Authors: Barbara Natterson-Horowitz
As a cardiologist, I was extremely interested to learn that, beyond altering blood chemicals, pain that is self-inflicted can sometimes affect the heart itself.
Researchers in Massachusetts outfitted a group of rhesus monkeys known to be self-biters with tiny vests housing heart-rate monitors the scientists could check with a remote control. They found that when the monkeys naturally nibbled at their unfamiliar new ensembles, their hearts showed no significant spike or drop. But when the monkeys bit themselves, their heart rates were markedly elevated for thirty seconds before the behavior, then plunged dramatically the instant their teeth hit fur. A precipitous drop in heart rate—especially
one that comes suddenly after it’s been elevated by thrill or fear—can create the feeling of calm. Like the self-biting rhesus monkeys, cutters (half-fearfully, half-excitedly) anticipating the moment when the blade hits their skin may be experiencing a mild tachycardia (increased heart rate), followed by a sudden, calming drop once the skin is broken and the blood flows.
So one reason people and animals self-injure may be biochemical: they are caught in a neurotransmitter-based feedback loop in which their bodies reward them with calmness and good feelings after they do something that causes pain. And their hearts may be amplifying the feeling by slowing drastically right after racing with excitement.
What’s interesting is how these two opposites—pleasure and pain, grooming and disfiguring—produce similar results in the body. So similar that some people’s bodies seem to have mixed them up. Picking, poking, and chewing—which sometimes end up hurting us—stay in the gene pool because they’re on the same spectrum as grooming, which calms us down, keeps the peace, maintains our health, and binds our anxiety. But that still leaves us with a problem: whether it’s on a normal spectrum or not, self-injury in humans and animals is aberrant, dangerous, and needs to be controlled. Not only is it a sign of psychic distress, but it can cause serious health consequences, starting with nasty infections and ending with death.
It’s here that veterinary medicine may offer new insights, or at least new paths, for human doctors to explore. Traditionally, psychiatrists have tried to understand self-harm through a checklist of personality disorders and evidence of past traumas. We might start by looking for a history of sexual abuse or features of borderline personality disorder. But our veterinary colleagues have a more direct approach. Lacking the ability to talk to their patients (and perhaps aided by this as well), they have identified the three most common triggers of self-injury: stress, isolation, and boredom.
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Call a veterinarian to treat a flank biter and she may inquire about the patient’s upbringing. (In a canine parallel, a puppyhood spent in a shelter is now recognized as a contributor to disturbed behavior in adult dogs.) Having ruled out a traumatic early “foalhood” and physical causes (say, a twisted bowel or torn ligament), she will then look for acute stress, isolation, and boredom.
a
To gauge stress, the veterinarian may investigate the animal’s social situation and environment. Is there a bully in the stable? Human or equine? Stress from feeling uncertain or insecure in its environment can lead an animal to self-injure.
Isolation can also provoke it. Simply providing companionship is one fix that veterinarians try.
Birds—even ones that seem to want to be alone, that attack and drive out cage mates—have stopped injuring themselves when their enclosures were moved closer to those of other birds. And self-harm plummets in many species of monkeys and apes when they are caged with a companion of the same species.
Many stallions stop hurting themselves when they’re allowed to graze in the company of mares—their natural grouping—instead of being housed in a stall alone.
Animals of many kinds, from cheetahs to racehorses, are sometimes paired with other species, like donkeys, goats, chickens, or rabbits. Part of the reason this works seems to involve the larger animal’s fear of stepping on the smaller ones … as if a sense of purpose itself diminishes the need to self-harm.
Boredom really rings alarm bells for vets. Free-ranging horses, for example, graze many hours a day. But when a stable hand straps on a feedbag and sates a horse’s hunger with an easy hit of tasty, calorie-dense grains, the animal is left with an overfull stomach and time for its idle hooves and teeth to fill.
Boredom is such a risk factor for stereotypies that animal behaviorists in zoos have developed a whole science around it.
