Cutting: Understanding and Overcoming Self-Mutilation

by Steven Levenkron

A seminal work on treating self-mutilation, revised and updated with illuminating case studies and newly available resources. Nearly a decade ago, Cutting boldly addressed a traumatic psychological disorder now affecting as many as two million Americans and one in fifty adolescents. More than that, it revealed self-mutilation as a comprehensible, treatable disorder, no longer to be evaded by the public and neglected by professionals. Using copious examples from his practice, Steven Levenkron traces the factors that predispose a personality to self-mutilation: genetics, family experience, childhood trauma, and parental behavior. Written for sufferers, parents, friends, and therapists, Cutting explains why the disorder manifests in self-harming behaviors and describes how patients can be helped.

Genres: Psychology, Nonfiction, Mental Health, Mental Illness, Self Help, Research, Medical

269 pages, Paperback

First published September 2, 1998

Reviews

[Danielle · Rating 1 out of 5]

Okay, fine - this book provides some interesting insight into the world of cutters, and why they do what they do. Clinically, it's fine.

However, Levenkron's tone is unbearable, and the book is packed with these nauseating case examples in which he acts as some great guru of wonder and light, the only one who can possibly understand the struggle of the poor, misunderstood cutter. His description of how his patients eyes light up when he spouts his "wisdom" is almost laughable. In addition, there's a part of the book where he describes how he gently tends to his recently-cut patient's wounds with rubbing alcohol and a cotton bud - this is something that has been specifically decried in other psychology texts about the ethics of touch in therapy and boundary violation (which is why I picked this book up, actually - out of curiosity).

His narrative is certainly indicative of some serious countertransference issues, which is worrying. However, the book is interesting to read, if you're the kind of person who gets a weird thrill out of looking at train wrecks or reading Failblog. For a much better, more objective book on self harm, however, I recommend Marilee Strong's "A Bright Red Scream".

[stephanie · Rating 3 out of 5]

levenkron is a kind of annoying writer. he's come out with maybe the first ya-lit book on anorexia ( the best little girl in the world) and then his follow-up on self-injury, and this book is his "conclusion" on self-injurious behavior.

his main thesis is that people (mostly teenage girls) cut because they have a lack of communication. in behavioral terms, they are indirectly communicating their intense emotional pain by outwardly hurting themselves, a physical manifestation of the "psychache" (to steal from schneidmann) that allows people to respond because language has failed them.

he doesn't take into account the people that cut for grounding purposes, who cut purely for attention, who cut because they begin to dissociate, who cut because they can't think of anything else to do. the people who cut to remind themselves they are alive, to see something moving within them - blood is very symbolic, and just because it is symbolic, it shouldn't be overlooked. also, i feel he ascribes too much of the problem to the parental relationship - while this is indeed the often a good place to start looking, it is not the end all - after all, many girls do not start self-injuring until they leave for college.

(which brings up another aspect he overlooks - the current "trendiness" of being a cutter, and the different ways people self-injure. while cutting is the most common, it's not the only one, and it's not the most dangerous, i would argue.)

[Elinor · Rating 3 out of 5]

This book is definitely interesting and you can tell the author is describing real cases that he has had to deal with.

On the down side, Levenkron is so caught up in the Karpman triangle it is off-putting: the parents are abusive or neglectful and it’s most definitely their fault their children are hurting themselves. The kids are obviously victims who never contributed to any of the sour dynamics with friends and family. So what else could Levenkron do but save them? Ugh!

Also, this book doesn’t really cover cutting in people who have not suffered child abuse, thus alienating 40-60% of the self-harming population in one fell swoop.

So, I like the book, there is lots of interesting stuff to be learnt from it, but it falls short by furthering the misconception that all self-harmers have been «  broken » by inadequate parenting.

[Jennifer Day · Rating 2 out of 5]

I suppose in a clinical light this might be a good book. But for a former cutter and self-mutilator it came off as extremely patronizing and as if all the author wanted was a pat on the back. There are gems hidden throughout the book but there are many others such as The Skin Game (I think that's the title) and Bright Red Scream. If you really want/need more information on what self-mutilation is really about and what it can be like to suffer from this often misunderstood and misaligned affliction then please, look for another book. This one may help you but it doesn't delve nearly enough into it for me.

