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Scar tissue

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Scar tissue

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SCAR TISSUE

by

Tom Quinn

A Professional Project Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF ARTS
(PRINT JOURNALISM)

May 2009

Copyright 2009 Tom Quinn

ii

Table of Contents

Abstract……………………………………………………………………………iii
Scar Tissue……………………………………………………………………….…1

iii
Abstract
Self-injurious behavior, which often manifests itself in the form of cutting or
burning, is often the physical expression of profound emotional pain. What follows
is the story of my struggle with cutting and the debilitating anxiety that initially
drove me to self-injury as a means of coping.

1
It’s well after midnight, and I’ve been in bed for hours. I lie on my back,
staring wide-eyed at the ceiling fan whirring over my head. The green glow from
my digital alarm clock mocks me even as the passing minutes and hours feed my
restlessness. I’ve got jars full of colorful tranquilizers and absurdly named sleeping
pills on the nightstand next to me, but when I’m wired like this I need something
more immediate, something more hands-on.
After listening carefully to make sure the rest of the house is asleep, I sit up
in bed, gather my tools and quietly make my way downstairs in the darkness. By
now I’ve memorized each step, and I know exactly where to place my feet to keep
the old floorboards from making any noise.
Once I get to the kitchen, I turn on the light and lay out paper towels, gauze,
antibiotic ointment and serrated knives. The ragged edges mean more blood with
less effort, and tonight I’m out for blood. I need it to calm myself, to get a handle on
my racing thoughts.
I cross my left leg over my right, exposing an area of my calf that I haven’t
worked on for a while. Knife in hand, I carve a series of parallel lines that run from
my knee to my ankle. If I listen closely I can hear my skin ripping as I drag the knife
across, leaving cuts that will scar but aren’t deep enough to need stitches. Within
seconds the blood starts to seep out, slowly at first but more quickly as the droplets
run together and surrender to gravity. I let it drip down my leg, warm and sticky and
wonderful.
I use the paper towels to clean up the mess, mopping up the blood like so
much spilled Kool-Aid. Once the bleeding has slowed, I slather on a thick coat of

2
the ointment. Say what you will about my sanity, but my hygiene is tip top. I wrap
my leg tightly in gauze, mostly to avoid leaving any evidence on my sheets, and head
back upstairs, the quiet house none the wiser to my ritual.
Curiously, at no point during my self-prescribed treatment for insomnia does
it even occur to me how unhinged a person has to be before flaying his or her limbs
starts to seem like a good idea. I know that some people who cut themselves feel
guilty or shameful afterward, but I feel a calm even a Zen master would envy. In
fact, the only thing bothering me as I slip into a dreamless sleep is that nothing
bothered me at all.
I could keep cutting forever, and that scared the Hell out of me.

*****

Pop culture might portray cutting as reserved for rich, emotionally immature,
white kids desperate for their parents’ attention, or for weirdo gothic wannabe
vampires who enjoy the taste of their own blood. Or for mental patients on suicide
watch, teen drama queens with daddy issues, self-punitive religious types. In truth,
however, it doesn’t matter. Each stereotype contains a grain of truth, and they’re all
equally compelling. We’re all cutters, and our reasons for doing it are just as
diverse.
“Pigeonholing people who hurt themselves in [as attention seekers] is
dangerous because it sends the message that a very serious behavior is really not a
big deal,” says Dr. Sari Shepphird, Ph.D., a Los Angeles psychologist who

