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Skin Game
By Caroline Kettlewell. New York: St. Martin’s Griffin, 1999, 178 pages, $11.95.
In Skin Game, a memoir by Caroline Kettlewell, the author describes her most intimate thoughts and emotions about her aberrant relationship with razors, and she tells her story of self-mutilation. The book provides a personal look at Kettlewell’s life, beginning with when she was a child, and when the cutting first commenced. Throughout the book, Kettlewell describes how the self-mutilation escalated, and what other additional symptoms accompanied the cutting. Kettlewell offers vivid imagery and somewhat disturbing insight into her life as a self-mutilator.
The book begins with Part I. Under this subtitle, the author includes a quotation, “Skin has a good memory. Skin is like the ground we walk every day; you can read a whole history in it if you know how to look” (p. 1). This quote is the precursor to the first twenty chapters of the book. In each of these chapters, the author describes the trials and tribulations that she had dealt with during her adolescence. The issues the author speaks about in Part I seem like “normal” dilemmas that most adolescents would encounter during this point in their lives; however, the author’s interpretation of these issues, and the way she has gone about dealing with them offer a point of divergence.
During chapter 1, Kettlewell opens with a scene of a flashback from when she was in seventh grade, in which she is in the girls’ room at her private grammar school, tearing away at her skin with the saw blade of her Swiss Army knife. This is the first attempt at her self-mutilation, and is the first encounter with her intrigue of cutting her own skin. In this chapter, Kettlewell refers to cutting herself and seeing her own blood as “seductive” and “hypnotic.” She feels compelled to cut into her skin, and describes her thoughts poetically and romantically. She states, “The key to success is to envision the thing in your mind. Draw the bright chrome of the blade along the slender rope of vein wrapping sinuous around your left wrist, and everything parts obediently beneath your command, like the Red Sea before Moses” (p. 5).
It may be suggested that if a psychotherapist is considering prescribing this book to a patient or possibly for loved ones of the client to read, that one or two chapters be assigned to be read between therapy sessions. This could be achieved once trust is gained from the client, and a therapeutic relationship formed. It is also necessary that some insight is present from the client about self-mutilation as well. Discussion and clarification of the reading material should then follow during the subsequent session. In chapters eleven and twelve, Kettlewell attempts to explain the reasons as to why she cut her body. These chapters are probably the two that leave the biggest impact on the reader, especially due to the strength of the language that the author uses.
In chapter eleven, Kettlewell seems to be making excuses for or hypothesizing her actions rather than explaining or giving the actual reason as to why she self-mutilated. She reports that “on a global human scale, ritualized self-mutilation is surprisingly common. What in Western culture is pathologized as an indicator of profound dysfunction is in other cultures the very vehicle, the visible signs of society’s claim upon that body. . .” (pp. 58-59). She also cites Arnando Favazza in his study on self-mutilation, “Self-mutilation may sometimes be a creative act linked with the restructuring of chaos into. . . order” (p. 59). She states that self-mutilation is common, in different forms, and that even if “you ever wanted to punch the wall, pull your hair out. . . Don’t you think you might not be one of us?” (p. 59). She further defines the textbook case of the self-mutilator: “young, female, probably with an eating disorder thrown in. . . who started cutting sometime early in adolescence” (p. 59).
She then, herself, questions why she self-mutilated, and even now, as an adult, cannot arrive at a completely legitimate reason. She relates that she had the typical teenage troubles, but asks if they were grounds enough to do what she did. She finally explains, then, that she cut because it seemed like a reasonable thing to do at the time. She states that she cut because “something had to give. . . because the alternatives were worse” (p. 60). She describes her self-mutilation as a way of soothing herself from the “internal chaos” (p. 60). She states that cutting was her defense “against a sense of the world gone out of control” (p. 60). When Kettlewell cut herself, usually with razor blades, it was as though she dissociated from herself, and for that brief amount of time, she was at peace from the many thoughts and worries that streamed in her head.
Chapter twelve continues with Kettlewell’s intimate thoughts about self-mutilation. She reports that she cut often, and states almost romantically that, “My scars ought to be a charm bracelet of mneumonics, each a permanent reminder of its precipitating event, but maybe the most disturbing thing I can say about the history of my cutting is that for the most part I can’t even remember the whens and whys behind those wounds” (p. 63). She also explains that it “didn’t take much” for her to cut herself. She reports that she self-mutilated out of frustration, humiliation, insecurity, guilt, remorse and loneliness.