[Clackamas · Rating 3 out of 5]

The first half of this book was good. It had a lot of information about early research on self-harmers, what predisposes certain people to the behaviors, and WHY people use this coping mechanism. The second part dealt with treatment though. Normally I would enjoy that, since I work with kids who have this problem. However, I found Levenkron's cookie cutter approach a little insulting. Also, by about the 2/3 point I was super tired of listening to him talk about himself and what an amazing therapist he is.

[Melynda Yesenia · Rating 3 out of 5]

As an introduction to books written about this subject, and the field is growing all the time, Levenkron's book is not so bad. I read this at the library after practically tripping over it jammed between two huge art books in the contemporary/ coffee table section, like someone had been reading it incognito.

This book oversimplifies a subject that is incredibly complex and screwed up. His main stance on the subject seems to be that cutting as a behavior arises from being overlooked or abused, probably by your parents and feeling trapped or helpless as your psyche develops. That may well be true for some and the act of finding a book that faces head-on what everyone has always told you is a terrible secret is cathartic, for sure, but a lot of the book falls short of supporting those people whose problems fall outside of Levenkron's assessment. If you know someone who cuts and you'd like to get a slant view of what they go through, I suggest you ask them, but otherwise, this book might help you out. If you're a cutter and you've read every other book out there, this one fits well into the stable of therapy manuals and "oh what will we do for our fucked up kids?" books that flood bookshops' mental health sections nationwide. However I do suggest you read it in full view since shame isn't going to help you feel any better about anything.

Obviously I have personal experience with cutting. I was and still have the disposition of a self-abuser though as I've grown up I've found less damaging ways to do so. I know that the tendency can be to search and search for the one holy-grail handbook, the one title that will make you feel justified or will teach you how to stop. This book is probably not that book, though it may make you feel less alone.

[Mary Elizabeth · Rating 5 out of 5]

If you or anyone you know is a self-harmer or you wish to learn about why people self harm, this book is a great place to start!
An amazingly insightful read and look into the lives and minds of those who self-harm. It is not demeaning nor praising of the action, and treats it seriously, through true and real stories of patients the writer had worked with. As a person who is in recovery, there are portions of this book that were so eerily familiar. The author knows what he’s talking about. He also goes into detail about what mental disorders are, why they develop, and near the end he goes on to talk about healthy recovery and advice for those in recovery.
All in all, this is an amazing read, and I highly recommend it to anyone who wants to understand the pain of others. It is hard to stomach at times, but the end result and the understanding you gain from it will leave you changed for the better.

[Dawn Livingston · Rating 2 out of 5]

Lots of case studies where the author is a guru of sorts that is the only one that can help and gives the impression he deserves a pat on the back. The book comes across as patronizing. And it offers only a narrow view of self harm. It talks mainly if not exclusively of teens and young adults. It doesn't talk about all the reasons why people self harm. It focuses on self harm being an inability to communicate and express oneself and that it stems from sexual abuse or issues with parents for those that are teens. It's too limited and I don't agree with his conclusions.

It has some information but I'm sure there must be better books out there, maybe Bodily Harm: The Breakthrough Healing Program for Self-Injurers.

[Jennifer · Rating 4 out of 5]

This book was written by an actual Doctor who uses specific sessions with patients as examples of why people cut (or burn) and what he did for each specific case. I found it quite interesting and learned a few tricks to use on myself. It was also more proof that people cut for different reasons and what works for one person doesn't always work for another. It is the best book I have found on this subject so far.

