Greetings from the snowy mountains. I could have stayed forever.
I promised to write a bit about self-mutilation so here goes.
As a surgeon, I'm no stranger to cutting, but I try not to cut myself. OK, so I've removed a mole from my skin under cognac-swig anesthesia, and sutured a wound or two, but that's about it.
I remember a young woman who came to see me when I was working as a GP in a public clinic. She had cut herself with a kitchen knife, just superficial cuts, in the wrists, and stomach area as well. Dozens of cuts. This was no suicide attempt; suicide by self-cutting just doesn't happen that much, with the exception of the Japanese. She told me she was under tremendous stress. After listening to her story, I almost started cutting myself.
She had lived in Africa for the past three years, working for an aid organization. There she had fallen in love with a local man, and they had decided to adopt an orphan child. The child had HIV. They brought the kid home with them, and had only returned from Africa a few months ago. The HIV disease of their child had progressed to the point where he had to get treatment, and both parents were unemployed at the time, and it was hard for them to make ends meet. What do you know, as soon as he gets resident status, the guy takes off. He found another woman and moved in with her. My patient was left alone, unemployed, living in a small, cheap apartment, unemployed, with a child who had AIDS.
I've often wondered what goes on in the head of someone who decides to commit suicide. The anxiety must be so strong, it becomes unbearable just to exist from one second to the next. At that point, when existence itself becomes the problem, it seems only reasonable to want to cease to exist - there's no choice, really. This is a medical emergency, and if there is no help available stat, the result is suicide.
My patient wanted to live. She had severe anxiety, and had tried to alleviate it with medication, psychotherapy and hypnotherapist. She found a way to ease the anxiety. She found that physical pain worked as a diversion. She started cutting herself - as long as there was physical pain, she found it possible for her to keep existing. It came to the point where she had to cut herself constantly. That's when she decided she needed to talk to a doctor. She told me all this in a perfectly calm voice and reasonable manner, and her actions, to me, seemed quite logical, and there was no evidence of psychotic thought processes or anything like that. I believed her. I gave her a good dose of Valium and arranged a psych consult. She seemed immensely relieved just to have someone else take the responsibility (or maybe it was the Valium).
It's not easy being homo sapiens sapiens. Too much cortex.