In Parts II and III, Kettlewell explains how her life seemed to spiral downward due to depression and anxiety, how her behavior became more dangerous, such as becoming promiscuous, and she adds how the cutting escalated even more because of these things. She finally reveals her scars to other people, some who become horrified, and some who accept her and want to help her. Kettlewell describes how her ex-husband urged her enter psychotherapy, and at last, with the help of both psychotherapy and anti-depressants, and with the birth of her son, she is eventually able to stop cutting herself.
This book is a well-written first account of the author’s struggle with self-mutilation. It does not seem as though Kettlewell envisioned a specific target audience for her story, so it may be assumed that people, both young and old, could possibly be helped by or relate to her experiences. Since most of the book is written looking back at her adolescence and the beginning of her adulthood, perhaps those in that age range might benefit from this story the most. Especially since the language the author uses to express her emotions during this point in her life is so powerful, Skin Game may be particularly useful and can be easily related to what self-mutilators at this age are going through. Adolescence can be a confusing time in general, and for those who self-mutilate, they may not have the insight as to why they are cutting, or what in their life is provoking them to feel as though they must resort to hurting themselves. This book may provide these young people with enough insight to see what their reasoning is, and possibly how they can go about dealing with their problems in a different way. For someone who has just started to self-mutilate, or is thinking about self-mutilating in order to “escape” as Kettlewell did, Kettlewell’s recapitulation of her experiences might persuade him or her not to cut, and therefore ultimately prevent the individual from going through similar events.
In addition, older people who have had a history of self-mutilation may also be able to benefit from Kettlewell’s book. Perhaps they have ceased to self-mutilate, but are still confused as to why they even began. This book may be able to allow these individuals to actualize that they, too, have had similar emotions to Kettlewell, and once again, this realization may allow for some peace in their lives.
One weakness of Skin Game, which may also pose a threat especially to readers who are on the brink of self-mutilation, is that Kettlewell recalls her memories and feelings of her cutting a bit romantically, as if she was reminiscing about a past intimate relationship. For those readers who are not able to comprehend the deeper meaning behind Kettlewell’s story, that self-mutilation led to upsetting and unfortunate occurrences in her life, as well as other dangerous behaviors and some serious scares of physically harming herself, this book may give appeal to self-mutilation. This, therefore, may put ideas into the individual who has a weaker sense of self, and these individuals could therefore misinterpret the dangers of self-mutilation. Kettlewell’s passionate language could possibly lead this person to find appeal in cutting. Therefore, the psychotherapist treating a client such as this should be aware of possible negative repercussions, and use this book cautiously; for it is not geared toward everyone with a self-mutilation problem. It is critical that the client is prepared for the candor of the material. Thus, this book also may be most appropriate for someone who is at least in their teenage years and some high school education so that the language used in the text is comprehended.
Another drawback of the book is that it is targeted more toward females, as the author is female and relates to issues girls frequently encounter during adolescence, such as having relationships with boys, finding a close-knit group of girlfriends at school, and self-image. Although boys may deal with similar issues as well, it might be to a lesser extent, and therefore there may be a weaker connection between the material in the book, the author's experiences, and what is actually true to life for males with a self-mutilation problem.
Additionally, this book may not be targeted to all individuals who self-mutilate. In order for bibliotherapy to be successful in this case, the self-mutilators must voluntarily read the book, and have a willingness to change and to overcome their problem, or at least come to terms with their problem or admit that they have one. For those who fall into this category, Skin Game could potentially be a useful guide to clients, especially to learn more about their emotions associated with their cutting behavior. The book could provide a good source of dialogue about particular situations described in the book that may resemble the client’s own experiences. Moreover, specific questions about the client’s behavior may arise in the psychotherapy setting due to situations or dilemmas that were presented in the book.
Overall, however, although this book is a good choice for those who have insight into their problem to read, it is a better choice for psychotherapists to read in order to gain serious insight into and understanding of the life of a self-mutilator. It may be more appropriate for use of psychotherapists in order to formulate a treatment plan than it is for the self-mutilating patient, especially if that patient is not well aware of the consequences of reading such a poetic-sounding book about self-mutilation. There are, though, certain chapters that would be recommended for the patient who does have insight. Chapters eleven and twelve delve into the possible reasons as to why one self-mutilates, and they have the potential to comfort the self-mutilating patient because he or she is not alone. For these individuals, it is recommended that chapters one, eleven and twelve be assigned and integrated over the course of the psychotherapy. It would be ideal for the first chapter to be assigned early on in psychotherapy, and for chapters eleven and twelve to be assigned once good rapport is built. The possibility to relate to the author and come to terms with the self-mutilation is present, and this may be a good treatment choice for those certain individuals who have enough insight into their problem. Discussion should follow after each chapter is completed.