As mentioned earlier, environmental enrichment creates psychological and physical well-being in animals by fostering behaviors naturally present in the wild. Zookeepers
excite carnivores with frozen balls of blood and the scent of their favorite prey. Enrichment can be as simple as a new dirt mound to explore; logs, feathers, and pinecones to play with; and different sounds to hear.
b
When vets notice animals engaging in stereotypies, they increase or vary the environmental enrichment.
When the coyote handler at the Phoenix Zoo watched two coyotes pacing the same pathway in a tight-limbed, ears-back gait, she gave them frozen blood popsicles to play with, hung pigeon wings on branches to encourage them to jump, spread giraffe and zebra urine around bushes to entice them away from their pathway, and filled burlap tubes with peanut butter to get them to work for their treat. After a few weeks, the coyotes were trotting calmly with upright ears.
Trainers give horses a variety of toys to play with, but the most surefire solution for preventing this confirmed herd animal from getting bored and stressed is to … give it a herd. After all, horses evolved to live in groups. They generally don’t even sleep well unless one of their own stays awake as a sentry. It’s no wonder solo living can be stressful for them.
And here’s where recognizing our deep connection with other animals may shed some light on the issue of human self-injury, both by putting what we already know into a new context and by suggesting innovative ways to treat the problem. It takes us to a story of a gorilla, some gum, and some nail polish.
Several years ago, a handful of veterinarians wearing face masks and scrubs hunched over a mountainous male gorilla in the gleaming white treatment room of the Birmingham Zoo. Babec was suffering from congestive heart failure, a condition I treat in humans almost every day. It leaves apes of both species weak and lethargic. In the most severe human cases of it, patients feel short of breath and exhausted doing even the simplest activities: walking from the bed to the bathroom, putting on their clothes, sometimes even just talking. The sickest human heart-failure
patients lose their appetites and drop muscle and weight. Babec, too, had slowed his eating; at 320 pounds, he was a shadow of his former 400-pound self. The ailing gorilla was about to be fitted with a high-tech pacemaker—the same kind that’s put into human patients suffering from the most advanced cases of heart failure.
While the technicians anesthetized and intubated Babec, the doctors scrubbed their hands, swabbed disinfectant on his chest, and shaved a large rectangle of silvery-black fur over his heart. Under anesthesia for medical procedures, gorillas can seem uncannily human. Their leathery palms, whorled with familiar-looking fingerprints, relax open at their sides. Their scary bulk and prominent brow ridges, which can look so intimidating when the animal is awake, seem vulnerable, pensive, and even wise when they’re under anesthesia.
The doctors made a careful incision with a sterile scalpel and got to work installing the pacemaker. The six-hour operation went well. They closed the wound, bandaged it, and cleared the room so the vet techs could get Babec ready to wake up.
But a couple of things happened during the operation that would send the charge nurse in a human OR into hysterics. In the middle of the procedure, an assistant gave Babec a manicure, painting his normally darkish nails Ferrari red. Down by his feet, another zoo staffer shaved little patches of fur from his legs and sewed loose “decoy” stitches into skin the doctors hadn’t even approached with the scalpel. Meanwhile, several of the vets did something that is strictly forbidden in a human operating room. Behind their masks, their jaws wrestled large wads of gum. And every so often, they sneaked a marble-sized ball out of their mouths and, inexplicably, worked it into Babec’s fur.
The attending veterinarian later explained to me that these human health-code violations were, in fact, clever patient-care strategies. Specifically, they were designed to defend the delicate stitches holding together the true incision in Babec’s chest, which, if left unguarded, Babec would pull out in a matter of minutes. But how to protect it? My human patients can generally be cajoled into avoiding the urge to fiddle with their sutures, at least for the thirty-six hours it takes for scar tissue to emerge. But all the lectures in the world won’t stop a gorilla from probing at the wound.
So the vets developed an ingenious subterfuge. They would protect the stitches by distracting the patient. And they would do it by harnessing
the same instinctive urge that propels the gorilla to pick in the first place: the impulse to groom.
