Arkansas PBS > Programs > Hidden Wounds

Hidden Wounds

Cutting

the act of inflicting pain on your own body by cutting the skin until it bleeds.

Levels of self abuse

• Slight irritation of the skin
• Superficial scratches
• Razor blade marks
• Cuts or skin penetration
• Cigarette burns

Signs or behaviors to look for regarding individuals who might be cutting themselves

Peers often see a problem with their friends early on

• Isolating or pulling back
• Change in behavior
• Sharp objects missing
• Withdrawn or secretive
• Fresh scars or cuts
• In abusive relationships
• Hiding sharp objects
• Hoarding bandages

Myths about cutting

• They are crazy
• They do it for attention
• All they have to do is stop doing it
• Cutting is just a weak suicide attempt
• If we ignore it, it will go away
• They will grow out of it

How do I get help? Look in the Yellow Pages

Clothing: If individuals are wearing long sleeves, and it is warm outside, they may be hiding scars from cutting.

• Psychiatrists
• Psychologists
• Social Workers
• Licensed Professional Counselors
• Counseling Agencies

      or

• Call your local mental health center
• Talk to your school counselor
• Discuss it with your pediatrician

The Crisis Center - A 24 Hour Statewide Help Line

www.nwacrisiscenter.org
Main and Adult Line - 1-888-274-7472
Teen Line - 1-800-798-8336
Friend Line - 1-888-723-3225
Spanish Line - 1-866-751-5937

Transcript

I ASK YOU FOR BETTER GRADES AND THIS IS WHAT I GET? I THINK IT'S YOU THINK IT'S MORE IMPORTANT TO STAY UP ALL HOURS OF THE NIGHT.

WHAT? .

YOU THINK IT'S FUNNY.

WHAT? .

YOU THINK IT'S FUNNY. LAZY, WORTHLESS

ASHLEY, ASHLEY.

HEY.

HEY YOURSELF, WHO WERE ON THE PHONE WITH ALL LAST NIGHT. I KNOW IT WASN'T ME.

SORRY, I WAS TALKING TO JIM.

THE GUN KID? AGAIN?

COME ON, HE'S A REALLY NICE GUY.

MAN I'M SURE ONE DAY HE'LL MAKE A MODEL PRISONER.

THAT'S SO NOT FAIR. THE GUN WASN'T EVEN LOADED AND HE WAS JUST TRYING TO SCARE EDDIE.

THAT'S COMFORT SGLING YOU'RE SO OOEVL YOU KNOW THAT.

BECAUSE I DON'T WANT TO SEE YOU STANDING OUTSIDE SIDE A PRISON SENDING HAND SILTION SIGNALS UP TO HER PWOID.

THAT'S HOW IT STARTS.

PLEASE. DO YOUR PARENTS KNOW?

NOT REALLY.

THEN HE'S YOUR BOYFRIEND.

WHATEVER, I GOTTA GO.

WHATEVER.

WHERE? THE BATHROOM. AGAIN, YOU BETTER GET THAT LOOKED AT.

SELF-INJURY IS A PRETTY BROAD CATEGORY AND CAN INCLUDE ALL THE WAY UP TO SUICIDE BUT WE ARE TALKING ABOUT IN TERMS OF SELF-INJURY INCLUDING CUTTING DO NOT INCLUDE SUICIDE. BECAUSE IT'S CONSIDERED TO BE A BEHAVIOR THAT DOES NOT HAVE AS A GOAL KILLING ONESELF.

STUDIES HAVE SHOWN THAT IN THE U.S. POPULATION, SOMEWHERE BETWEEN 8 AND AS MUCH AS 17% OF THE POPULATION HAS AT LEAST ONE EPISODE OF SELF-INJURE ROUST BEHAVIOR, INTENDING TO INJURY. THE NUMBERS MAY BE AS HIGH AS 5 TO 10% HAVE REPETITIVE INSTANCES OF SELF-INJURY AND SO IT IS UNFORTUNATELY NOT A PROBLEM WHERE OUR KIDS AND YOUNG PEOPLE ARE ALONE. IT IS ALL TOO COMMON.

THE KINDS OF THINGS YOU MIGHT SEE ARE REALLY ALL OVER THE MAP. IT COULD BE JUST SLIGHT IRRITATING OF THE 61, USING A PENCIL, ERASER AND RUBBING.

SUPERFICIAL SCRATCHES, EVEN WITH YOUR FINGERNAILS, RAZOR BLADES.

HEAD BANGING, BITING, CAN BE CUTTING OR BITING FINGERS AND THINGS LIKE THAT.

IT CAN BE CUTTING, KIND OF PENETRATING WITH PINS AND NEEDLES, THAT SORT OF THING.

CIGARETTE BURNS, PEOPLE THAT WILL THEMSELVES WITH CIGARETTES.

THERE HAVE BEEN TIMES WHEN I HAVE KIDS THAT I'LL NOTICE MARKS OR THEIR PARENTS BRING IT UP WHEN THEY BRING THEM IN, OF COURSE IF I NOTICE THE MARKS I'LL ASK THEM ABOUT IT AND OFTENTIMES THEY KIND OF SAY, OH, YEAH, I WAS DOING SOMETHING OR KIND OF MINIMIZE ANYTHING ABOUT IT BECAUSE THE TENDENCY IS NOT TO SAY MUCH ABOUT IT AND NOT LET OTHER PEOPLE KNOW WHAT'S GOING ON.

THE CUTTING AND BURNING ARE PROBABLY THE TWO MOST COMMON WITH CUTTING BEING THE PRIMARY, THE TOP. THEY CUT ON THE ARMS AND LEGS, ABDOMEN IS WHERE YOU SEE IT MOST OFTEN. THAT'S WHERE YOU SEE IT THE MO T MOST.

SELF CUTTING BEGAN IN THE 1960S AND IT'S MORE PREVALENT TODAY, NOT SURE WHY, BUT TO HAVE THE IDEA, I THINK IT'S LIKE ANYTHING ELSE SOMEONE TRIES FOR THE FIRST TIME, SOMEWHERE THEY'VE SEEN OR HEARD ABOUT IT. WHEN AN INDIVIDUAL GETS TO A POINT OF EMOTIONAL PAIN, EITHER MOUNTING TENSION, THEY ARE FEELING ANGRY, IT'S ALMOST LIKE COMING HOME FROM THE END OF A STRESSFUL DAY AND YOU CAN'T TAKE IT ANYMORE AND YOU GO FOR A DRINK.

I'VE WORKED WITH SEVERAL STUDENTS WHO HAVE SELF-INJURED, MOSTLY THEY'VE BEEN FEMALES WHICH IS WHAT GOES ALONG WITH THE STATISTICS, CUTTING HAS BEEN THE MOST FREQUENT THAT I HAVE SEEN AND THEY RANGE EDGE AGES FROM I'VE SEEN NINTH-GRADERS UP THROUGH 12th GRADERS. THAT'S THE AGE I WORKED WITH.

FEMALES USUALLY PRESENT MORE OF FEBRUARY, WHETHER THAT PRECLUDES THAT MALES HAVE THE INCIDENT, FEMALES JUST TYPICALLY SHOW UP FOR TREATMENT OF THE SELF-INJURY BEHAVIOR. MALES MAY ACT OUT MORE AGGRESSIVELY IN HIGH-RISK BEHAVIORS BUT I DON'T KNOW THAT THEY AS OFTEN ACTUALLY CUT OR BURN.

WELL, OF COURSE THE PURPOSE OF CUTTING WOULD BE TO REGULATE YOUR MOOD OR TO COPE. THAT SEEMS LIKE A REALLY BAD IDEA, AND IT IS, BUT IN THESE INDIVIDUALS, MANY OF THEM, THAT SEEMS TO BE WHAT THEY ARE USING IT FOR, IS TO COPE WITH NEGATIVE OR UNPLEASANT EMOTIONS BECAUSE THEY DON'T SEEM TO HAVE OTHER GOOD WAYS OF COPING. THEY HAVE NOT LEARNED GOOD COPING SKILLS AND THEY FALL INTO THESE REALLY BAD DYSFUNCTIONAL WAYS OF COPING BECAUSE THEY FIND THE CUTTING DOES SOMETHING FOR THEM. IT GIVES THEM A SENSE OF CONTROL, MAKES THEM TEMPORARILY FEEL A LITTLE BIT BETTER.

I THINK THE FEMALES TEND TO INTERNALIZE A LOT OF WHAT THEY'RE FEELING INSTEAD OF OUTWARDLY EXPRESSING WHAT'S GOING ON WITH THEM, AND THE HIGH-RISK BEHAVIORS, THEY TAKE IT OUT ON THEMSELVES.

I HAVE KNOWN OF YOUNG WOMEN WHO WOULD CUT AND THEY WOULD BE RELIEVED AS SOON AS THEY WOULD SEE THE BLOOD. SOME OF THEM DON'T EVEN REALLY FEEL THE PAIN OF THE CUT WITH THE KNIFE OR THE RAZOR BLADE OR WHATEVER.