[Jerboaz‼️ · Rating 3 out of 5]

took me 5 months to read this book..lol

The title is definitely misleading …i picked this up for advice to help myself, but its definitely geared more towards people surrounding a self harmer and i see how this book could be helpful for someone close to a person who hurts themselves,cuz it breaks down and gives a bunch of examples of real patients and their reasons for doing it, but to read it from the perspective of someone who engages in that behavior, it just left me unsatisfied. A problem i had with it was that he really doesnt go over the population of self mutilators that didnt experience child abuse. He kind of just chalks everything up to the persons childhood. Which leaves a good chunk of people out🗿 Also this guys tone is annoying! He portrays himself as some sort of savior who makes these poor tortured young women have an EPIPHANY from his words… “I know just what you need even though you dont even know what you need yet im so good at saving teenage girls from themselves”🌞 Also felt sooo repetitive at times like YES THUS GIRL WAS ABUSED AS A CHILD AND NOW SHE CUTS HERSELF… DO YOU WANT TO TELL THE STORY AGAIN SIR?🌞🌞🌞. Definitely was weird that even though the author stressed that both girls and boys do self harm, he consistently uses she/her pronouns to refer to self mutilators??? ALSO to read this as someone who does hurt themselves, it can definitely be triggering as hell🌞 theres some graphic descriptions of injuries and methods to self harm that i found distasteful in a book like this, and without warning .I imagine it could be similar for some anorexics as welk as that is discussed but i dont know about that.. On a separate note, the part about “backwards recovery” was definitely a good addition to the book,especially if it was read by someone close to a self harmer who is wondering why after so much treatment they seem to be getting worse. It is informative in that regard and in a lot of others too that im not giving it credit for.. And to be fair this book is like 20 years old so let me stop hating so much

Was okay, interesting enough🥸

[Mathilde · Rating 3 out of 5]

Boek gelezen vanwege een casus in mijn werk met een dove studente die ook automutileerde. Ze vertelde dat ze enkele keren na slapen wakker werd met sneden en schrammen. En vroeg zich af hoe dat kon. Daarop ben ik gaan lezen. Qua inhoud boeiend ook hoe hulpverlening erop kan inspringen, wat er per situatie nodig is.

[Kirsten · Rating 3 out of 5]

I picked this up at the library after being rather disappointed with A Bright Red Scream. Cutting is a much less sensationalized book on the issue, and one that I think is a lot more useful for those who would seek to understand the issue more thoroughly. The subtitle of the book makes it sound like a self-help book for people who cut or otherwise self-mutilate, but it really reads more like something written for concerned friends and parents, or for therapists who are just beginning to understand the issue. I think it would be helpful for patients, as well, but more in an "understanding the roots of the disorder" kind of way than in a "how to stop doing it" sort of way. Overall, it was better than A Bright Red Scream, but it still left me unsatisfied; a lot of the book was taken up with Levenkron describing how he handled specific cases, and it occasionally comes off as somewhat self-congratulatory.

[Kennedy · Rating 2 out of 5]

I recognize this book was first published in 1999. Person-first language was nonexistent, and it infuriated me on every single page. I believe his intended audience is either people who love an individual who self-harms, or those struggling with self-harm themselves. With the latter audience in mind, he shares too much detail about self-harming behavior - details that could be triggering to someone who struggles. He also references eating disorders a number of times (understandably, since self-harm is frequently comorbid with an ED) - the problem is that he used numbers (weight, height) when talking about those clients - content that makes the book inappropriate for someone struggling with an eating disorder. There were a few good insightful nuggets, but overall I was bothered by the presentation of self-harming behaviors, and I was annoyed with the way this clinician presented himself. I think there are better books related to self-harm out there.

[Autumn]

There's good information and good insights, but after I was 3/4 of the way through the book and the author never once mentioned a patient not making some sort of progress in their first meeting, I began to question his narrative. Especially since what he was telling his patients/how he handled their difficult behavior was exactly how the therapist I saw responded and it got him nowhere.
The use of "she" for self-harming patients was also annoying. While there may be more women who self-harm, there are certianly men who do, too.
While this book is outdated some (it was published before 2000), it isn't a terrible introduction to self-harm, but certainly shouldn't be a stand alone read for anyone who has never self-harmed before and is going to be a rough read for readers who have self-harmed as the author leans towards a negative perception multiple times (it's understandable to a certain degree, but it can feel ostracizing).