3
specializes in treating maladaptive behaviors like eating disorders and self-harm.
“This isn’t a phase that’s just going to go away on its own. This is something that
some people will struggle with for their entire lives.”
Cutting, burning and other injurious behaviors fall within the category of
deliberate self-harm, which is defined by mental health professionals as the
deliberate, direct destruction of body tissue without conscious suicidal intent but
severe enough for tissue damage to occur. It is important to distinguish this type of
behavior from similar but more socially acceptable activities (i.e., branding,
tattooing, piercing, etc.) as well as legitimate attempts at suicide. The underlying
motivations for each action differ significantly. Whereas the body “artist” alters his
or her physical appearance as a means of expression and the suicidal individual seeks
death, those who engage in self harm are most likely using it as a means of dealing
with emotions that are difficult or even painful to face.
“Suicide and self-harm are two totally different things,” insists Shepphird.
“Suicidal patients are trying to actually end their lives, while people who turn to
cutting or burning themselves are usually looking for a way to make life more
livable.”
Even the medical community sometimes fails to make this distinction as it
gropes to understand deliberate self-harm. What little research has been done on the
subject tends to feed the stereotypes, since it has focused almost exclusively on
adolescent females.
The typical life story of an adolescent female cutter often includes a history
of physical or emotional maltreatment, substance abuse, eating disorders, and/or a

4
failure to establish a healthy bond with one’s parents. While this set of risk factors
may be useful in treating teenage girls, it rarely applies to adults, especially males,
engaged in deliberate self-harm. I’ve never touched drugs or alcohol, I have a solid
relationship with my parents and the only experience I have with abuse—substance
or otherwise—comes from reading Irvine Welsh, a Scottish novelist notorious for
broaching the traumatic and the taboo.
“I think a lot of research still needs to be done,” says Shepphird. “There are
any number of reasons why an individual could present with this type of behavior,
but I think we’re a ways away from being able to really pinpoint and address specific
risk factors.”
A group of studies conducted over the last five years suggests that a
combination of two personality traits may play a major role in the development of
self-harm as a coping behavior. The first is a tendency to experience what
psychologists call negative intrapersonal and interpersonal consequences, which
include severe feelings of regret, guilt or shame. In my case, my religious
upbringing instilled in me an intense fear of hellfire and damnation which, combined
with my perfection-driven personality, left me vulnerable to feelings of intense guilt
and shame for something as minor as an accidental profanity in a moment of anger.
The second trait has to do with the inability to appropriately express feelings
in general, and negative feelings in particular. Growing up, I was the picture of
stoicism. I felt a certain disdain for bleeding hearts and touchy-feely types, and
looked down on them as inferior. In other words, I was prone to intense negative
emotions, yet never learned how to deal with them in a healthy manner, making me a

5
prime candidate to turn to self harm later in life as a means of holding myself
together.
“We’re starting to see that a lot of people who hurt themselves in this way
come from backgrounds where emotions weren’t dealt with properly or [were] even
ignored entirely,” says Shepphird. “Not everyone is born with this innate ability to
tell other people how they’re feeling. Some people really struggle to learn how to do
that.”
Part of the reason why self-harm is so poorly understood by the general
public has to do with its counterintuitive nature. While most people can at least
understand, if not appreciate, the therapeutic qualities of crawling into a bottle of
cheap wine or eating away one’s feelings at the local McDonald’s, a healthy person
isn’t likely to comprehend the benefits of self-destructive cutting or burning. Only
someone who has experienced crippling emotional pain with no other apparent
recourse can understand why cutting feels so damn good. It takes a truly
maladjusted individual to appreciate the relief that comes from self injurious
behavior.
“People come to rely on this behavior because it does work, albeit briefly,”
says Dr. Janet K. Smith, Ph.D., another Los Angeles psychologist who specializes in
maladaptive coping behaviors. “Inflicting pain releases adrenaline and endorphins
into the system, which really can make you feel better.”
Smith, however, stresses that the euphoria that accompanies the release of
such chemicals is only part of the reason people deliberately harm themselves. After
all, dozens of activities—exercise, sexual intercourse, and so on—can cause similar

6
chemical reactions in the brain and body and are often as effective at elevating mood.
According to her, self-injury has a cognitive component that borders on delusion.
“In some cases I think we’re talking about beliefs that are very far removed
from reality,” says Smith. “The idea of blood flowing and sort of releasing or
washing away negative feelings is not something that makes sense to most people.”
If something makes sense to most people, it ceases to be crazy, doesn’t it?