IT'S A WAY TO FEEL ALIVE, IT'S ACTUALLY A WAY TO FEEL SORT OF CONNECTED AND IT IS VERY DIFFICULT TO DESCRIBE BUT WHAT THEY DESCRIBE IS FEELING A SENSE OF RELEASE OR RELIEF AFTER THE CUTTING. THEY TEND TO WANT TO EXPRESS SOMETHING GOING ON INSIDE THEM AND DON'T KNOW HOW TO DO THAT. IT'S BECOME THEIR COPING MECHANISM, HOW THEY DEAL WITH THE WORLD AROUND THEM, AND SO THEY WILL EITHER AS AN ATTEMPT TO FEEL SOME, YOU'LL HEAR A LOT OF TIMES THEY FEEL NUMB, IT'S A WAY FOR THEM TO ACTUALLY FEEL AN EMOTION EVEN THOUGH IT'S A PAINFUL ONE OR SOMETIMES IT WILL BE TO PUNISH THEMSELVES IF THEY FEEL LIKE THEY HAVE DONE SOMETHING WRONG OR HAVE POOR SELF-ESTEEM, THEY WILL DO THAT SOMETIMES AS A PUNISHMENT. TWO DIFFERENT GROUPS I SEE A LOT.

OKAY, EVERYBODY LISTEN UP. I WANT TO REMIND YOU THAT THE AUDITIONS FOR THE ONE-ACTS ARE ON THURSDAY AT 3:00, SO I WANT YOU TO COME TO THE AUDITORIUM PREPARED TO PRESENT ABOUT A TWO-MINUTE MONOLOGUE IT CAN BE FROM A BOOK, PLAY, MOVIE OR EVEN SOMETHING THAT YOU HAVE WRITTEN. JUST AS LONG AS IT'S A DRAMA. SO I HOPE TO SEE ALL OF YOU THERE ON THURSDAY AND I'LL SEE YOU TOMORROW. >>.

STUDY THOSE MONDAY LOINGZ. ASHLEY, CAN I SEE YOU FOR A MINUTE?

SURE. I'LL SEE YOU IN A MINUTE.

OKAY.

SWEETIE, THIS ISN'T LIKE YOU.

OKAY.

SWEETIE, THIS ISN'T LIKE YOU. WHAT'S UP?

THOSE LITTLE SUBTLE CUES, I THINK, SOMEONE WHO HAS JUST A FEELING ABOUT THEM THAT THEY'RE DOWN, THEY'RE PULLING BACK AND ISOLATING SOME. IT'S KIND OF THAT SICKth SENSE OR INTUITION YOU GET WITH PEOPLE.

ONE THING TO NOTICE FOR ANY KIND OF PSYCHIATRIC DIFFICULTY IS CHILDREN AND ADOLESCENTS IS A DRAMATIC CHANGE IN BEHAVIOR SO WITH KIDS IN WITH THIS PROBLEM YOU MIGHT SEE CHANGES IN WHAT THEY WEAR SO THEY MIGHT QUIT WEARING SHORT-SLEEVED GARMENTS AND WEAR LONG-SLEEVED SHIRTS, BAGGY CLOTHES.

YOU SHOULD BE LOOKING FOR YOUR CHILD ACTING OUT OF THE ORDINARY AND FINDING OUT WHY YOUR CHILD IS NOT FOLLOWING THROUGH WITH WHAT SEEMS TO BE NORMAL. FOR INSTANCE, IT'S 85 DEGREES OUTDOORS AND HE HAS ON LONG SLEEVES. WHY DOES YOUR KID HAVE ON LONG SLEEVES? WHY IS IT THAT EVEN AT HOME YOUR KID NEVER REALLY UNDRESSES AND STAYS COVERED UP? WHY IS IT THAT YOUR DAUGHTER OR SON WHO SHARES A ROOM WITH SOMEONE SPENDS SO MUCH TIME IN THE BATHROOM BUT WHEN THEY COME OUT, THEIR SENSE OF GROOMING HASN'T CHANGED? WHY IS THAT? WHY IS IT THAT THE BOY OR GIRL NEEDS MULTIPLE EXACTO KNIVES BUT YOU NEVER SEE ANY NEW PROJECTS BEING PWIMENT OR CREATED? IT'S A MATTER OF STOPPING AS PARENTS AND LOOKING AND SEEING BEHAVIOR THAT IS NOT NORMAL, THAT SEEMS OUT OF THE ORDINARY.

IF YOU NOTICE SHARP OBJECTS MISSING, RAZORS, KNIVES, THERE HAVE BEEN PEOPLE THAT IT DIDN'T HIT THEM UNTIL LATER, OH, YEAH, I WAS MISSING THAT IN MY KITCHEN, THEY DIDN'T THINK THAT IT WOULD BE THAT THEIR CHILD WAS TAKING IT TO CUT THEMSELVES.

WHEN YOU SEE SOMEONE WHOSE BEHAVIOR CHANGES MARKEDLY, THEY ARE SUDDENLY NOT INTERESTED IN THE THINGS THEY WERE INTERESTED IN BEFORE, THEY ARE NOT BEHAVING IN THE SAME WAYS, THEY WERE MORE WITHDRAWN, MORE SECRETIVE, THOSE ARE ALL INDICATORS.

SOME SIGNS THAT A STUDENT IS ACTUALLY SELF INJURING WOULD BE SOME FRESH SCARS OR SEVERAL CUTS ON THE ARMS. IT'S USUALLY THE ARM OPPOSITE THE DOMINANT HAND AND PARALLEL CUTS ARE PRETTY COMMON. SEEMS LIKE THE MORE AND MORE OF OUR GIRLS GET INTO ABUSIVE RELATIONSHIPS, THEY HAVE LOW SELF-ESTEEM TO BEGIN WITH AND THEY MEET UP WITH SOMEONE WHO SEEMS DYNAMIC AND ALL OF THAT AND AT THE SAME TIME THEY ARE VERY CONTROLLING AND THERE'S A HOOK FOR SOME REASON. SO YOU HAVE ABUSIVENESS GOING ON IN A RELATIONSHIP AND AT THE SAME TIME, YOU KNOW, THEN THE PERSON IS TAKING IT OUT ON THEMSELVES, TOO.

HEY,

HEY SO WHAT WAS THAT ALL ABOUT?

OH, NOTHING. SHE WAS ALL ON MY CASE BECAUSE I MESSED UP THESE LAST COUPLE TESTS. SHE WANTED TO KNOW IF THERE WAS SOMETHING BOTHERING ME. THE USUAL CRAP.

REALLY.

THINGS. WHAT CAN I SAY? USED TO BE A GIRL SCOUT.

THAT WOULD EXPLAIN A LOT.

ANYWAY, IT'S LIKE GET A LIFE, MS. TANNER.

I KNOW WHAT YOU MEAN, SOMETIMES I THINK SHE WOULD HAVE MADE A GREAT SOCIAL WORKER.

SERIOUSLY LIKE I DON'T HAVE ENOUGH TO WORRY ABOUT AT HOME.

THAT LAST TEST, THOUGH, THAT'S A REALLY BIG PART OF OUR GRADE.

YEAH, SO?

I JUST MEANT --

I'M GONNA GO FOR IT MEG, I ALWAYS DO. >>.

SOMETIMES THE BEST FRIEND CAN HOLD THE KID MOST ACCOUNTABLE.

YOU MIGHT FIND VARIOUS UTENSILS AND EQUIPMENT ON THEIR PERSON LIKE CUTTING UTENSILS OR BANDAGES AND FIRST AID EQUIPMENT, THINGS OF THAT NATURE.

ANY TIME THERE'S A CHANGE IN SORT OF BEHAVIOR OR WAYS OF COPING AND DEALING WITH SITUATIONS, THAT'S ALWAYS MANAGE TO BE AWARE OF AND EXPLORE AS PARENTS.

LOT OF PATIENTS, ONCE THEY CHOOSE TO HIDE THE FACT THAT THEY ARE CUTTING, THEY'RE NOT DISCLOSING, THEY BECOME VERY GOOD AT HIDING THAT FACT AND THEY ARE VERY GOOD AT CUTTING THEMSELVES IN WAYS THAT ARE NOT OBVIOUS TO FRIENDS OR FAMILY. AGAIN, THESE ARE OFTEN OLDER ADOLESCENTS AND YOUNG ADULTS SO IT'S PRIVACY IS OFTEN EASY TO COME BY.

