It’s worrisome and disheartening to realize just how many people around the world regularly engage in self-injury or self-harm. They cut or burn their skin, pull their hair, scratch and interfere with wound healing, bang or hit the body, or swallow sharp objects or toxic substances.
Experts say that up to two million Americans, most of them teenagers and young adults, commit such acts each year. The psychiatric profession, meanwhile, has been unable to pinpoint a cause for why these individuals feel compelled to harm themselves.
Obviously, these people are emotionally troubled. Increased risk is found in individuals with borderline personality or bipolar disorders, yet many sufferers do not have a recognized mental disorder. Often they were sexually or verbally abused in childhood, and they experience themselves as failures and misfits. They usually describe themselves as being bad, unworthy, defective, and deserving of punishment.
As I attempt to show in this article, the behaviors of the people involved in self-harm, along with their emotional turmoil, make complete sense when we consider evidence from depth psychology. These individuals, for the most part, are plagued by inner conflict. Such conflict involves invisible inner dynamics—especially the engagement in the psyche between self-aggression and inner passivity—which strongly influence human emotions and behaviors.
In presenting evidence for the psychological source of self-injury, I benefit greatly from the book, Falling Into the Fire: A Psychiatrist’s Encounters with the Mind in Crisis (Penguin Books, 2014), by Dr. Christine Montross, an assistant professor of psychiatry at Brown University. Dr. Montross, who wrote the book during her residency in psychiatry and her first years as an attending psychiatrist, describes at length her experience and treatment of one of her patients, Lauren, who had been admitted to a hospital 23 times in the previous four years after intentionally ingesting objects such as wood screws, knife blades, fork handles, screwdrivers, scissors, and pieces of curtain rod. In her latest hospital admission, Lauren had crushed up lightbulbs and swallowed the glass and wire.
Lauren was indeed a challenge. “Some days she ignored me; others she tore into me in a fit of rage,” Dr. Montross writes.
Lauren met each of our encounters with derision. Although I typically felt composed and in control during clinical meetings with patients, working with Lauren made me feel inept. I couldn’t even reasonably call it “working with Lauren.” I was floundering, and I was sure she could see it. No matter how steadily I attempted to keep my cool, I began to feel that Lauren could sniff out my discomfort … And the more wobbly I felt, the more emboldened and unwavering her aggressive stance became.
One day Lauren’s abusive language toward the doctor was particularly vicious.
Dutifully, if halfheartedly, I knocked on her open door one late afternoon. “Lauren? It’s Dr.—“ “I know who the fuck it is,” Lauren interrupted. She sat up and began to address the two security guards at her bedside, gesturing toward me. “This fuckin’ Amazonian joker comes in every day with her overgrown, ugly-ass eyebrows and talks to me like I’m a two-year-old just so she can say she’s saving the world and write some bullshit nonsense in my chart about how my psych meds need to be changed.” My stomach … dropped. Had I been condescending to her. Had I gotten carried away with narcissistic fantasies?
Dr. Montross goes on to describe this encounter for several more paragraphs, ending with her leaving the room feeling “humiliated” under Lauren’s continuing barrage of insults. To give the doctor credit, she writes that she did manage at a later date to refrain from taking personally Lauren’s continuing abusive words.
It appears that Dr. Montross was unaware of vital knowledge with which she could have introduced rationality to the challenging encounter with her patient. Lauren’s mockery and aggression was an externalized rendition of the mockery and aggression that she experienced, whether consciously or unconsciously, from her inner critic or superego. Dr. Montross might have said at that moment words to this effect: “Lauren, you are just doing to me what you do to yourself. This is the way you feel about yourself on an inner level. This abuse you direct at me mirrors the cruel tone of the self-rejection and self-hatred that you absorb from an inner part of you. If you begin to see this and understand this, you can learn to stand up to that inner aggression and neutralize it. You have to see what you’re doing to yourself. This is the inner dynamic through which you become your own worst enemy. This is what compels you to be so self-damaging.”
