READERS GUIDE

Questions and Topics for Discussion

INTRODUCTION
Anyone who doesn’t really know Katie Roskova would think she was a model teenager: studious, smart and attractive, and a talented, hard-working athlete to boot—even if she is quiet and doesn’t socialize much with her classmates. But who really knows Katie? She appears to be the luckiest girl in the world. The truth, as Steven Levenkron points out, is that she is desperately unhappy. Driven by her mother to achieve unrealistic goals in her junior skating career, Katie is both angry and ashamed at her inability to meet her mother’s—and her own—expectations. With her father out of the picture and no close friends at school, Katie has no one to whom she can express these overwhelming feelings. Her solution, internalizing her anger and turning it against herself, has devastating consequences.

Young people like Katie are more common than you might think. There are currently an estimated 1.9 million “cutters” in America. This practice generally begins in adolescence but can continue for decades if not treated properly. Adolescence is a particularly difficult time for many, when social pressures to be “normal” can make just about anyone feel awkward and incompetent. For those without the emotional support of parents or some other adult to turn to, or whose home situations offer only further psychological and physical distress, the bad feelings can become intolerable. It’s natural to turn these feelings inward, but for some kids, that can be psychologically harmful and physically dangerous. Repressing emotion can lead to a kind of numbness. As a result, many kids find that cutting themselves forces them to feel something, and reminds them that they are alive. For others, cutting presents a challenge to withstand pain—a chance to prove to themselves that they can handle just about anything. But of course, nobody should be expected to handle pain alone. Unfortunately, that’s just how many adolescents feel—isolated, ashamed, and unwilling to trust anyone enough to share their anger and fear.

What do we learn from Katie’s story? Perhaps she is lucky after all. Finding a therapist sensitive enough to let Katie tell her own story and yet persistent enough to keep her in therapy isn’t easy. Many therapists are hesitant to take on clients who cut themselves; they find the practice abhorrent, and frequently refer these patients to mental hospitals because they are afraid of the possibility of suicide. Books like The Luckiest Girl in the World will help many adolescents and adults alike understand that cutting is actually a symptom of an often highly treatable problem, that it is more common than people think, and that by ignoring or refusing to acknowledge the problem we are not only endangering the welfare of the cutters themselves, we are also reinforcing the feelings that lead them to harm themselves in the first place.

Just looking at Katie Roskova, you’d think she had it all: she was pretty, popular, an A-student at an exclusive private school, and on her way to becoming a champion figure skater. But there was another Katie—the one she hid from the world—who was having trouble dealing with the mounting pressures of her young life. And it was this Katie who, with no other means of expression available to her, reacted to her overbearing mother, her absent father, her unforgiving schedule, and her oblivious classmates by turning her self-doubt into self-hatred. And into self-mutilation.

In his previous novel, The Best Little Girl in the World, Steven Levenkron brought insight, expertise, and sensitivity to the painful subject of anorexia nervosa. Now he applies these same talents to demystifying a condition that is just as heartbreaking, and becoming more common everyday. Through his depiction of Katie’s self-mutilating behavior—she is called “a cutter” by her peers—and her triumphant road to recovery, he offers a compelling profile of a young girl in trouble, and much-needed hope to the growing numbers who suffer from this shocking syndrome.

Steven Levenkron has treated anorexics and cutters as part of his full-time psychotherapy practice in New York City since 1970. He has held positions in many hospitals in the New York metropolitan area, among them, clinical consultant at Montefiore Hospital and Medical Center, clinical consultant at The Center for the Study of Anorexia and Bulimia in New York City, and adjunct director of Eating Disorder Service at Four Winds Psychiatric Hospital in Westchester, New York. Currently he is a member of the advisory board of The National Association of Anorexia and Bulimia (ANAD) in Highland Park, Illinois.

His previous book, the groundbreaking novel The Best Little Girl in the World, dealt with the subjects of anorexia and bulimia, and was made into a television movie.

A 1998 ALA Best Book for Young Adults

Is it true that “cutters” tend to be girls rather than boys?

Yes. Eighty percent of all cutters are girls. And the reason for that is that girls are more apt to self-inflict pain as a means of protecting those around them, the people with whom they’re really angry. Girls don’t get as “simply” angry as boys. They are concerned that their anger will damage others, and so it seems safer, to them, to express this anger inwardly, toward themselves, rather than externally, toward those around them. By and large, women do take their anger out on themselves. The other thing that is interesting is that a lot of these girls are normally very outgoing, charming, delightful people. This is the false self they present to the outside world. These girls can get close to others, but you cannot get close to them.

Are cutters born with these tendencies?

Some are born with a higher level of anxiety and depression, traits that they do inherit genetically. But if you combine these traits with conditions in which they are emotionally or physically abused the result can be that these children feel trapped. They become unable to form emotional attachments. This results in a failure to trust others, and finally a failure to depend on others. Now, if you can form an attachment with a cutter, then the trust and the dependency can follow.

So that’s where the role of the therapist comes in.

That’s right. You see, cutting is a language. It’s a way of expressing what can’t be expressed in words. So many people are blinded by the behavior because they find it so repulsive. What’s really more important is the underlying situation that led to this type of behavior.

It seems odd that Katie’s mother never noticed her daughter’s scars. Are parents often “willfully” ignorant of problems like Katie’s ?

Children are very good at concealing these scars. Although each cut is a severe cry for help, the girls are too sick to actually reach out. So they find places on their bodies that are easily concealed, such as their forearms or upper arms, their upper thighs or their stomach. They’ll wear long sleeves and pants even in summer to hide these scars.

Still, you’d think a parent would notice this type of thing!

Well, a lot of parents are on the run from adolescence. What I mean by that is, they’ve been conditioned to believe that this is an age in which privacy is very important—many parents fear their children’s anger at the invasion of privacy—and so they don’t consider inspecting their children. But the thing about privacy is that it can lead to isolation. I’m not saying that bedroom doors should be open doors at all times, but when privacy is taken to the extreme, it becomes hiding, and that behavior needs to be eliminated.

What kinds of stresses in addition to parental pressure can lead to this kind of behavior?

There are three kinds of scenarios. The hardest is where there is cruelty by a parent or older siblings. This can take the form of emotional, physical, and sexual abuse. In this case the child learns that pain is part of living. The more benign scenario is a child who is overlooked by exhausted and depleted parents. And then there is the situation in which a parent, usually a mother, will express her own unhappiness by making emotionally needy statements. This can make the child feel responsible for the parent’s happiness. That is another reason why girls so often turn to cutting, since they tend to be protective of the people around them. We should shield our children from certain kinds of honesty.

If someone were to suspect a friend or classmate of having this type of problem, what should he or she do?

The best thing you can do is call her on it. Say, “It looks as if you’re cutting yourself. Do you think you want to talk about it?” A lot of cutters will pass off their scars as accidents, such as a fall from rollerblading. But because these people don’t have a language with which to express themselves it’s important to help them put these feelings into words. Unfortunately, there are a lot of therapists who choose not to handle this type of case, and would rather see the child in a hospital. They can’t get past the idea of what cutting is. But these are only surface injuries. The real harm is what’s going on inside, the feelings that cutters don’t have words for. Cutting is their language. Cutting is like writing a diary in blood on their skin.

Questions for a Mother/Daughter Discussion