THERE ARE STUDENTS WHO WILL WEAR MULTIPLE BRACELETS ON THEIR WRISTS OR WRIST BANDS, NOT JUST THE LONG SLEEVES, YOU KNOW, BUT THEY'LL FIND OTHER WAYS TO HIDE IT. THERE WAS A STUDENT IN A CLASS THAT THE CLASS WAS GETTING READY TO DO A LAB AND THEY WERE GOING TO HAVE TO HAVE THEIR HANDS IN WATER AND THE STUDENT HAD THEIR RIGHT ABOVE THE WRIST BAND OF THE SWEATSHIRT THEY HAD A HOLE CUT AND THEY HAD THEIR THUMB HOOKED THROUGH THAT HOLE AND THEY REFUSED TO MOVE THAT TO WASH THEIR HANDS TO BECOME READY TO PARTICIPATE IN THE LAB.

YOU SHOULD DO IT.

YEAH, RIGHT. EASY FOR YOU TO SAY, YOU'RE NOT THE ONE WHO HAS TO GET UP IN FRONT OF ALL THOSE PEOPLE AND POWER YOUR GUTS OUT.

HEY, BETTER TO POWER THEM OUT YOURSELF THAN HAVE SOMEBODY RELATIONSHIP THEM OUT FOR YOU.

IS THAT WHAT YOU ALWAYS SAY?

IT'S PROBABLY JUST THE NEW HAIRCUT TALKING.

YEAH.

BUT STILL, AT LEAST I TRY, YOU KNOW, WHICH IS MORE THAN I CAN SAY FOR YOU.

EXCUSE ME!

WELL, ARE YOU GOING TO AUDITION FOR THIS THING OR WHAT?

I DIDN'T EVEN HEAR THE DOORBELL, MEING.

LISTEN, GO GRAB SOME BROWNIES AND I'LL TELL ASHLEY YOU'RE HERE. THEY SHOULD BE COOL BY NOW.

THANKS. MRS. SANCHEZ, COULD I -- DO YOU HAVE A MINUTE? IT'S ABOUT ASHLEY.

I NEVER SAW THAT MOVIE. MAYBE BECAUSE I DIDN'T FEEL LIKE CRYING MY EYES OUT FOR LIKE THE NEXT 3 DAYS.

YOU'RE SAD, YOU KNOW THAT.

WHEN ARE YOU COMING BACK.

MY DAD'S STILL TALKING TO THE SCHOOL BUT WE'RE HOPING MAYBE IN ANOTHER MONTH.

THAT WOULD BE SO GREAT.

EITHER WAY IT'S NERVE WRACKING THOUGH, YOU KNOW, I MEAN MY COUNSELOR SAYS IT WOULD BE GOOD FOR ME TO GO BACK.

THE WHOLE SCHOOL KNOWS THE GUN WASN'T EVEN LOADED AND WHAT I HAD YODZ, YOU'RE NOT THE FIRST PERSON THEY EVER PICKED ON YOU KNOW.

I GUESS.

SERIOUSLY.

YEAH.

YOU KNOW, YOU'RE REALLY A --

YEAH I KNOW A BIG PAIN IN THE --

NO, WELL, SOMETIMES. BUT, NO, SERIOUSLY, ASH, YOU'RE REALLY A GOOD FRIEND. THANKS.

I THOUGHT MAYBE SHE WAS SICK OR SOMETHING, REALLY SICK AND SHE WASN'T TELLING ME.

NO, SHE'S FINE. SHE'S FINE.

SHE PRACTICALLY LIVES IN THE BATHROOM AT SCHOOL.

SHE'S NOT THE ONLY ONE THAT LIVES IN THE BATHROOM.

SHE'S CARRYING AROUND THIS BIG BOX OF BANDAGES YOU WILL OF A SUDDEN AND I'M LIKE WHAT'S UP WITH THAT, THAT'S WHAT GOT ME THINKING THAT MAYBE SOMETHING WAS UP. WITH HER HEALTH AND ALL, I MEAN. THEN I THOUGHT THAT IT WAS YOU OR MR. SANCHEZ WHO WERE 6 BECAUSE SHE SAID SOMETHING ABOUT HAVING ENOUGH TO WORRY ABOUT AT HOME AND ALL I.

I DON'T KNOW ABOUT MRS. MRS. SANCHEZ BUT I'M DOING JUST FINE.

OH, HI THERE, MR. SANCHEZ I DIDN'T EVEN SEE YOU THERE.

SPEAKING OF HEALTH HOW IS YOUR MOM DOING? WE MISSED HER IN CHURCH LAST SUN.

A LOT BETTER, THANKS. JUST SOME FLU THING. NOW MY DAD HAS IT.

OH, THAT'S NO GOOD.

HEY, AS LONG AS THEY DON'T GIVE IT TO ME, YOU KNOW.

TELL THEM BOTH WE'RE ASKING ABOUT THEM, OKAY.

SURE, THANKS.

WHAT'S THIS ABOUT ASHLEY NOT FEELING WELL.

HEY, HEY.

WHEN DID YOU GET HERE.

I WAS JUST COMING UP TO GET YOU.

NOW WHO'S GOING TO HELP ME GET RID OF THESE?

WELL, IF THE OTHER STUDENT SAYS I'M NOT GOING TO TELL THEM AND I'LL HATE YOU FOREVER IF YOU TELL F. IT'S STILL PROBABLY THE RIGHT THING TO DO AND THE BEST THING TO DO TO GO AHEAD AND TELL AND MAYBE THE FRIEND MAY WANT TO INCLUDE HIS OR HER OWN PARENTS IN THAT DECISION AND TELL THEM AND THEN TOGETHER THEY MAY BE ABLE TO GO TO THE PARENT OF THE TEENAGER WHO IS DOING THE CUTTING.

BEING ABLE TO REACH OUT TO THE PARENT TO SAY SOMETHING IS GOING ON WITH YOUR CHILD, THESE ARE THE THINGS I'VE NOTICED AND EVEN TO HAVE INFRASTRUCTURE FROM PEERS TO SAY THE PEERS ARE SAYING, CHECK OUT HER ARMS AND SOMETIMES YOU ONLY HAVE ONE SHOT WITH THE PARENT AND YOU HAVE TO BE PRETTY DIRECT, NONJUDGEMENTAL AND LET THEM KNOW YOU ARE CARING AND NOT TRYING TO CRITICIZE OR GET INTO THEIR BUSINESS.

75% OF THE FAMILIES, THEY KNEW SOMETHING WAS WRONG, A SNEAKING SUSPICION IN REGARDS TO SELF MUTILATION, USUALLY NOT BUT THEY HAD A FEELING THERE WAS SOMETHING NOT QUITE RIGHT AND THEY ALMOST ALWAYS THINK THE KID IS DOING DRUGS.

I'VE HAD REACTIONS ALL ACROSS THE SPECTRUM. I HAD ONE DAD SAY I KNEW SHE WAS DOING THAT AND I TOLD HER IF SHE DID IT AGAIN I WAS GONNA GROUND HER, WHICH IS NOT THE APPROPRIATE RESPONSE. AND THEN I'VE HAD PARENTS SAY FINALLY WE KNOW WHAT'S GOING ON, WE HAVE BEEN WANTING TO GET HELP, WE'VE BEEN WANTING TO KNOW WHAT'S GOING ON, THANK YOU SO MUCH.

I ALWAYS BRING IN THE TEENAGERS AND THEIR PARENTS FIRST TOGETHER AND I WANT TO GET THE FEELING TO WHERE EVERYBODY IS WITH THIS PARTICULAR VISIT AND I SAY, WELL, WHAT -- I START WITH THE TEENAGER. WHAT BRINGS YOU HERE TO MY OFFICE TODAY? AND I WOULD SAY 40% OF THE TIME THEY SAY MY PARENTS. AND I SAID DO YOU KNOW WHY THEY BROUGHT YOU HERE?

NO, NO DWRD.

IF THE PERSON IS UNDER 18, THE PARENTS CAN PARTICULAR THEM IN EVEN AGAINST THEIR WILL BUT USUALLY YOU CAN GET THEM TO GO IN GRUDGINGLY, TO TALK TO THEM ABOUT THEIR PROBLEMS AND THAT MAY BE WHAT THEY NEED TO DO IF THEY HAVE TRIED EVERYTHING ELSE AND THEY WON'T TALK OR COOPERATE AT SOME POINT THEY MAY JUST HAVE TO TAKE THE BULL BY THE HORNS AND BRING THEM IN.

YOUR PARENTS ARE SO NICE.

YOU THINK?

YEAH, MY PARENTS BARELY SAY HELLO TO PEOPLE.

YOUR PARENTS ARE ALWAYS NICE.

IT'S NOT THE SAME. YOU HAVE PARENTS THAT ACTUALLY MILE AND STUFF.

WHATEVER. I'LL SEE YOU TOMORROW.

LATER.

LATER. [PARENTS ARGUING]

ASHLEY, BRING YOUR BUTT DOWN HERE RIGHT NOW. ASHLEY, COME DOWN HERE.

YOU GOT PROBLEMS AT HOME NOW, HUH?

NO.

THAT'S WHAT YOU GOT? PROBLEMS AT HOME.