[F Macias-Mossman · Rating 2 out of 5]

Levenkron is a narcissist and the book is his way of displaying his brilliance as a psychotherapist. If you can get past his writing style (I am such a hero, blah-blah) there is actually interesting subject matter here and at least more than surface level in regards to self-mutilation. However, with the emergence of Emo culture in America and Fight Clubs, it will be interesting to see how the origins of these views will shift.

[Grant Talabay · Rating 5 out of 5]

This book covers the seemingly insane notion of cutting. It breaks the practice down simply so that the lay person can understand it. Highly recommend if you know someone who self mutilates.

[Rabbit {Paint me like one of your 19th century gothic heroines!} · Rating 4 out of 5]

Very informative, but I had to skip the personal story section, since I found it triggering.

[Kelly435 · Rating 4 out of 5]

This book was very helpful to me scene I've been trying to stop self-harming myself. It gave me a chance to really reflect on my pass and move forward with my life.

[Sam · Rating 3 out of 5]

I did not finish this book. I appreciated the case examples, but did not always agree with the author’s approach.

[Lisa J · Rating 3 out of 5]

This is a detailed exploration of the often-misunderstood behavior of self-mutilation or self-harm. It focuses on cutting as the mechanism for self-mutilation however it makes clear in the early pages that self-mutilation may take many forms. I also appreciate that Levenkron made sure to point out that although one gender has greater prevalence for the diagnosis, the behavior is not exclusive and a specific gender does not provide immunity. The book presents many case examples which help to supplement the reader’s understanding of the information presented. For someone who engages in self-mutilation and struggles to understand the causes and prognosis for the behavior, the book provides some valuable information on internal and external risk factors for developing the disorder, maintaining the behavior, and hopefully recovering from disorder with time and proper care.

“A victim’s illness is not her identity” (chef’s kiss). What I really loved was the writer’s repeated description of fully recognized people rather than merely focusing on the disorder. He gave us a well-rounded picture of each client, so we saw their humanity beyond the diagnosis. This is a welcomed change from how society treats persons with mental illnesses. Even as a therapist myself, I am so sick of hearing people including other therapists (sadly) refer to people like “He’s schizo or she’s anorexic.” No, he is a person who has schizophrenia. She is a person who has anorexia. We don’t say “Hi, he’s cancer; or she’s kidney stone. Yet the ongoing stigma attached to mental illness makes it ok to reduce complex human beings with indefinite facets to their identity down to a disorder.

What was missing was more information for clinicians. While there was mention that this is a difficult subject even for therapists and how that difficulty can result in clinicians lacking the skills to support people who self-mutilate, the book did not speak directly to clinicians in a meaningful away. Rather than interspersed paragraphs about his clients’ trouble seeking treatment before coming to his office, if the goal is to see a positive change in the therapy world for persons with self-harming behaviors, I think a full chapter dedicated to clinicians at the end of the book would have been appropriate. The writer labeled the back part of the book Toward Recovery. If there is a discussion to be had about recovery, then leaving out more information about the role of clinicians and what clinicians can do to meaningfully help was a major oversight. I read the 2006 version which was an update to the original published in 1998. Hopefully, if there’s a third update, it will include a chapter for clinicians.

[Alexa · Rating 4 out of 5]

This is an amazing book for anyone involved with or curious about self-harm, whether they themselves are self-harming, or if a friend or loved one is doing so. Levenkron clearly has a lot of experience and insight into how self-harmers think, feel, and cope with the world. He provides case study after case study of self-harmers and describes their varying experiences that led to their self-harming, as well as ways he helped them recover.

One of my favorite aspects of this book was the wide range of individuals he described. He explained very well that not everyone who self-harms comes from extremely dire circumstances. Self-harm is not something only experienced by psychotic people who have no hope of being treated, or from those who experienced severe physical or sexual abuse. Self-harm can afflict any individual, even if their situation wouldn't be classified as "severe." Self-harm is not reserved for severely disturbed individuals, and is simply a maladaptive coping mechanism that any person from any walk of life could develop.

