I have scars from self-injury on my thighs and my arms. My first scars are a cluster of four on my right wrist. For years, they were the only scars I had. I saw them when I woke up, when I was cold and they blushed purple, when I was in the shower, when I raised my arm to hold the railing on a bus. I was acutely aware of them, and thought everyone around me was, too. I viewed them as an identification tag, a medicalert bracelet, a blaring signal that I had dealt with the kind of mental illness that makes you hurt yourself. At my sickest, I developed scars in tiger stripes on my thighs. When I started university, I added scars to my arms. As my illness of identity took hold, I began to crave scars. My identity was shaped around my illness, and my scars were tattoos or a way to tell the world who I was. I wanted people to notice them, I wanted people to understand how I felt – the kind of sick that is only recognized if you are physically wounded.
For me, scars carry equal parts shame and pride. I do not wish they were gone, but sometimes I catch myself pulling down a sleeve and flushing with embarrassment. Sometimes I hand my change to a barista with my wrist in plain sight, sometimes I turn my palms toward my body and press my arms to my sides.
When I was sixteen, I saw Maddie Gorman perform a poem about her self-injury scars. It was not only my introduction to spoken word and its ability to communicate what I had always wished my scars could, but the first time I heard another person talk about self-injury scars and their impact on identity and self-worth. “I am a tiger,” she said. “I know what it’s like to bleed through my stripes.”
The Scar Cognition Scale
In 2017, researchers at Temple University created the Scar Cognition Scale to measure individuals’ relationships with their non-suicidal self-injury (NSSI) scars. The variation in feeling toward scars is represented in the five scales of the questionnaire. They are described below, in order of relevance to the sample of undergraduates in the Temple University study.
Reminders of Negative Experiences: 79%
The intense pain we have lived through is often brought to mind when we look at or think about our scars. Sometimes I spend hours touching the raised skin, thinking of the day I felt bad enough to hurt myself. Certain areas of scarring connote different periods of my life: the first grouping from age 14 (which I did in the bathroom of my first therapist’s office after I lost my first best friend), the fifteen on my thighs during one of my worst episodes at age 20 (the autumn before I was diagnosed with BPD, and after the summer I broke it off with my first girlfriend and engaged in a destructive relationship with a woman I worshiped and despised), and the three on my arm from a particularly challenging academic period. It is acutely distressing to be reminded of these events every day, every time I glance at my own skin.
It is unsurprising that this is the most common of scar cognitions, among current self-injurers and those who no longer engage in the behaviour alike. My own experience is echoed in the authors’ discussion of these findings: “given research suggesting individuals engage in NSSI often in the context of intrapersonal and/or interpersonal distress, it is reasonable that particular scars resulting from NSSI act to trigger specific memories of aversive past experiences. It also has been suggested that viewing one’s NSSI scarring may trigger similar phenomenological states experienced during the self-injury episode itself”. Treatments for self-injury should target this phenomenon, as this triggered state often leads to relapses in self-injurious behaviour.
Social Stigma: 63%
The term “stigma” comes from the Greek: to mark with a pointed stick. It is fitting, then, that a physical marking of mental illness is paired with shame. Scars resulting from NSSI are often characteristic of the behaviour in their location and appearance. I remember consulting a friend in high school for ways to excuse mine, and she suggested telling people I fell out of a tree. I laughed and asked her when falling out of a tree would result in methodical, perfectly spaced lines on one of my wrists. Although NSSI scars are recognizable as such, the behaviour is largely misunderstood by laypeople and medical professionals alike. In an episode of Mentally Yours (a podcast on mental illness out of the UK), Seaneen talks about the lifelong consequences of living with scars.
“It’s kind of followed me… I’m still treated like I self-harm. When I was pregnant and I had my midwife’s appointment, she wrote down in the records “slashed arms”… they treat self-harm – because you have scars – as current… even if you’ve got ten years behind you, fifteen years behind you, you’re still a “self-harmer” because of the scars. It’s literal stigma, you’re always marked by it.” In a YouTube video, Marie talks about being harassed about her scars by strangers at a bus stop and whether or not people with self-injury scars should cover up when they leave the house.
Pride and Strength: 52%
I was relieved to find I was not alone in drawing positive cognitions from my scars. Half of the Temple University sample also felt this way about their scars: hopeful, resilient, or proud, as evidence we have been able to live through intense pain (both emotional and physical).
Perceived Weakness: 48%
Alternatively, some self-injurers endorsed feeling weak or afraid when they think about their scars. When individuals who endorse these feelings view their scars, they might feel ill-equipped to cope with distress or resist urges to self-injure. Studies of NSSI have repeatedly demonstrated a majority (~80%) of people who engage in NSSI do so to regulate strong negative emotional experiences. Negative emotion peaks right before an act of NSSI, and significantly reduces in its wake. People who regularly employ NSSI as a coping strategy might feel unskillful in other emotion regulation strategies, their scars reminders of this deficit.
Suicidal Thoughts: 42%
Some self-injurers report feeling more capable of engaging in suicidal behaviour, and feeling suicidal desire when they think about their scars. This phenomenon could be a combination of hopelessness resulting from the permanency of scars, and the stigma of being marked with these permanent scars.
In my introduction to this post, I talked about how I craved the sense of identity my scars gave me. As I got sicker and identified more with my illness than the other parts of me, I identified as well with my scars. Rather than fitting with the positive cognitions subscale of the Scar Cognition instrument, the item asking if participants’ scars made them feel unique fit best with suicidal cognitions, suggesting the kind of identity that results from NSSI scars may be maladaptive, and isolate self-injurers from a sense of belonging with others.
My scars have been an identity, a mark of shame, a trigger, and a pensieve. They remind me of my most out-of-control feelings and my most resilient self. They are the fine lines between death and me, between staying alive and the destruction of all I live for. They are the ease with which I could slip away, and the fight my body puts up against my mind. They are part of me, and I am part of we who wear our most painful secrets on the outside.