DAD, NO.

THAT'S WHAT YOU'RE TELLING YOUR FRIENDS.

DAD, I CAN EXPLAIN.

SHOW GOT A BIG MOUTH, TOO, JUST LIKE YOU!

WHAT HAPPENS IN THIS HOUSE, STAYS IN THIS HOUSE. YOU UNDERSTAND?

I DO, YES.

DO YOU UNDERSTAND?

YES. UNDER ARKANSAS LAWS, YOU CAN AND SHOULD REPORT SUSPICION OF ABUSE OR NEGLECT OF A CHILD AND THEN THE APPROPRIATE AUTHORITIES WOULD INVESTIGATE THAT.

IT IS A TOUGH SITUATION BECAUSE USUALLY IF THE PARENTS COME IN AND THEY ARE PART OF THE PROBLEM THEY ARE GUARDED ENOUGH TO KNOW THAT THEY'RE PART OF THE PROBLEM AND THAT IS A VERY I THINK YOU HAVE TO TAKE ON THE HUMAN ASPECT OF IT AND YOU REACH OUT TO THE PARENTS. IF YOU JUDGE THE PARENTS, YOU'RE GONNA LOSE THEM. YOU KNOW, WE HAD TO REACH OUT TO FAMILIES TO SAY, WE HAVE A SITUATION HERE. YOUR CHILD IS DYING, YOUR CHILD IS MISERABLE AND TO SAY, DO YOU REALIZE YOU'RE PART OF THIS PROBLEM? HOW CAN WE HELP CHANGE THIS?

I ENCOURAGE PEOPLE TO APPROACH THE SITUATION JUST AS A PROBLEM WITH THE CHILD AND ENCOURAGE THEM BE AGGRESSIVE, THERE MAY NOT BE PHYSICAL OR SEXUAL ABUSE GOING ON IN THE HOME BUT IF YOU APPROACH IT AGGRESSIVELY AND SORT OF BRING THE FAMILY IN AND SAY, WE HAVE TO FOCUS ON THIS MEDICAL ISSUE, THEN THOSE THINGS TEND TO COME TO LIGHT.

I THINK IF A TEACHER WERE GOING TO THE FAMILY, THE FOCUS HAS TO BE ON THE CHILD. A TEACHER CAN'T FOCUS ON WHAT'S GOING ON IN THE FAMILY OR CONFRONT THE FAMILY MEMBERS ABOUT THEIR PROBLEMS. THEY NEED TO MAKE IT VERY CLEAR THE KID'S SYMPTOMS AND RISKS AND DIFFICULTIES AND THAT THE CHILD NEEDS HELP. THEN THEY RELY ON OTHERS TO -- MENTAL HEALTH PROFESSIONALS OR PHYSICIANS OR WHATEVER TO DEAL WITH THE MORE EXTENDED FAMILY SYSTEM ISSUES.

IT DOESN'T MATTER WHAT BROUGHT IT ON, THE ISSUE IS NOT MINE TO FIGURE OUT WHAT BROUGHT IT ON. IT IS MY JOB TO GET THE CHILD TO GET HELP SO SHE OR HE CAN STOP THE BEHAVIOR. EVEN THOUGH THE PARENTS QUESTIONED WHAT CAUSED THIS, THAT'S NOT THE ROOT OF IT AT THIS TIME.

YOU BRING EVERYBODY TOGETHER AND YOU SAY, THIS IS WHAT, YOU KNOW, HAS COME TO MY ATTENTION THROUGH THIS PROCESS, AND WE JUST -- THAT'S OUR CONFIDENTIALITY ON THE FRONT END BECAUSE I REMIND THEM OF THAT CONVERSATION AND WHAT I'VE GOT TO DO BY LAW, AND THEN WE KIND OF GO FROM THERE. I SAY IT'S NOT THE PHYSICAL OR SEXUAL ABUSE, IT'S EMOTIONAL ABUSE, WE WORK ON REALLY HOW TO, YOU KNOW, OVERCOME THAT AND DEAL WITH THAT IN THERE.

HEY,

HEY, YOU READY TO DO DAMAGE AT THE MALL OR WHAT?

THE MALL?

YEAH THE SALE ENDS TODAY. WE'VE ONLY BEEN TALKING ABOUT IT ALL WEEK.

I KNOW. I CAN'T GO, THOUGH.

WHAT?

I'M SORRY.

WHY NOT?

I CAN'T. I PROMISED JIM I'D MEET HIM AT THE LIBRARY.

JIM.

THANKS FOR LETTING ME KNOW.

MEG, I'M SORRY.

WHATEVER.

MEG ISN'T TALKING TO ME TODAY.

WHY.

BECAUSE I TOLD HER I WAS MEETING YOU AT THE LIBRARY YESTERDAY.

WHY DID YOU TELL HER THAT.

SHE'S JUST, JUST BECAUSE SHE'S MY BEST FRIEND DOESN'T MEAN I HAVE TO SPEND EVERY SINGLE WAKING MOMENT OF MY LIFE WITH HER DOES IT.

YES, BUT YOU SHOULDN'T HAVE TO LIE TO HER EITHER.

YEAH, I'LL MAKE IT UP TO HER. IT'S JUST...

WHAT?

I'VE BEEN HAVING TROUBLE KEEPING IT TOGETHER LATELY IS ALL AND I DON'T THINK SHE UNDERSTANDS IS ALL.

UNDERSTAND WHAT?

I DON'T KNOW, JUST THIS FEELING... LIKE I'M FLOATING OFF INTO SPACE OR SOMETHING. LIKE I'M SLOWINGLY BEING CUT OFF, A LITTLE BIT AT A TIME. YOU KNOW? IT'S NUTS, I KNOW.

NO, IT'S NOT. I KNOW JUST WHAT YOU MEAN.

YOU DO?

YEAH, I DO. I MEAN, I DON'T WANT TO GET INTO IT ALL RIGHT NOW.

NO, NO, I UNDERSTAND.

BUT, YEAH, I GET IT.

YEAH, SEE, I DON'T THINK MEG WOULD UNDERSTAND, I MEAN, MAYBE SHE WOULD, I DON'T KNOW SO AUDITIONS ARE TOMORROW?

YEAH.

YOU'RE STILL GOING, RIGHT.

WITH WHAT?

COME ON. YOU COULDN'T DIG UP ONE SINGLE MONOLOGUE.

I KEPT TRYING TO CHANGE IT. IT WASN'T ME, YOU KNOW.

SO WRITE YOUR OWN.

YOU CAN'T DO THAT.

WHY NOT WERE ALREADY READY TO REWRITE SOMEONE ELSE'S STUFF.

IT'S DIFFERENT.

NO, IT'S NOT.

IT IS.

I'M SERIOUS.

SO WHAT SHOULD I WRITE ABOUT?

WHATEVER YOU KNOW.

I USED TO BE ASLEEP IN MY BED, I USED TO BE, SLEEP A LOT AFTER SHE DIED, REMEMBER. YOU'D ALWAYS COME IN AND CHECK ON ME. YOU JUST SAT ON THE END OF MY BED AND WATCHED ME.

HEY I WAS JUST COMING TO GET YOU.

I'LL BE RIGHT BACK. I GOTTA GO.

I'LL BE RIGHT BACK. I GOTTA GO.

WHAT ELSE IS NEW? AN INDIVIDUAL MAY EXPERIMENT WITH A MILD-DEGREE OF CUTTING BEHAVIOR OR SOMETHING LIKE THAT BUT THEN NOT GO ANY FURTHER AND IN OTHER CASES IT DOES PROGRESS AND TO SOME DEGREE IT'S ACTUALLY ADDICTIVE. THAT'S THE INDICATION THAT A LOT OF TIMES WHEN YOU ENGAIBLING IN THIS BEHAVIOR IN A REPEATED MANNER IT DEVELOPS ALMOST AN ADDICTIVE QUALITY. THERE'S EVEN SPECULATION THAT THAT HAD SOMETHING TO DO WITH THE BRAIN'S NATURAL CHEMICALS, OPIATE-LIKE SUBSTANCES CALLED ENDOOR FINS THAT WHEN YOU CUT THE BODY, THAT PRODUCES ENDOOR FINS AND SO THAT CAUSES MOMENTARILY A LESSENING OF PAIN AND INCREASE IN MOOD AND THEN THE DESIRE TO DO IT AGAIN, MUCH LIKE A DRUG ADDICT.

THE FIRST FEW TIMES I SAW KIDS WITH SCARS AND MARKS ON THEM AND WE DIDN'T MAKE A BIG DEAL ABOUT IT AND BEGIN TO EXPLORE IT BUT AS THEY CAME BACK IN FOR OTHER SUBSEQUENT VISITS, I NOTICED THEY BEGAN TO HAVE MORE AND MORE MARKS THAT WERE DIFFICULT TO EXPLAIN.

