The Bleeding Edge


There are many ways to hurt yourself.

You can make mistakes, says things you shouldn’t, get into relationships you have no business being in, or accept responsibilities you have no training for. Some of these are indirect and take days or months or even years to manifest themselves to you, even though others may have seen the problems long before you did. 

Some hurts are long, slow, and painful. They fester, ooze and seep into all parts of your life as surely as a blood-borne infection travels to the far reaches of your body before it kills you if left unchecked. These hurts can be self imposed, as when one stays in a career entered because of family tradition and not passion. They can be foisted upon you by others, as we see in sexual abuse or neglect that steals away the innocence of childhood and pulls a dark veil down over adulthood like a musty bedroom window shade. 

Some hurts are self inflicted, surgical, quick. They serve different purposes. 

I see a lot of people who are cutters. Their term, not mine. 

They use pocket knives, straight razors, kitchen knives, box cutters to inflict wounds on themselves. Often, these are on the inside of the wrist or arm, neat row after neat row of older-to-newer red lines in various states of healing that read like an archaeological dig of psychological pain and suffering. Sometimes they are on the back of the arms, hiding in plain sight. Sometimes they are on the abdomen, always there but hidden behind this season’s tank top and that one’s bulky sweater. Other times they live on the inside of the thighs, a quiet altar of introspective pain that is shared with no one, visible to no one.

Staff at emergency departments, like other professionals, get very antsy and go into action when they see four inch longitudinal cuts on wrists requiring sutures. The cleaning, anesthetizing, and re-approximation of cleanly sliced skin can be done by any competent health profession with eyes closed and mind on the next trauma coming through the door. 

Problem is, every cutter is then summarily stamped suicidal in big red virtual block letters on their chart. Cutting equals bleeding equals exsanguination equals death equals very bad undesired outcome equals emergency psychiatry consult.

All that glitters is not gold, and all that cuts is not seeking death.

Cutters tell me differently, and I believe them.

“It helps me feel something other than the pain in my life.”

“It takes my mind off my mom’s death.”

“It grounds me. It helps me focus better.”

“I like watching the blood trickle down my arm and drip onto the table. It makes me feel real.”

“It makes me feel like I’m in control, even if it’s just for a little while.”

Cutting of the sort I’m describing to you rarely portends death.

On the other hand, it is a sure sign that someone is in pain and wants to live. 

It should be viewed as a sign that someone is reaching out.

As surely as clean lacerated edges come together and heal, albeit leaving visible scars, emotional slashes can be healed too. 

The scars will be there, unseen, most likely forever.

The difference will be that the person will put down the cutting tools and learn how to stitch themselves up emotionally when life rips something open again.

As it inevitably, inexorably is wont to do.



“Yeah, Doc, I drink. I drink a lot. Some nights I drink a case of beer and a half pint. Can’t sleep if I don’t drink. Relaxes me. Pure and simple. Numbs me up like novocaine.”

A toothless grin.

“It’s the feeling of floating away. I don’t know, I just keep coming back to it. Stuff goes in, feel a little flushed, a little rush, then I go somewhere else, you know? I just kinda float off on a cloud for a while. Things back here hurt. I don’t have a job. I can’t buy my kids stuff. I can’t provide. I’m nothing, Doc. I’m nothing to nobody.”

One tear, sliding silently down the weathered cheek like a raindrop after a crashing, lightning-filled storm.

“It just feels good somehow. I know that’s weird. My mom freaked the first time she found out I do it. Oh, I don’t know, whatever I can find. My Dad’s box cutter, a kitchen knife. Razor blades are the best. I watch myself do it, you know? I sort of float over myself, watch myself cut. The lines are neat, sharp, clear. But it’s the blood that helps me. Watching the blood trickle down makes me feel something. It makes me feel human. It just- I don’t know- it just makes me feel something. Anything.”

A recent conversation with a friend made me revisit a concept that I return to over and over again in my professional life.

“We all just want to be significant. We all just want to know we matter.”

Simple concept, that. Self-worth. Self esteem. Mattering to your friends, your family, your spouse, your children, your employer. Should be a given, shouldn’t it? We’re all created, we all have a place here, and we all matter. At least we should.

What keeps some people from feeling that they really matter? What drives them to drink, to inject themselves with toxic substances and to incise themselves in neat, orderly rows of red ooze?

Pain. The common denominator is pain.

No, I’m not talking about the pain I felt when my doctor jabbed my knee with a needle last night to give me relief from unneeded fluid buildup. I’m not talking about the pain you feel when you hit your thumb with a hammer or burn yourself on a hot stove. I’m not even talking about the pain after surgery for the cancer that you now know will eventually kill you.

I’m talking about that deep, aching, throbbing, existential pain that makes you question why you are even here. Why you are alive at all. Can’t relate? I am so glad you can’t.

That kind of pain burns a hole in your soul like change hanging heavily unspent in a pocket. It demands to be felt. It will not go away. It eats at you, day after day after day, making you question your values, your worth to your children and your ability to contribute anything of value to the world at large. It wears you down like a slow-moving glacier, cold and heavy and relentless, sliding over the once-green bumpy mountainside of your life and reducing it to one, long, perfectly smooth expanse of nothing. It leaves no distinguishing marks. You become nothing. You are nothing.

And so you fight desperately to spend that pocket change, to trade it for something shiny and new, something that will make you feel good for a minute, an hour, a day. You try with all your might to melt that glacier, knowing full well that it is too large, too heavy, too wide and deep to extract from the hillside of your life below. You push up and out, but feebly. You take the last breath from the last air in the last pocket, and you resign yourself to the fact that no one will even know that you were here. You are nothing.

So you drink. You can quit anytime you want to. You’ve done it a thousand times. But you don’t.

So you push the plunger one more time, biting the rubber and holding it tight, feeling the inescapable, orgasmic flush of absolute pleasure that will kill you. You don’t care if it does, because for this one moment, this one beautiful moment in time, all is right in the world and God Himself is sitting here with you, stroking your sweaty forehead and easing you out of the world you’ve come to hate.

So you cut. You make the lines fine, evenly spaced, surgically precise. You wait for the first drop of blood, the first small rivulet that stands up for one second, supported by its own surface tension, that same surface tension that has kept your life intact for one more day. You watch the blood trickle down, a small red river of pain, tiny, tiny pain that flows out of you and is controlled by you and is something that you can deal with. Something that you can see, and feel, and hide from others for just one more day.

Maybe tomorrow will be better.

Maybe tomorrow the pain will go away.