*****

I remember the day I lost my mind like some people remember their bar
mitzvahs or college graduations. It was a defining moment. I can trace all my
anxieties, depression, cutting, medication and therapy to that one afternoon. Nothing
has been quite the same since.
While some people describe a gradual descent into madness or at least exhibit
some sort of warning sign, my plunge gave me whiplash—zero to crazy in three
seconds flat. One minute I was at peace with the world, and the next everything
changed. Down was up, black was white, right was wrong. Oh, and suddenly I
hated myself and felt like I didn’t deserve to live.
From 2002-2004, I lived and worked in Sao Paulo as a missionary for the
Church of Jesus Christ of Latter-Day Saints. Shortly after arriving, I began to
experience what would later—much, much later—be diagnosed as a type of severe

7
anxiety disorder; the combination of my isolated location and LDS beliefs forced me
to deal with the problem entirely on my own.
While other missionaries sang hymns, wrote enthusiastic letters to their
families and otherwise relished being engaged in what they saw as God’s work, I
was all but paralyzed by an intense fear or dread that seemed to have neither cause
nor explanation. I wanted to run, to get away from something, but at the same time I
felt hopelessly trapped. I could shave, iron my crisp white shirt and knot on a tie, but
still I felt infinitely uglier than the slums and shanty towns that spread for miles in
every direction. Sleep was often out of the question; I spent many a night curled up
in a ball while listening to the Velvet Underground or some other contraband music
on a tiny tape deck that was held together almost entirely by electrical tape and
stickers. My pious superiors would have taken it away if they had known about it,
but that tape deck was the only thing giving me the gumption I needed to keep
knocking on doors during the day.
Had my problems ended there, I might have remained stable during my two-
year mission. Early on, however, I learned that nothing exacerbated my mental
illness quite like religion.
For many Mormons, the prescription for physical and emotional well-being
while on a mission is simple: Faith plus hard work equals a happy, healthy
missionary. Should a missionary find himself discontented in any way, it follows
that the underlying cause must be a deficiency in one of those two areas. Thus all of
the solutions proposed by my ecclesiastical superiors involved some combination of
reading the scriptures, praying and/or working harder. And because none of their

8
solutions did anything to make my life any more tolerable, I concluded that I was
defective, irreparably damaged. I was convinced that the God I was purportedly
serving didn’t care about me—or worse—didn’t even like me.
It took almost a year before I began to consider that the people around me
were unable to grasp the problems I was facing. It wasn’t until the lone church-
approved psychologist in all of South America—a “Dr. Blake” who lived in
Santiago, Chile, three time zones away—literally diagnosed me, via telephone, as
being possessed by Satan that I came to a very important realization about my
superiors: I was mentally ill, but they were all out of their goddamn minds.
From that point forward I took matters into my own hands. I wanted to self-
medicate, though my religion prevented me from employing any of the traditional
controlled substances. Over several months, I tried on maladaptive behaviors like a
teenager tries on outfits at Forever 21. Thinking I might have obsessive-compulsive
disorder, I tried to manage my anxiety by engaging in repetitive behaviors such as
counting things, cleaning obsessively, and turning lights on and off.
Desperate for a way to ease my pain, I experimented with, in order:
overeating, starving myself, engaging in compulsive exercise, lapsing into near-
catatonic laziness, wearing nothing but earth tones, and avoiding earth tones
altogether. All somehow seemed logical at the time.
No dice.
My futile experiments also attracted the wrong kind of attention. A Mormon
missionary’s status comes from his ability to conform, to think how he is supposed to
think and act as he’s supposed to act. Those who fall outside the standard deviation