By not having this knowledge at her disposal, Dr. Montross was at a distinct disadvantage. In the face of Lauren’s assault, the doctor experienced self-doubt, becoming passive and losing her authority. True, at that moment Lauren might have rejected the above analysis. Even so, words that got to the source of her self-damage, had they been spoken, could have a powerful, positive influence on her over time.
Passivity was also at the core of Lauren’s predicament. She was passive to her inner critic in allowing it to bully her in this manner. Instead of being strong and deflecting the inner critic’s judgments, she absorbed the accusations of her alleged unworthiness. In dealing with inner conflict, many neurotics can inwardly defend themselves with some success. But others are more conflicted. They’re beaten down until they passively capitulate. For self-injurers, punishment at this point in the form of self-injury becomes the chosen “solution” to the inner conflict.
In most neurotics, the inner punishment involves the acceptance of some degree of guilt, shame, moodiness, or depression. In more conflicted individuals such as Lauren, greater self-defeat and self-damage are involved. (The American Psychological Association reports, from a study on self-injurers, that “one factor stood out: How often they spontaneously described themselves as being ‘bad,’ ‘defective’ or ‘deserving of punishment.’”)
Sigmund Freud addressed this question of self-punishment. In a discussion on the role of guilt, he described a feature of inner conflict in Civilization and Its Discontents. In his 70’s at the time, he wrote that the unconscious ego (the seat of inner passivity) has “the perception” of being watched over by the harsh superego.
The fear of this critical agency [superego] . . . the need for punishment, is an instinctual manifestation on the part of the [unconscious] ego, which has become masochistic under the influence of a sadistic super-ego; it is a portion, that is to say, of the instinct toward internal destruction present in the [unconscious] ego, employed for forming an erotic attachment to the super-ego. (The Freud Reader. New York: W.W. Norton & Co., 1989, 765).
Freud is saying that we can produce a perverse, masochistic pleasure from our own subjugation. In psychoanalytic jargon, we “libidinize” or “sugar-coat” the punishment. Sexual masochism is the obvious expression of this. Another variation occurs when pedophiles become sexually aroused through identification with the subjugation of their victims. Committing self-injury is a non-sexual variation on this. The person who engages in self-injury has been beaten down and subjugated by his or her sadistic superego. At this point, they can employ a claim-to-power defense, whereby they unconsciously assert, “I am not interested in being beaten down and at the mercy of my self-aggression. I do have power and control. I’m taking matters into my own hands and making the choice at this moment to hurt myself.” Self-injurers report feeling control over their minds in the process of harming themselves. This claim of being in control is irrational and quite absurd, of course, because at this point, far from being powerful, the individual has become the pawn of his or her inner critic. Nonetheless, the individual does feel satisfaction or even euphoria from the illusion of power.
It’s important to note that the self-injury is itself a psychological defense. As mentioned, the individual frames the defense along these lines: “I don’t want to feel crushed, humiliated, bad, and shamed by my inner critic. I do have some power. Look at how much in control I feel in the act of harming myself.” The defense is effective to the degree that the individual feels some initial relief or euphoria. The relief or euphoria serves as “proof” that the individual wants to feel power rather than, in masochistic fashion, to grovel helplessly before the inner critic.
Often this masochistic process is acted out in a state of dissociation, meaning these individuals, despite their illusion of power and control, are so inwardly and outwardly passive that they’re not at all present to their better self, thereby unable to protect themselves from self-harm.