Babec’s vets told me he awoke from his surgery the way my human patients often do: groggy, disoriented, and uncomfortable. Peering around the recovery area, he started to move his hand toward his chest, with its new incision, then froze with it in midair. The Ferrari-red fingernails gleamed like hard candies. They held his attention for a good few minutes. When he moved his hand back toward his chest, he didn’t get far before his fingers found a wad of gum. He picked and pinched and pulled at the offending material and had only just finished extracting it when his fingers touched another (the veterinarians had heat-treated it after chewing, to kill germs). The fake stitches in his ankles would be next. Every time he finished with one task, another was waiting to grab his attention—distracting him from the most important thing: his chest sutures.
This is a place where human medicine and animal medicine are already converging, although without either side realizing it.
Some therapists counsel self-injurers to try a less invasive, distracting “hit” of pain when they get the urge to cut, burn, or bruise. Plunging a finger into a carton of ice cream, squeezing a piece of ice, or snapping a rubber band around the wrist sometimes does the trick. Cutters who crave the bloom of fresh blood can draw a red marking pen instead of a blade across the places they’d like to cut. They can drag ice cubes made with red food coloring over the skin to produce a satisfying crimson trickle. Or they can swipe their fleshy canvas of choice with henna paint (this has the added advantage of drying to a pleasing scablike consistency, which can be picked off the next day). These distractions all deliver the
release … relief
response, just in safer ways.
But the vets also point out that animals need both immediate physical distractions and more long-term social changes—in other words, they need solutions to their stress, isolation, and boredom. And when you think about it, that might go for people, too. Young adults in the age of our distant ancestors didn’t have anything like the spare time and painless abundance of modern America. The typical middle-class teen is a little like the horse alone in its stall, with most of its needs—especially food but even entertainment and physical activity—provided in easy-to-digest chunks. He’s left with lots of extra time and few activities as invigorating as a daily struggle for survival.
The problem may be worsened by technology that isolates even as it entertains and informs. Even those of us who love these activities recognize that watching television, playing video games, and “social” networking alone in a room can leave us feeling disconnected from real people.
A survey comparing free-time activities and contentment found that the only pastime that consistently left people of all ages and socioeconomic groups feeling unhappy was watching TV. While bird owners and others with common problems can find solace in online gatherings of people with the same issues, this phenomenon also has a dark side. The Internet provides cutters (and those in other self-injuring subcultures, including anorexics) with the
wrong
kinds of peer groups—ones that enable and support the behavior, offer tips for “improving technique,” post poetry praising it, and describe tactics for hiding it.
Zookeepers make animals forage. Should we explore getting teens involved in growing and preparing their own foods, an activity that can produce feelings of profound calmness and satisfaction … and purpose? Just as an animal’s stereotypies decrease when it has a companion, a pet can provide company, responsibility, exercise, and distraction to a human. Like a lonely horse reintroduced to a herd, isolated cutters could be encouraged to find herds of their own. Whether in more mainstream pursuits (sports, theater, music, volunteering) or more niche passions (medieval reenactment, making YouTube videos, competitive Scrabble), the company of other flesh-and-blood human beings depending on one another can bring a deep sense of belonging.
Psychotherapy, the traditional (and often very effective) treatment for extreme self-harm, may actually combine the two approaches vets use for self-injuring animals. Supportive counseling gives a cutter the beginnings of a herd: a person to talk to, sit near, and be responsible to (by showing up for appointments). Psychotherapy can also be viewed as a form of social grooming, calming and “touching” another person through voice, language, response, and presence. Actual touch and massage therapy with literal physical contact (repetitive tactile stimulation) between healer and patient might also be useful ways to
release … and relieve
feelings of isolation and stress.
But zoobiquity also raises a deeper question about self-injuring behavior in humans. If someone is burning himself with cigarettes, we certainly need to find a way to stop him. But can we and should we accept or tolerate less extreme forms? In fact, we already do.
The recent rise in self-injury coincides with the popularization of a form of controlled bodily injury. While examining my patient who showed me her cutting scars, I couldn’t help but remark on her nearly head-to-toe collection of tattoos. She told me she’d gotten most of them during a five-year hiatus from cutting. Now she was doing both. “I think the reason I’ve been doing so much more tattooing is that I really want to cut,” she told me. “People say a tattoo doesn’t hurt. But it does.”