been receiving psychiatric treatment for several years at the time of her participation in the study, including anger management and medication for ADHD. Her mother viewed much of Dana’s aggression as typical adolescent growing pains or in the mother’s words “that raging hormone period.” Her diagnostic picture from the KID-SCID included ADHD , oppositional defiant disorder , and major depressive disorder . We have presented and analyzed these vignettes with an emphasis on experiential specificity and on the importance of youth’s own voices under conditions of structural violence. 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 relations4 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, 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.Finally,flood and drain tray 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, 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.