MUCH OF THE PROBLEM WITH CUTTING AND SELF INJURY HAPPENS AMONG THOSE INDIVIDUALS MOST VULNERABLE BECAUSE THEY HAVE POOR COPING SKILLS. THEY HAVE DIFFICULTY FIGURING OUT HOW TO PROBLEM-SOLVE WHEN THEY HAVE DIFFICULT THINGS GOING ON IN THEIR LIFE OR OTHER WAYS OF OR OTHER KINDS OF PROBLEMS IN REGULATING EMOTIONS.

THEY FEEL A SENSE OF RELEASE FROM BEING BOUND UP AND BEING TRAPPED BY WHATEVER STRESSOR IT IS. MANY OF THEM WILL WATCH THE BLOOD COME OUT, SOME LIKE TO SEE IT RUN FAST, OTHERS LIKE TO SEE IT OOZE AND IT GOES PARTLY WITH VIVID IMAGINATIONS.

THAT LITTLE GIRL, YOU SAID SHE DIDN'T GO FAR. NOT FAR. THAT'S WHAT YOU SAID. SHE DIDN'T GO FAR. DID SHE, MARY? [ APPLAUSE ]

VERY NICE, MEGEN. THANK YOU. AND I THINK YOU'RE OUR LAST ONE, IS THAT RIGHT.

LOOKS LIKE YOU HAVE ONE MORE, MISTANNER.

OH, ASHLEY. GOOD.

OH, ASHLEY. GOOD.

GOOD LUCK. [WHISTLING]

WHENEVER YOU ARE READY, ASHLEY.

GUYS, STOP!

PLEASE, STOP. THAT WAS MY FIRST MISTAKE, ASKING HIM TO STOP. I JUST MADE IT WORSE. IT JUST MADE HIM ANGRIER, MADE HIM WHALE ON ME EVEN HARDER. PRACTICALLY BROKE MY JAW THE FIRST NIGHT. BUT EVERYBODY'S GOT SOMETHING, RIGHT? PLUS IT WAS ONLY WHEN HE WOULD DRINK. NO BIG DEAL, REALLY. SOMEBODY ELSE HAS PROBABLY GOT IT A WHOLE LOT WORSE, I'M SURE. BESIDES IT'S GOTTEN TO THE POINT THAT YOU JUST CAN'T FEEL IT ANYMORE. YOU SORT OF SHUT DOWN. YOU DIE A LITTLE BIT INSIDE. SO THAT'S WHEN I STARTED CUTTING MY LEGS IN THE HOUR AND STUFF, JUST MESSING AROUND.

NOT TOO MESSED UP, RIGHT?

BUT IT WORKED. IT MADE ME FEEL ALIVE AGAIN BUT IN A WAY I COULD CONTROL AND THEN I STARTED ON MY ARMS WHEN MY LEGS GOT TOO BEAT UP. AND IT'S NOT EVEN BETTER. BUT SEE, LATELY, LATELY I'VE BEEN CUTTING DEEPER. IT'S LIKE THIS RACE BETWEEN GETTING SLAPPED UP AND THIS. I MEAN, WHAT'S GONNA KILL ME FIRST? I CUT PRETTY DEEP LAST NIGHT. OH HIT ME PRETTY HARD AFTER DINNER, ALMOST BLACKED OUT. I KNOW HE DOESN'T MEAN IT, BUT I DON'T THINK I CAN LIVE LIKE THIS MUCH LONGER. I CAN'T REMEMBER MUCH MORE AFTER I CUTLASS NIGHT, JUST A LOT OF BLOOD. THIS IS A BAD DREAM. I REALLY HOPE I WAKE UP SOON. [ APPLAUSE ]

I THINK THE VIDEO, THIS PART, IS IMMENSELY POWERFUL. GREAT ACTING AND WRITING AND SO FORTH BUT I THINK IT ALSO DEPICTS THAT WE AS CAREGIVERS AND HELPERS NEED TO LOOK AT CHILDREN'S ARTISTIC PRODUCTIONS SO THAT THIS WAS A DRAMATIC PRODUCTION AND I DARE SAY SHE DIDN'T HAVE IT WRITTEN DOWN. WE CAN LOOK AT KIDS' DOOD ALSO, DRAWINGS, POEMS, SONGS AND HAVE SOME LEVEL OF CONCERN, TRY TO BE OPEN TO HEARING WHAT THEY HAVE TO SAY, DON'T IMMEDIATELY GET INTO A LECTURING OR CRITICAL STANCE, TRY TO UNDERSTAND WHAT'S GOING ON, WHAT KINDS OF EMOTIONS OR PROBLEMS ARE DRIVING THEM TO IT BUT YOU STILL EVENTUALLY LET THEM KNOW THAT YOU DO NOT ENDORSE THIS AS A WAY TO HANDLE PROBLEMS, YOU THINK IT'S A REAL PROBLEM THAT HAS TO STOP AND THEY NEED TO FIND AN ALTERNATIVE SOLUTION BUT YOU'LL BE VERY SUPPORTIVE IN HELPING THEM FIND THAT ALTERNATIVE SOLUTION AND HELPING THEM OVERCOME THE PROBLEM.

TEACHERS REALLY HAVE TO BE EDUCATED ON HOW TO REACT BECAUSE THEY'RE OUT THERE WITH THE STUDENTS EVERY DAY AND THEY ARE THE ONES THAT MIGHT NOTICE SOMETHING GOING ON OR THAT THE STUDENTS WOULD GO TO THE TEACHER FIRST AND THE TEACHER DOESN'T NEED TO RESPOND WITH THEIR MOUTH HANGING OPEN SAYING, WHY ARE YOU DOING THAT TO YOURSELF? YOU'RE DOING WHAT! WHY WOULD YOU DO THAT?

THOSE WHO ARE ANGRY WHEN FIRST CONFRONTED MAY JUST BE COVERING UP THE EMBARRASSMENT AND SHAME AND OTHER PAIN ASSOCIATED WITH HAVING HIDDEN THAT PROBLEM FOR SO LONG. SO IF YOU GET THEM IN AND THEY GET HELP AFTER THEY RECOVER, THEY TEND TO BE MUCH MORE GRATEFUL AND APPRECIATIVE OF WHAT'S BEEN DONE. BUT YOU KNOW, EVEN IF THEY DIDN'T, IT'S STILL A GOOD IDEA, THE THING TO DO, BECAUSE LOOK AT THE ALTERNATIVE IF YOU DON'T DO SOMETHING TO GET HELP.

THERE HAVE BEEN CASES I'VE KNOWN OF WHERE WE WOULD SAY THE PERSON NEEDS HELP AND THE FAMILY WOULD SAY SHE'LL GET OVER IT. WE'LL SEE THAT SHE GETS OVER IT AND THAT'S ALL WE HEAR OF THEM.

GOD, THAT WAS SO AWESOME.

I WAS SO SCARED.

YOU COULDN'T TELL. I SEE YOU WENT ALL OUT, TOO. WHAT THAT IS FOOD COLORING?

YOU, YEAH,

GOSH YOUR SUCH A CLOSET THEATER GEEK.

THERE'S LOTS YOU DON'T KNOW ABOUT ME. I REALLY HAVE TO GO TO THE BATHROOM. I THINK I HAVE SOME SORT OF BLADDER INFECTION.

YOU THINK?

WHERE IS SHE GOING.

TO HER SECOND HOME, THE GIRL'S BATHROOM.

ASHLEY, I WAS LOOKING FOR YOU. YOU WERE ABSOLUTELY WONDERFUL UP THERE. INCREDIBLE.

YOU LIKED IT?

LIKED IT? ARE YOU KIDDING? AT THIS POINT, SWEETIE, YOU'RE GONNA BE IN THE SHOW NO MATTER IF YOU WANT TO OR NOT.

OH, THANK YOU SO MUCH. THIS REALLY MEANS A LOT.

YOU'RE THE ONE DOING US A FAVOR. YOUR PARENTS SHOULD BE SO PROUD.

YEAH, I GUESS.

WHERE DID YOU GET THE MONOLOGUE?

I SORT OF WROTE IT.

REALLY?

YEAH, THAT'S A REALLY POWERFUL PIECE.

IT ACTUALLY KIND OF REMINDED ME OF A FORMER STUDENT OF MINE.

REALLY.

YEAH, HER NAME WAS TAMMY. SHE WAS A REALLY SWEET GIRL AND SHE WAS A CUTTER, JUST LIKE THE CHARACTER IN YOUR PIECE. I REMEMBER ONE NIGHT WE WERE STAYING LATE FOR REHEARSAL AND I CAN'T EVEN REMEMBER WHAT THE SHOW WAS NOW, BUT WE GOT TO TALKING. SHE WAS USUALLY ONE OF THE LAST GIRLS TO LEAVE AND I'D TAKE HER HOME SOMETIMES BUT THIS NIGHT I COULD TELL SHE WAS REALLY UPSET SO I ASKED HER WHAT WAS WRONG ONE THING LED TO ANOTHER AND SHE TOLD ME, SHE TOLD ME ALL ABOUT IT.