9
are often labeled “problem missionaries,” and are subject to more scrutiny than the
rest.
Considering I had already struck out with the church-approved psychologist
in Santiago, I was probably one faux pas away from weekly one-on-one meetings
with my Mission President, who was basically the Mormon equivalent of a Stalinist
East German party official. In short, what I needed was a secret coping behavior—
maladaptive or otherwise—to help me manage my crippling emotional pain.
And so began the cutting. A high school friend of mine swore by it, so I
figured I might as well give it a shot. It didn’t come naturally at first; I probably
stared at my leg for a good hour—starting, stopping, and starting again—before I
found the courage to do it. But once I saw the blood and felt the calm it brought, I
knew I was on to something. Relief was almost instantaneous.
Cutting was my new God, my new Yahweh, my new Allah, peace be upon
Him and His messenger.
The pain associated with slowly dragging a knife across one’s skin is
different from an ordinary injury; it’s like nothing else I’ve ever experienced. When
you snag your arm on an exposed nail or step on a piece of glass or dice your finger
while cutting onions, the injury portion of the experience is over almost before you
realize what’s happened. You curse, apply pressure to the cut, and feel the pain ebb
and flow with the beating of your heart.
Consciously cutting oneself, however, is a whole different ball of wax. The
initial pain is mild, but it builds exponentially toward unbearable. The feeling is
comparable to a burning sensation, and in a quiet room you can actually hear your

10
skin ripping as it surrenders to the knife’s jagged edges. It sounds brutal, but the
peace it brought me was practically celestial.
Regardless of what I was feeling, cutting helped—be it anger at those who
kept me trapped in Sao Paulo or a mix of bitterness and envy towards every
missionary who didn’t cry himself to sleep every night, or disappointment in myself
for not being strong enough to tough it out. The welling blood eased my emotional
pain and somehow made it tangible. Then, only with cutting, could it be temporarily
exorcised.
Work became more bearable, primarily because I knew that a measure of
relief was waiting for me as soon as I returned to whatever crappy apartment in
whatever slum I called home at the time. I would look at my watch, note how much
longer I would have to hold out, and tick off the number of hours that stood between
me and my knife.
In the years following my return from Brazil, cutting continued to be my
preferred means of dealing with problems. I spent six months in therapy and
sampled various medications with names like those of faraway planets: Zoloft,
Paxil, Prozac. As a result, the frequency and intensity of my cutting waned and even
disappeared entirely for a time. But whenever pressure piled up and threatened to
upset my tightly controlled universe, I could find solace in the red streaks my blood
left as it dripped down my arms and legs. The small serrated knife I kept hidden in
my desk drawer was always available. It never let me down.
I generally did a good job of keeping my wounds and scars hidden from the
rest of the world. Still, there were times when my carelessness led to awkward

11
conversations. I used to get flustered when confronted, but that was before I realized
that most people will accept almost anything in order to avoid facing the fact that a
friend or loved one actually needs to cut himself. My explanations would range from
the probable (caught some barbed wire while climbing a fence) to the vague
(gardening accident) to the absurd (got my arm stuck in a vending machine).
Eventually, I began to challenge myself to come up with a different cover story for
every inquiry. It was fun for a time but ultimately made me lonely; no one else
would ever understand why I was laughing.
The deepest, most violent scars on my body correspond with my starting grad
school at USC in fall of 2007. As accustomed as I was to placid Salt Lake City, I
nearly drowned in big city anonymity during my first few months in Los Angeles.
Making new friends was a slow process; I saw a lot of movies by myself. I moved in
with my aunt and uncle to save money, but their house seemed cold and their
stainless steel kitchen gave me the feeling of having been abducted by aliens.
Cutting helped me cope, but I found myself needing more and more blood to
achieve the sense of equilibrium I had gained in the past. Worse, I got to the point
where cutting didn’t even register as painful. It became part of a routine, like
trimming my nails or shaving. The cuts, which started out as little more than
scratches, got progressively deeper. Two or three of them probably warranted
stitches, but I never sought medical attention.
Aside from the obvious, the trouble with wanting to cut yourself all the time
is that the opportunities don’t present themselves as often as you’d like. My anxiety
would show up anytime and anywhere, but I wasn’t always in a position to drop

12
everything and start slashing. I even put together a travel kit with a pocket knife and
some bandages, but I still found myself in situations—at school, at work, or in long
movies—where I would have to wait hours before I could indulge. I once spent an
entire afternoon curled up under the covers in my bedroom at my aunt’s house,
waiting for an opportunity to get my tools out of my car. It was Saturday, however,
so she and my cousins were content to lounge in the den, talking, laughing, and
effectively separating me from my waiting knife. All the while, I hid from the
world, feigning sleep and shivering in spite of the warm weather. I thought about
calling someone, but I knew that no amount of conversation would make me feel any
better.
I was a junkie and cutting was my drug of choice. I needed help.