My one criticism for this book is how based in psychoanalytic principles it is. I know it was written in the '90s and self-harm was a pretty unexplored topic and there wasn't much, if any, research done about it, so psychologists didn't have that many options when it came to explaining the behavior. However, some of Levenkron's explanations were based in this psychoanalytic theory, and it bothered me at times because he would explain certain things so matter-of-factly, and I'd be left thinking "where's the evidence for that though." I know he's an expert in the field and clearly has a lot of experience with this population, but ugh. Psychoanalysis. I'm hoping that if he wrote a more updated book about self-harm that he would tie in actual research on the subject.

Sadly, as educational as this book is, it is outdated. Still a worthwhile read though, especially for parents, friends, or other loved ones of those who self-harm.

[Anne Sun · Rating 3 out of 5]

Levenkron does an excellent job discussing self-harm and self-mutilation, and provides much valuable insight into clinical cases from patients he's encountered while working as a therapist. What frustrated me is the clique stereotypes that follow many of the dialogues introduced in each section. Many of the patients are victims of some sort of abuse and neglect, have traumatic childhoods, etc. Though these are all contributing factors that increase to the likelihood of self-mutilating behaviors, it fails to consider the presence of possible genetic disposition and more subtle environmental factors. The hero complex is also extremely prominent in Levenkron's work, especially when talking about many of his patients and how his insight ultimately "changed their lives."

Overall not a terrible book, but feeds into many common mental health stereotypes and feels like an ego boost more than anything.

[Maria Smallwood · Rating 5 out of 5]

As a cutter that has been cutting for 25 years, I thought this book was written for everyone like me. I've been cutting since I was 10 and every therapist, psychologist, and psychiatrist I've seen had always told me to just stop. This man truly understands what is inside the cutters head. It's just like a drug addict can't "just stop", I should know, I've been in recovery for 7 years. It's a process. I don't cut like I used to, but I still cut from time to time. Even my current therapist tells me to stop and try other methods of coping. I need to tell her to read this book.

[T Mas · Rating 3 out of 5]

Clinically speaking this book is okay for insight into some of the different “jumping off” points of self-harm behaviors. I personally will not recommend this book to others due to some of the extensive case study work that reads like boasting paired with tactics that walk the ethical boundaries (in my opinion).

Simply, the information could have been condensed into 100 or so pages and been more impactful that the 250ish present in the published work.

[☆Mishka☆ · Rating 2 out of 5]

Good writing and could keep up with it but although Levenkron states that both boys and girls can struggle with self mutilation he keeps referring to the person with she/her pronouns and the therapist they go to as he/him. Although this is okay he doesn't talk about other reasons then just childhood trauma, which although in most cases a tributing facture is not the only reason ( got to page 106-121 )

[Almira · Rating 5 out of 5]

This is a really good well written book within depth knowledge about the different parenting styles from childhood to adulthood which contribute to self-harming behavior. Levenkron writes professionally with a clear understanding of self-mutilation and rhetorical questions regarding the subject.

I highly recommend this book especially to anyone working in the mental health sector to gain more perspective on this topic.

This book should definitely have more praise thank you!

[David · Rating 5 out of 5]

Levenkron is an ubermensch. Excellent description of the disorder, and an insightful, hopeful account of how treatment might look. Not exhaustive by any means, and at times I wish he would have dwelt more on potential setbacks to recovery and how to deal with them, but overall you couldn't do much better than this as an introduction to a tenaciously difficult subject.

[Joshua Sampson · Rating 4 out of 5]

Filled with insightful views into case studies concerning a wide variety of patients, mostly female. The book is a product of its time, 1998 with a 2006 update, but even so, the information is relevant. Even after 20 years, the difficulties of self mutilation are misunderstood and part of an unnecessary dirty secret in too many lives.

[Camden Hoeffner · Rating 4 out of 5]

Very helpful, educational book about people who engage in non-suicidal self-harm. Great resource for people who self-harm, friends/family members of people who self-harm, and people who work with those individuals. I will say that this book does contain many depictions of individuals who engage in self-harm and descriptions of their self-harm, so I would be wary if that is a trigger for you!

[Anna Jantz · Rating 3 out of 5]

This book can be helpful in understanding how to support people struggling with self harm and their care. I think that at times the author makes statements about all who struggle with self harm which is over reaching.