WHAT HAPPENED AFTER SHE TOLD YOU AND ALL?

WELL, LONG STORY SHORT, I WAS ABLE TO GET HER SOME HELP AND I'M HAPPY TO REPORT SHE'S DOING SO MUCH BETTER NOW. IN FACT SHE JUST CAME TO SEE ME THE OTHER WEEK AND SHE'S GOING BACK TO SCHOOL TO GET HER TEACHING DEGREE WHICH OF COURSE MADE ME VERY, VERY HAPPY.

THAT'S JUST SO GREAT.

SO WHO DID YOU BASE YOUR CHARACTER ON?

HMM?

WHAT WAS YOUR INSPIRATION?

JUST, YOU KNOW, A BUNCH OF THIRNGS.

OH.

WELL, I SHOULD BE GETTING BACK.

OH, NO KIDDING. I DIDN'T REALIZE IT WAS THAT LATE.

THANK YOU SO MUCH.

YOU'RE WELCOME, HONEY. YOU'RE WELCOME.

I'LL SEE YA'.

AND ASH, I WOULD RELY TO HEAR MORE ABOUT YOUR CHARACTER, HER FAMILY AND WHY SHE DID WHAT SHE DID. I THINK YOU'RE GOT THE MAKINGS OF A POWERFUL PIECE.

THERE IS SOME PUSHBACK WHEN WE TRY TO APPROACH PEOPLE WHO ARE HAVING DIFFICULT DIFFERENT DIFFICULTY IF THEY HAVE ABOUT PURPOSELY KEPT FROM DISCLOSING IT. THEY ARE OFTEN RESISTANT EVEN WHEN ASKED TO COME FORWARD AND EXPRESS WHAT'S BOTHERING THEM. IT REALLY BOILS DOWN TO AN UNDERSTANDING THAT IF ONE HEARS ABOUT A FRIEND OR A FAMILY MEMBER, THE TIMES WE HAVE TO FACE THE RISK OF MINOR ANNOYANCES AND MINOR ALIENATION IN ORDER TO INTERVENE IN A WAY THAT IS GLING TO POTENTIALLY SAVE A LIFE. WHAT I ENCOURAGE MY PATIENTS' FAMILIES AND FRIENDS MUCH OF THE TIME IS TO REITERATE THAT IF THEY WERE -- IF THEY TRULY DIDN'T CARE AND TRULY WERE UNCONCERNED, THEY WOULDN'T BE ASKING THOSE QUESTIONS, THAT IT'S ONLY OUT OF CONCERN THAT THEY'RE ASKING THE QUESTIONS.

THE ADOLESCENT PROBABLY INITIALLY MINIMIZING AND, I DON'T KNOW, IF THEY HAVE ALREADY TOLD THIS TO YOU ONCE, THEY ARE TOTALLY DENYING, THEY COULD DEFINITELY MINIMIZE HOW MUCH THEY ARE DOING OR WHERE THEY ARE DOING IT OR HOW OFTEN. BUT AS TRUST BUILDS AND THEY KNOW THAT I'M NOT SO, YOU KNOW, HONED IN ON OKAY, SO LET ME SEE WHERE YOU DID THIS, WE'RE TALKING MORE ABOUT HOW THEY ARE FEELING AND DEALING WITH IT, THAT BUILDS TRUST AND SOMEONE CAN COME IN AND SAY LAST WEEK, OKAY, I CUT, YOU KNOW, BUT IT WHAT WAS ONLY ONE TIME AND THIS IS WHY AND WE TALK ABOUT WHAT WAS GOING ON.

DENIAL ON THE PART OF THE CHILD IS USUALLY NOT SIGNIFICANT. IN REGARDS TO THE DENIAL ON WHETHER THEY HAVE THE BEHAVIOR, YES, IT IS, UNTIL YOU REALLY CONFRONT THEM AND YOU CAN'T BE TOO AGGRESSIVE BUT YOU HAVE TO BE ASSERTIVE ENOUGH TO GET AN ADMISSION. THE INTERNET, IT CERTAINLY HAS GREAT ASPECTS AS FAR AS INFORMATION AND IT KIND OF CAN BE THE DEVIL, TOO, FOR A PARENT YOU CAN GOOGLE JUST ABOUT ANYTHING, TYPE IN SELF-INJURE, SELF-CUTTING, SELF MUTILATION AND THERE WILL BE A PLETHORA OF SITES TO CHECK OUT AND GET INFORMATION ABOUT IT. THERE ARE SUPPORT GROUPS, YOU KNOW, YOU CAN FIND THROUGH THE INTERNET BUT IF YOU'RE A YOUNG PERSON LOOKING FOR HOW TO DO MORE AND HOW TO DO THINGS, THAT'S THERE, TOO. IT'S AMAZING THE KNOWLEDGE THAT IS GAINED.

BECAUSE THE INTERNET IS SO READILY AVAILABLE AND BECAUSE THE GENERATION, TEENAGERS HAVE GROWN UP WITH THE INTERNET AND IT BEING REALLY THEIR FIRST SOURCE OF INFORMATION, THAT IS SOMEWHERE THAT THEY CAN GO TO FIND OUT ABOUT SELF INJURY BECAUSE ALSO IF THEY ARE JUST CURIOUS AND WANT TO KNOW HOW, THAT IS THE PLACE THEY CAN GO TO GET IDEAS. IT'S ALSO A PLACE THEY CAN GO TO BLOG OR JOURNAL SOME OF THEIR THOUGHTS AND FEELINGS ABOUT SELF INJURY. THERE ARE A COUPLE REALLY GOOD WEB SITES AND ONE IS THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY WEB SITE, FACTS FOR FAMILIES, AND THAT IS THE PROFESSIONAL -- NATIONAL PROFESSIONAL GROUP OF ADOLESCENT, ACADEMY OF PEDIATRICS, ALL HAVE GOOD WEB SITES, MANY OF THESE ARE PROFESSIONAL SOCIETY WEB SITES AND GOTTEN BETTER AND BETTER AT MAKING THE INFORMATION EASIER TO GET TO. YOU CAN LOOK AT CUTTING AND LOOK AT ALL KINDS OF DEPRESSION AND ANXIETY. ISOLATION, WITHDRAWAL, THINGS LIKE THAT.

THE ONLY WEB SITE THAT I EVEN RECOMMEND PATIENTS EVER GO TO FOR ANYTHING THEY THINK IS MEDICALLY RELATED IS WEB MD AND WEB M.D. HAS LOTS AND LOTS AND LOTS OF REFERENCES TO WHATEVER STUFF YOU MAY PUT IN TO GIVE YOU BRIEF INFORMATION ABOUT IT AND OTHER WEB SITES THAT THEY HAVE ALREADY REVIEWED THAT ARE REPUTABLE, THAT ARE NOT FLY-BY-NIGHT OR NOT RUN BY A CONSULT OR SOMETHING THAT GIVES YOU THE INFORMATION SO YOU CAN SEEK SPECIFIC INFORMATION FROM SPECIFIC WEB SITES. THAT HAVE GOOD REPUTATIONS.

I HAVE SOME WEB SITES THAT ARE SPECIFIC TO CUTTING AND SELF INJURY THAT INCLUDES AAMFT.ORG, FOR MARRIAGE AND FAMILY THERAPISTS, THEIR WEB SITE HAS A GOOD COMPONENT, THERE IS CAHE DOT EDU, WHICH IS NEW NEW MEXICO STATE, SELF INJURY.COM AND SELF INJURY DOT ORGANIZATION AS WELL AS HELP GUIDE DOT ORGANIZATION ALL HAVE GOOD INFORMATION ABOUT THIS SUBJECT. SERIOUSLY, YOUTH AND FAMILY IS ANOTHER ONE AND THEN THE WEB SITE FOR THE MENTAL HEALTH COUNCIL OF ARKANSAS AND THAT'S THE ONE THAT PROVIDES THE INFORMATION ABOUT WHICH MENTAL HEALTH CENTER IN YOUR AREA IS COVERED.

I DON'T REMEMBER MUCH AFTER I CUTLASS NIGHT. IT WAS A LOT OF BLOOD. MAN, THIS IS A LONG DREAM, I REALLY HOPE I WAKE UP SOON.

WOW.

WOW? WOW LIKE THAT WAS REALLY GOOD OR WOW IT REALLY SUCKS?

NO, ARE YOU KIDDING ME, THAT WAS INCREDIBLE.

WOW.

EXACTLY, SO, I MEAN, WHERE DID THAT ALL COME FROM?

FROM ME.

WELL, YEAH, BUT...

WELL, I MEAN, IT'S ABOUT ME.

WHAT DO YOU MEAN?

I MEAN, I'M A CUTTERSORRY FOR FREAKING YOU OUT OR WHATEVER.