*****

Since then, I’ve spent many an afternoon in my psychiatrist’s office, a posh
suite in Santa Monica that boasts floor-to-ceiling windows and a view that stretches
from the ocean six miles to UCLA. The meticulously-arranged furniture and
spotless cream-colored carpet give off a feeling of cold sterility, but the scattered
papers and dog-eared books that adorn her desk and shelves lend the place a sort of
lived-in feel. The décor reflects the woman: she has her distant, professional side
that uses four clocks scattered about the office to make sure her appointments end on

13
time, and another side that quotes lowbrow slapstick comedies and makes bizarre
statements just to see how I will react.
The early sessions with her were a fencing match. We were feeling each
other out, trading points and counterpoints, most of which had to do with the pros
and cons of self-harm. I wasn’t entirely convinced that cutting was a bad thing. I
wanted to get it under control, and I certainly wanted to deal with the underlying
anxiety and depression. Stopping altogether could wait.
“You’re going to have scars all over your arms and legs.”
“Yeah, but they’re not very noticeable, and people rarely just assume I’m a
cutter.”
“Some people are going to make the connection, and they might judge you
for it.”
“Anyone who would think less of me because of something like that probably
isn’t someone I want to have around anyway.”
“You could seriously hurt yourself.”
“I know what I’m doing. I stay away from major blood vessels, and I
sterilize everything. To prevent infection, you know.”
I knew on some level that cutting was unhealthy and that sooner or later I
would have to find a different way to deal with my problems, but as a 24-year-old
graduate student with no time and less money, I figured I would worry about
becoming a well-adjusted individual once my schedule cleared up a bit. My master’s
degree was my top priority, and my mental health would just have to wait.

14
Furthermore, I’ll admit that I derived a perverse feeling of pride from reading
in an issue of Counselor magazine that we self-harmers were among the most
difficult patients to treat and that some therapists went out of their way to avoid
taking us on as clients. It made me feel as though I had found a place in the upper
echelons of the maladjusted; as my friends and family will attest, being among the
best has always been important to me.
It wasn’t until I bled through my gauze for the first time that I began to think
my psychiatrist was on to something. I woke up one morning to find my bandages
saturated and my sheets stained with blood. My cuts had never taken more than 45
minutes to stop bleeding, yet there I was eight hours later and still dripping. At some
point between changing my bandages and acknowledging that I would need to buy
new sheets for my aunt’s guest room I realized for the first time that I was capable of
seriously injuring myself. At the risk of sounding trite, admitting I had a problem
became the first step toward recovery. It helped me see things from my
psychiatrist’s point of view.
“Much like quitting drugs or alcohol, simply saying that you want to stop
cutting is a helluva lot easier than actually going through with it,” explained my
psychiatrist.
She also noted that while the medical community has yet to come to a
conclusion as to whether self-harm qualifies as a legitimate addiction, the rush of
feel-good hormones that comes hand-in-hand with physical pain makes curbing this
unhealthy habit much more difficult than, say, refraining from biting your finger
nails.

15
“Among the challenges associated with treating patients with a penchant for
self-harm is the fact that cutting, like eating disorders or substance abuse, is often
more of a symptom than a disease,” she said. “Whether brought on by a specific
traumatic incident or learned over a period of time, self-harm becomes a part of an
individual’s repertoire of coping behaviors.”
I started cutting as a means of dealing with the misery that was my Brazilian
misadventure but continued to use it to deal with all kinds of negative emotions.
Feeling lonely? Rough day at school? Online dating site not exactly filling up the
social calendar? Might as well bust out the knife.
“In adults, a failure to properly express emotions and an overall flat affect are
among the chief problems that lead to the development and maintenance of self
harming behaviors,” my psychiatrist noted. “In other words, people who have
trouble either experiencing or dealing with emotions sometimes turn to cutting as a
means of blowing off steam.”
In my case, I rarely dealt with emotions at all. Apathy was more than a state
of being, it was a way of life—and all the more reason for me to turn to self-harm.
“You can’t keep ignoring your emotions and treating them like they don’t
matter,” insisted my psychiatrist. “You’ll need to deal with them sooner or later, and
the longer you wait the more likely you are to use cutting as a coping mechanism.”
For most people, expressing emotion just comes naturally. Hell, my two
roommates can’t seem to stop themselves—arguing, whining, and bellyaching. But
for me, learning how to convey my feelings was difficult, and it’s something with
which I still struggle.