I must digress at this point. Having quoted Freud on the problem of self-injury, I feel the need now to briefly address the widely expressed skepticism concerning the value of his work. While in his early writings he insisted that sexual conflict was at the heart of neurosis, he later correctly deduced that inner conflict involving the id, superego, and ego was the greater influence. Freud’s contribution is noted by Columbia University professor Jeffrey A. Lieberman in his book, Shrinks: The Untold Story of Psychiatry (First Back Bay paperback edition, 2016). Dr. Lieberman, a past president of the American Psychiatric Association, takes issue with Freud in some respects, yet he writes nonetheless:
What was especially disappointing about Freud’s insular strategy is that so many core elements of his theory ultimately proved to be accurate, even holding up in the light of contemporary neuroscience research. Freud’s theory of complementary and competing systems of cognition is basic to modern neuroscience, instantiated in leading neural models of vision, memory, motor control, decision making, and language. The idea, first promulgated by Freud, of progressive stages of mental development forms the cornerstone of the modern fields of developmental psychology and developmental neurobiology. To this day, we don’t have a better way of understanding self-defeating, narcissistic, passive-dependent, and passive-aggressive behavior patterns than what Freud proposed.
I might add that Freud’s theory of libido, in which he divides the pleasure principle into two separate instincts—eros (healthy pleasure) and thanatos (the perverse predisposition toward death and destruction)—is unfolding now before our eyes in the proliferation of terrorist death cults.
To return to Lauren and her self-injury, her aggression toward Dr. Montross was not just a displacement of her self-aggression, it was also a defense against recognition of her own passivity: “I’m not a passive person beaten down by the brutal self-condemnation dispensed from my inner critic. I have power. Look at how I can make my doctor run and hide.” Such aggression is, of course, a negative, reactive variety, not an expression of true strength. Nonetheless, it would have felt to Lauren like real, redeeming aggression. (The only aggression that some self-injurers can muster is against themselves.)
Sufferers from self-harm are not likely to welcome the news that they are masochistic. This masochistic aspect, however, doesn’t have to be emphasized. Instead, self-injurers learn of the existence and operating procedures of the harsh inner critic, and they also begin to recognize their inner passivity in its defensive, enabling relationship to the inner critic. Standing in the way of the spread of this knowledge are modern scientists of the mind. In my view, they don’t recognize the cruelty and harshness of the inner critic because they won’t own, within themselves, the dark side of human nature.
Referring in his book Shrinks to Freud’s dissection of the mind, Dr. Lieberman calls the superego or inner critic “the virtuous superego” (p. 42), implying that this virtuousness was Freud’s understanding of the superego. But in the quote above from Civilization and Its Discontents, Freud clearly understands the superego to be a “critical” and “sadistic” part of our psyche. Why would Dr. Lieberman misrepresent Freud on such a crucial point? Is he tiptoeing around this topic, reluctant to recognize that self-defeating and damaging tendencies are inherent dynamics of the psyche, active in varying degrees in most people, rather than genetic or medical anomalies or what he calls “an existential condition”? On the same page, Dr. Lieberman says that Freud understood the ego to be the “pragmatic” ego of our everyday consciousness. But here again Freud is misrepresented. In his many discussions on the id, ego, and superego, Freud was often referring to the unconscious ego. The unconscious ego is the originator and organizer of psychological defenses and the seat of resistance. Much of the time people produce their outward defensiveness, their inner defenses, and their resistance without being aware of doing so.
Freud’s creation, psychoanalysis, never achieved its healing potential because its practitioners failed to assimilate his deepest insights. As I see it, most people are unconsciously afraid of personal immersion in the most powerful insights from depth psychology because of the fear of being emotionally overwhelmed by a seismic shift in one’s sense of self, particularly in the manner in which one’s conscious ego is humbled.
The world needs to awaken to the existence in the psyche of both the harsh inner critic and self-sabotaging inner passivity. Most of us have an awareness of the inner critic. Inner passivity, in contrast, is more elusive. It takes up residence in our unconscious ego. It can be understood through its role as the enabler of the inner critic, as the originator and organizer of our psychological defenses, and as the inner default position of emotional weakness and self-doubt with which we are so tempted (often to a masochistic degree) to identify.
My latest book has just been published. It’s titled, Our Deadly Flaw: Healing the Inner Conflict that Cripples Us and Subverts Society (2022), and it’s available here in paperback (315 pages) or as an e-book.