NO, IT'S JUST, IT JUST TOOK ME BY SURPRISE IS ALL. I MEAN, I'M NOT REALLY -- I JUST DIDN'T EXPECT IT.

OKAY.

I MEAN, I'VE HEARD ALL ABOUT IT AND STUFF. I JUST NEVER GOT WHY PEOPLE DID THAT TO THEMSELVES, YOU KNOW.

I'VE GOTTA GO.

WAIT, ASH, I DIDN'T MEAN.

NO, IT'S FINE, I UNDERSTAND. I JUST GOTTA GO.

BUT... I JUST GOTTA GO.

BUT...

BYE. ♪ ♪ I'M IN A WAR WITH A WORLD I FOUND, A BLOODY WAR HAS GOT ME INSIDE DOWN BUT THROUGH THE PAIN, WITH A RAZOR BLADE, WHEN WILL IT END? HERE I GO AGAIN. ♪ SWIMMING THROUGH THE PAIN GEJ TO REACH THE OTHER SIDE. I WISH I COULD TELL YOU WHY, BUT IF I DID, I MIGHT LET GO AND I MIGHT DROWN. BUT I HOPE YOU'LL BE AROUND. HOPE YOU'LL BE AROUND. AROUND. AROUND. AROUND. ♪

THERE ARE A NUMBER OF OPTIONS IF YOU'RE LOOKING FOR HELP. JUST LOOKING IN THE YELLOW PAGES FOR PSYCHIATRISTS, PSYCHOLOGISTS, SOCIAL WORKER, LICENSED PROFESSIONAL COUNSELOR, THINGS OF THAT NATURE. BUT YOU ALWAYS HAVE SEVERAL OPTIONS IN EACH COUNTY.

I THINK YOU SHOULD CALL YOUR LOCAL MENTAL HEALTH CENTER. IF YOU HAVE A SCHOOL COUNSELOR YOU ARE WORKING WITH, THEY CERTAINLY HAVE REFERRAL INFORMATION. YOU CAN ALWAYS DISCUSS IT WITH YOUR PEDIATRICIAN AND THEY CAN MAYBE MAKE A REFERRAL BUT CHECK OUT YOUR LOCAL MENTAL HEALTH CENTERS, I WOULD ATTEMPT TO GET AN EVALUATION AND ON AN OUT-PATIENT LEVEL FIRST, THAT'S WHERE I WOULD START. BASED ON THAT EVALUATION, THEY MAY FEEL YOUR CHILD NEEDS SOMETHING A LITTLE BIT MORE SUBSTANTIAL THAN THAT.

IT'S JUST A MATTER OF ASKING FOR HELP. BUT THE WAY THE SERVICES ARE PUT TOGETHER, ANYONE CAN GET HELP AT ANY MENTAL HEALTH INSTITUTION BUT THE PROBLEM IS IT'S CALLED MENTAL HEALTH AND PEOPLE ARE SO AFRAID AND SO AFRAID OF BEING LABELED THAT NO ONE SEEKS HELP.

USUALLY IF YOU MAKE A CALL FOR AN EVALUATION, YOU GO IN AND THERE MIGHT BE A LITTLE BIT OF PSYCHOLOGICAL TESTING, THE PARENTS SHOULD BE INTERVIEWED TO RECEIVE ALL THE INFORMATION POSSIBLE, AND ANY PARENT SHOULD GO IN WITH ALL THE INFORMATION IF THEY HAVE A REPORT FROM THE SCHOOL, THAT ALWAYS HELPS TO HAVE ANY KIND OF INFORMATION IN FRONT OF YOU WHEN THAT MENTAL HEALTH PERSON IS MAKING THE EVALUATION, IT HELPS TO HAVE THE INFORMATION. IF THERE ARE DECLINING GRADES, HAVE THAT INFORMATION AVAILABLE AND ANY MEDICAL INFORMATION THAT'S AVAILABLE.

NORTHWEST ARKANSAS CRISIS INTERVENTION CENTER BUT WE DO BUSINESS AS THE CRISIS CENTER, PARTICULARLY SINCE WE SERVE THE ENTIRE STATE OF ARKANSAS BUT WE ARE A HEALTH LINE. WE TRIAGE CALLS OF ALL SORTS OF EMERGENCIES AND CRISESTHROUGHOUT THE STATE.

8:00 TO 5:00 IN THE OFFICE BUT WE ARE 24/7 FOR THE HELP LINES. THERE IS SOMEONE THERE ALL THE TIME TO ANSWER THE PHONE. WE HAVE AN ADULT LINE, TEEN LINE, A SPANISH LINE AND WE HAVE PHONE A FRIEND FOR YOUNG KIDS, TOO, BUT OUR MAIN LINE IS 1 H 888 H 274-7472. WE ARE IN ALL OF THE YELLOW PAGES AND WHITE PAGES IN THE PHONE BOOKS AND WE ALSO HAVE A WEB SITE AND THEY CAN GO TO WWW DOT NWA CRISIS CENTER DOT ORGANIZATION AND FIND OUR NUMBERS THERE. THERE ARE NO COSTS ASSOCIATED WITH CALLING. THE CRISIS CENTER INCURSE ALL THE COSTS, INCLUDING THOSE OF NONENGLISH SPEAKERS. WHEN WE HAVE TO CALL AND ACCESS THROUGH TELE INTERPRETER, WE INCUR THE COST FOR THAT. WE CAN BRIDGE THEM TO THE TELE INTERPRETER WHICH ALSO OFFERS OVER 100 LANGUAGES BUT WE ALSO HAVE A FULL-TIME HISPANIC BILINGUAL SPEAKER IN THE OFFICE AND WE HAVE A DEDICATED SPANISH LINE.

PAYMENT IS TOUGH. THERE ARE FORM A LOT OF OPTIONS. IN THE STATE OF ARKANSAS, YOU HAVE AT LEAST TWO GOOD PROGRAMS FOR LOW-INCOME INDIVIDUALS, MEDICAID AND OUR KIDS FIRST AND THERE ARE SEVERAL PUBLIC AGENCIES THAT PROVIDE SERVICES UNDER THOSE PAYMENT OPTIONS SO IF YOU SEEK OUT COUNSELING OPTIONS, JUST ASK IF THEY ACCEPT MEDICAID OR OUR KIDS FIRST AND IF YOU DON'T HAVE IT AND YOU THINK YOU MAY QUALIFY, THOSE PLACES USUALLY HAVE PEOPLE WHO ARE TRAINED TO HELP YOU FIND THE RIGHT RESOURCES AND GET SIGNED UP.

IF YOU HAVE THE STATE'S INSURANCE AND MEDICAID THAT A LOT OF CHILDREN DO HAVE CALLED OUR KIDS, IF YOU HAVE PART A, THEN YOU CAN GET PSYCHIATRIC AND PSYCHOLOGICAL SERVICES. YOU CAN CALL ANY NUMBER IN THE PHONE BOOK THAT OFFERS THAT, AND TELL THEM YOU HAVE A PROBLEM AND THEY ARE OBLIGATED TO DO AN INITIAL EVALUATION. THEN THEY WILL LOOK AT THE TYPE OF INSURANCE THAT YOU HAVE AND GIVE YOU AN APPROPRIATE REFERRAL OR RECOMMENDATION FOR A PLACE THAT TAKES YOUR INSURANCE THAT WILL BE AFFORDABLE FOR YOU AND YOUR FAMILY.

THERE ARE OTHER PROGRAMS, WE HAVE A DISCOUNT PROGRAM, SO IF YOU MEET THE INCOME ELIGIBILITY YOU COULD SIGN UP FOR THAT AND IT WOULD TAKE CARE OF YOUR BILL.

THIS CAN BE AN IDENTIFIED DIAGNOSIS, IT WOULD FIT UNDER OTHER CATEGORIES THAN JUST CUTTING OURSELF (SIC) MUTILATION BUT A DIAGNOSIS COULD BE MADE THAT IF A PERSON HAS INSURANCE THAT COVERS MENTAL HEALTH BENEFITS THEY COULD GET TREATMENT.

THERE ARE OFTEN DIFFERENT BEEN NITSZ IN INSURANCE COMPANIES FOR MENTAL HEALTH CARE THAN REGULAR HEALTH CARE, NONMENTAL HEALTH CARE. BUT THERE ARE BILLS IN CONGRESS RIGHT NOW TO DISCONTINUE THAT, TO HAVE WHAT'S CALLED PARITY, SO THAT MENTAL HEALTH BENEFITS WOULD BE AT THE SAME LEVEL AS ANY OTHER KINDS OF BENEFITS. [KNOCKING ON DOOR]

ASHLEY, I'M SORRY. I DIDN'T SEE YOU THERE. COME ON IN.

THANKS.

WHAT'S UP.

I JUST WANTED TO TAKE A LITTLE TIME TO TALK ABOUT MY MONOLOGUE AND ALL.

