Free Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis by Christine Montross Page B

supported, not alone and helpless. . . . Abused and neglected children never learn from their parents how to soothe themselves and cannot trust others to help them do so. So they may turn to cutting and other forms of self-injury as a means of self-soothing and reestablishing, at least temporarily, biological and psychological equilibrium.” Strong goes on to quote the psychologist David Frankel. “Usually kids internalize a sense of a parent they can call up from inside themselves for comfort in times of distress,” says Frankel. “These kids don’t have that—or what they call up is a Mom who wishes they were dead and a Dad who wants to sleep with them.”
    Dr. Diana Lidofsky, a psychologist and the director of psychotherapy training at Brown, elaborates upon Frankel’s assertion. Abusive parents who are intentionally malevolent certainly exist and may give rise to children who harm themselves, she agrees. Still, she believes that the parental failures that predispose a child to self-injurious behavior are more commonly based in deep neglect. Lidofsky characterizes this neglect as “chronic and toxic misattunement.” These parents, she asserts, may not physically or sexually abuse their children but may instead be “catastrophically absent, inadequate, and disturbed.”
    In people who deliberately hurt themselves, dissociation has often taken root as a coping mechanism in the midst of trauma. When a child is beaten or neglected or sexually abused, she may dissociate in order to distance herself from the experience. If she cannot physically get away from her abuse or neglect, she finds psychic ways to do so. If a person has to dissociate frequently, she may eventually shift into a state in which she perpetually feels disconnected and numb.
    Self-injury, then, with its flood of sensation, pierces this feeling of unreality and deadness. A razor blade splits flesh, and bright red blood pours forth and stains everything in its path. The hot metal rim of a lighter presses into skin, and smoke issues forth, carrying with it a jarring, searing smell of burn. Hair is torn from the scalp, tangling fingers in knotted tresses. A cold scissor blade slides down Lauren’s throat, and it is gripped and held by esophagus, sphincter, stomach; an ache persists, locatable, its cause known.
    •   •   •
    O ne day during Lauren’s hospitalization, I realized I didn’t know anything about her childhood or her family, and I decided to ask her. She was so furious with me that she would not even speak. Though she was choosing not to engage in her treatment, I didn’t want to do the same. So I returned to Lauren’s lengthy charts, in which I had first found a record of all she had ingested and all the ways in which the objects had been removed. Lauren was such a familiar patient to everyone else who worked in the hospital that I had picked up her care in the present moment, as if her history were as well known to me as it was to the doctors who had cared for her so many times before. I went back to Lauren’s earliest records to treat her like a brand-new patient, in the hope that I could find something we were all overlooking that could actually
help
her. I wanted to let go of all the behavioral plans and baggage that accompanied Lauren the minute she arrived in the ER; I wanted to let go of my own frustration and release the feelings of ineptitude she gave rise to in me.
    The psychiatric and medical and surgical notes of Lauren’s current admission no longer contained the detailed descriptions that might have characterized a first, second, or even third hospitalization. Instead the notes were full of shorthand phrases that summarized her years of treatment as a chronic patient. She was a “well-known” patient with a “long history of intentional ingestions.” A patient who had “failed multiple medication trials,” for whom an established care plan was immediately put in place. I had come to know her this way, as