16
One afternoon, for example, my psychiatrist surprised me.
“I want to hear you scream as loud as you can,” she said.
“I can’t.”
“Why not?”
“I can’t just scream in your office. It’s your office. It’s just not what people
do.”
“Well, it’s my office, and I get to decide what’s appropriate and what isn’t. I
want to hear you scream as loud as you possibly can.”
“Okay, but I’m warning you, it’s going to be loud.”
“Obviously. We’re talking about screaming here.”
“Okay, here goes.”
“Get on with it already.”
“GOD DAMMIT!”
“Good. But did you have to curse?”
“I don’t know. I guess not. That’s the kind of thing people usually scream,
isn’t it?”
Catharsis. These days I have no trouble screaming.

17

*****

It’s been nearly a year since I first started therapy, and I’m still working on
expressing my feelings like a normal person would. I’m making progress. I still feel
the urge to cut, but I’ve discontinued it in favor of healthy coping behaviors like
talking and running. Most importantly, I’ve stopped lying to the people I love. I’m
no longer ashamed of my scars, and I talk about them openly.
Telling people about my cutting generally elicited one of two reactions. The
first, generally reserved for close friends and family, was one of legitimate shock and
concern: Why didn’t you say anything before? Are you okay now? You know you
can always talk to me, right? Then we usually hug it out.
The second reaction, while not quite as common as the first, is markedly
more interesting. There are those—friends, acquaintances, classmates, etc.—who
look at my scars as if to say, “Cutting is so 20
th
century.” These are the people who
perpetuate the stereotypes mentioned earlier. I try to stay away from them; their
blasé attitude dismisses my pain and the progress I’ve made.
Although I don’t wear shorts or short sleeves as often as I used to, my
modesty is as much a result of my pasty complexion as it is my self-injurious past.
I’m weighing the pros and cons of getting a tattoo, not to cover my scars, but to
change their significance and mark the end of a long and often painful chapter of my

18
life. If I ever do, my tattoo will be an excerpt from a poem by Charles Bukowski, a
writer who spent a lifetime making sense of pain:

The best of the strange…
Are their own
Paintings
Their own
Books
Their own
Music
Their own
Work

Abstract (if available)

Abstract Self-injurious behavior, which often manifests itself in the form of cutting or burning, is often the physical expression of profound emotional pain. What follows is the story of my struggle with cutting and the debilitating anxiety that initially drove me to self-injury as a means of coping.

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Asset Metadata

Creator Quinn, Thomas C. (author)

Core Title Scar tissue

School Annenberg School for Communication

Degree Master of Arts

Degree Program Journalism (Print Journalism)

Publication Date 05/11/2009

Defense Date 04/01/2009

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Depression,OAI-PMH Harvest,self-injury

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Cray, Edward (committee chair), Castaneda, Laura (committee member), Miller, Lynn Carol (committee member)

Creator Email tomquinn242@hotmail.com,tquinn@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-m2228

Unique identifier UC1281937

Identifier etd-Quinn-2874 (filename),usctheses-m40 (legacy collection record id),usctheses-c127-235457 (legacy record id),usctheses-m2228 (legacy record id)

Legacy Identifier etd-Quinn-2874.pdf

Dmrecord 235457

Document Type Project

Rights Quinn, Thomas C.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Repository Name Libraries, University of Southern California

Repository Location Los Angeles, California

Repository Email cisadmin@lib.usc.edu