ABSOLUTELY. I'D LOVE TO. YOU LOOK TIRED, ASH.

I AM, I REALLY AM. REMEMBER HOW YOU ASKED WHO MY CHARACTER WAS BASED ON AND ALL?

YEAH. SO WHO IS SHE BASED ON?

IT WAS BASED ON ME.

OH, SWEETHEART SO WHAT DO YOU THINK? DO YOU THINK YOU CAN HELP ME LIKE YOU HELPED THAT GIRL?

OH, SWEETIE, I CAN. I KNOW I CAN.

OH, SWEETIE, I CAN. I KNOW I CAN. ♪ LIKE TO USE IN.

I WOULDN'T EVEN USE THAT CRAZY WORD FOR ANYONE, MUCH LESS CUTTERS.

THEY KNOW THEY HAVE STRESS THAT THEY NEED TO RELEASE AND THEY HAVE JUST CHOSEN AN INAPPROPRIATE WAY TO HANDLE UT BUT THEY ARE NOT CRAZY.

MANY PEOPLE I HAVE WORKED WITH WHO WERE CUTTERS WERE VERY SANE, RATIONAL, PRODUCTIVE HUMAN BEINGS.

THERE MAY BE VALIDLY SO MENTAL HEALTH ISSUES BEHIND IT, AND A NEED TO HAVE DIAGNOSIS MADE IN TREATMENT.

THAT'S EVEN A GREATER MESS, CUTTERS DON'T EVER WANT TO BE DISCOVERED. THEY HIDE WHAT THEY DO FROM FRIENDS, FAMILY, DOCTORS, COUNSELORS, THEY HIDE IT FROM EVERYBODY. CUTTING IS A VERY SECRET ACT, A LOT OF TIMES THE CUTTER OR SELF INJURYORS ARE ASHAMED THEY ARE CUTTING AND IT IS NOT DONE FOR ATTENTION OR FOR MANIPULATION.

IF IN FACT SOMEONE DOES CUT TO DRAW ATTENTION TO THEMSELVES, THEN IT'S PROBABLY A GOOD IDEA TO PAY ATTENTION TO THAT BECAUSE A PERSON WHO IS CUTTING TO DRAW ATTENTION TO THEMSELVES MAY VERY WELL BE DOING IT AS A CRY FOR HELP. BASICALLY SAYING, I HAVE PROBLEMS, PLEASE, SOMEBODY, HELP ME. IF IT WERE THAT EASY THAT WOULD BE GREAT BUT YOU CAN'T STOP THE SELF DESTRUCTIVE BEHAVIOR WITHOUT SOME WAY TO REPLACE WHAT THEY'RE DOING AND GETTING FROM IT. THERE'S A REWARD OR THEY WOULDN'T DO IT.

IT BECOMES THE ONLY WAY FOR' MUCH PATIENTS TO GET THROUGH THE DAY.

IT'S THEIR ONLY WAY OF COPING WITH AN EMOTION THAT IT'S NOT THAT EASY, IT BECOMES THEIR WAY OF DEALING WITH LIFE AROUND THEM AND SO STOPPING COULD MAKE THINGS WORSE FOR THEM, COULD MAKE THEM MORE OUT OF CONTROL. THEY DON'T HAVE THEIR MECHANISM THAT KEPT EVERYTHING IN ITS PLACE.

IF IT WERE THAT EASY, I WOULD BE OUT OF A JOB.

ALL THEY HAVE TO DO IS STOP THE UNDERLYING STRESSORS AND IF WE CAN STOP THAT UNDERLYING STRESSOR, THEY CAN STOP THE CUTTING BEHAVEOR. >>.

IT'S GENERALLY NOT A SUICIDE ATTEMPT AT ALL, IT'S DONE OUT OF ANGER TO HAVE A RELEASE FROM PAINFUL EMOTIONS, A SUICIDE ATTEMPT IS TO END MISERY AND THESE PEOPLE ARE NOT TRYING TO DIE, THEY ARE TRYING TO LIVE WITH THE PAIN.

NOT RELATE TODAY EACH OTHER. CUTTERS DON'T WANT TO DIE. THEY WANT TO GET HELP FROM THEIR PROBLEM. BUT THEY HAVE NOT DECIDE TODAY ASK FOR HELP AND THEY ARE HELPING THEMSELVES.

THE BEST WAY TO THINK ABOUT THIS TYPE OF SELF-INJURY BEHAVIOR IS ALMOST REALLY THE OPPOSITE, IT'S AN ATTEMPT TO TRY TO GET BETTER, EMOTIONALLY, IT'S A WAY THAT PEOPLE HAVE FOUND THAT THEY FEEL BETTER AFTERWARDS THAN THEY DID BEFORE AND IT'S A WAY TO TRY TO STAVE OFF EVEN A FURTHER SLIDE INTO DEPRESSION, ANXIETY AND FEELING DISCONNECTED AND OUT OF CONTROL.

SOME MUTILATORS CAN HAVE AN ACCIDENT OR CUT THE WRONG THING OR NOT BE WHERE THEY CAN GET HELP AND SO THEY MIGHT BLEED TO DEATH OR IN RARER CIRCUMSTANCES DEVELOP AN INFECTION THAT COULDN'T BE TREATED WELL. IT'S AN INTERESTING QUESTION OR AN INTERESTING THOUGHT BECAUSE THERE IS SOME INDICATION THAT A LOT OF PATIENTS WILL EVENTUALLY FIND OTHER WAYS TO COPE THAT ARE HEALTHIER. UNFORTUNATELY, BETWEEN NOW AND THAT PROCESS, WHICH CAN TAKE YEARS, THEY ARE PUTTING THEMSELVES AT RISK OVER AND OVER AGAIN AND OFTEN INVITING DEPRESSION AND ANXIETY TI AROUND THE VARIOUS ACTS THEY ARE CUTTING WHICH LEADS TO THOUGHTS OF SUICIDE BECAUSE THEY FEEL OUT OF CONTROL AND THEY CAN'T STOP THE CUTTING.

YOU KNOW, IT'S HARD TO KNOW WITHOUT KNOWING HOW MANY PEOPLE IGNORE IT AND IT DOES GO AWAY. THE ONES THAT I SEE, IT DIDN'T WORK IGNORING IT SO I WOULD SAY THAT IT'S A GOOD THING TO GET EVALUATED. DENIAL IS HUGE IN FAMILIES AND IT'S HUGE AMONGST ALL OF US, BUT, NO, IT DOESN'T GO AWAY, MISERY DOESN'T JUST STOP.

NO, IN FACT A LOT OF THE LITERATURE SAYS THAT MOST FEMALE CUTTERS ARE OF MIDDLE TO UPPER CLASS, THEY ARE IN THEIR 20s AND 30S THEY STARTED IN THEIR TEENS SO I THINK IT IS ADDICTIVE ENOUGH IN NATURE THAT THE THOUGHT, EVEN IF SOMEONE HAS GONE THROUGH THE PROCESS AND WORKED ON THE ISSUES, THE THOUGHT WILL STILL BE THERE.

I THINK RELIEVING STRESS AND GETTING OUT OF THE SITUATION, BEING AWAY FROM THE CIRCUMSTANCES MIGHT DECREASE THE LIKELIHOOD OF CUTTING SO THAT YOU COULD SAY THAT'S GOING OUT GROWING OUT OF IT BUT I DON'T REALLY THINK THAT'S WHAT HAPPENS.

THERE ARE SOME INDICATIONS THAT A LOT OF PATIENTS WILL EVENTUALLY ON THEIR OWN FIND OTHER WAYS TO ADAPT, BUT AGAIN IT'S THE SAME ASSUMING THAT SOMEONE WILL EVENTUALLY STOP USING COCAINE OR STOP ENGAGING IN OTHER VERY HIGH-RISK BEHAVIORS. IT MAY HAPPEN BUT THE ODDS OF SOMETHING HAPPENING, SOMETHING BAD HAPPENING, BETWEEN NOW AND THEN, CUTTING THAT GOES TOO DEEP AND TURNS LE THAT OR DEPRESSION SETTING IN BECAUSE OF AN INABILITY TO CONTROL THE CUTTING OR INFECTION OR OTHER MEDICAL COMPLICATIONS IS REALLY SO GREAT THAT IT'S REALLY PLAYING RUSSIAN RU LEET TO TRY TO LET THIS SORT OF THING RUN ITS COURSE.

IF THEY HAVE POSITIVE ROLE MODELS AND HAVE ADAPTED NEW WAYS OF COPING THERE CAN BE SOMETHING THAT STOPS, AND THE REMISSION PERIOD CAN HAPPEN, BUT THEY REALLY HAVE TO BE ABLE TO DEAL WITH WHAT'S GOING ON AROUND THEM REALLY HAVE TO BE ABLE TO DEAL WITH WHAT'S GOING ON AROUND THEM FOR IT TO RESOLVE ITSELF.