Cutting At Camp

By Dr. Christopher Thurber

Front-line staff members rarely think about the medical and psychological complexity that is detailed in an incoming camper’s health forms. Reviewing those forms is typically the responsibility of the camp nurse or doctor. However, when there is information pertinent to the health, safety, and social adjustment of a camper, these care providers must communicate that to the staff. Doing so puts the staff in the best possible position to support a camper’s wellness and development.

Unfortunately, some parents leave important mental, emotional, and social health (MESH) information off the health form. They may be concerned that personal information about their child will not be treated confidentially. Or, they may fear their child will be stigmatized, perhaps based on diagnostic stereotypes. As understandable as withholding elements of a camper’s health history is, it is also unfair to staff, who function as the surrogate caregivers. What may have taken parents and health-care professionals months or even years to figure out and problem-solve is now handed blindly to a relatively inexperienced counselor or cabin leader.

Some discoveries about previous unmentioned medical or psychological problems can be handled deftly, especially when the front-line staff and the health-care team at camp are communicating well. At other times, a behavior can be so upsetting, provocative, or confusing that it poses a significant challenge for everyone. Cutting is a good example. What would you do if you discovered a camper has been cutting?

Blood inside our bodies is the life force, but outside our bodies it is a sign of injury. Despite being desensitized by gratuitous bloodletting in movies, books, and video games, we are shocked to see a person self-harm. To assist directors, front-line staff, and other camp staff who are not medical or mental-health professionals, this article includes facts, insights, and helpful recommendations for responding to this sign of psychological distress. The article will help put this behavior in context, but it won’t equip you to treat the underlying distress. So always consult with a licensed provider when devising a treatment plan and making decisions about whether a camper needs a shortened stay.

What Is Cutting?
Cutting is compulsive self-harming and a way of coping with internal distress. This self-harming is distinct from any kind of planned beautification of the body, such as tattooing or piercing, and distinct from religiously sanctioned bodily alterations, such as circumcision or tribal rituals designed for health, bonding, or status. Cutting is often done in response to mounting distress after an upsetting event, but it is rarely an attempt to commit suicide. Sometimes, people who cut dissociate or have amnesia during the cutting event.

Who Does Cutting?
Both males and females cut, but cutting is more common among females. People who self-harm in this way may have a history of insecure interpersonal attachments. They may not have had reliable, loving caregivers who taught them to self-soothe, or who provided good examples of adaptive emotion regulation. Alternatively, cutters may be experiencing considerable stress due to social or academic demands. Perhaps they are wrestling with questions about their sexuality or struggling to resolve a complex relationship. Whatever the proximal stressor, people who self-harm tend to have symptoms of depression and/or anxiety. They are more likely than people who do not self-harm to abuse alcohol and other drugs, perhaps as a way to quell negative emotions. Sadly, about 50 to 60 percent of people who self-harm have been physically or sexually abused.

Why Do People Self-Harm?
People self-harm because they hurt inside. Cutting (or burning or scratching) brings both relief and attention. For some people, their self-identity is inextricably linked with the experience of pain. And because it is human nature to seek and find comfort in what’s familiar, even if it is painful, cutting behaviors may become chronic.

Cutting may be understood in a variety of ways:

·        Cutting is like a slap in the face. It abruptly stops emotional chaos.
·        Cutting is physically painful. It stops feelings of numbness.
·        Cutting is external pain. It takes external pain and makes it visible.
·        Cutting is self-directed. It puts the person in control of his or own path.
·        Cutting is like punishment. It is misguided self-blame for mistreatment by others.
·        Cutting is self-destructive. It destroys a possession (a person’s body) that someone else may have violently or coercively claimed as his or her own, such as in cases of abuse.
·        Cutting is self-expression. It is a dramatic alternative to tears or words.

Paradoxically, cutting has some short-term benefits:

·        It provides a sense of power and control, especially over pain.
·        It provides an acute form of physical pain as an alternative to chronic, emotional pain.
·        It provides an identifiable, visible wound and a concrete target for healing.
·        It releases endorphins and enkephalins, the body’s natural pain-killers.
·        It releases adrenaline, which is physiologically stimulating and pain-numbing.
·        It attracts attention, which may lead to genuine help and supportive relationships.

Because a person who cuts has crossed a conventional coping boundary and entered into self-harm territory, he or she is at a higher risk for engaging in suicidal behavior. So although most cutting is not an attempt by the person to end life, it is a significant risk factor for more severe self-harm. For that reason alone, consultations with parents and a licensed mental-health professional are essential. The good news is that treating the underlying distress causing the cutting is treatable. And although no front-line staff member would be called upon to treat such significant psychological distress, there are some principles of care—some emotional first-aid—that will help in the minutes and hours after the discovery of self-harm.

Principles Of Care
Whatever the person’s own explanation, self-harming is almost always a sign of significant emotional distress and unhealthy risk-taking. Caring for a camper (or a staff member, for that matter) who self-harms should be a collaborative effort among the person who cuts, that person’s parents, the senior staff at camp, and a licensed mental healthcare professional.

1.      Talk about what you see. It feels supportive to a person who has just cut to hear something like, “I see that you’re having a difficult time. Let’s check with the camp nurse and talk about how we can help.” If campers are hiding their cuts with long sleeves, ask “May I see your cuts, please?”

2.      Do not punish the person who self-harms. It is okay to set limits on what is permissible behavior at camp, but avoid shaming the person or expressing anger or frustration with the behavior. You can say, “It’s hard for others to watch you cut or to see your wounds.” But avoid saying, “Why on earth would you do something like that?” or “Don’t you see how upset the rest of your group is?”

3.      Be helpful and involve the health-care team. You can be helpful by displaying confidence, empathy, understanding, nurturing, and optimism about the person’s ability to learn better ways of coping. Allow space and time for the person to discuss his or her feelings. Provide assurance that you will assist the person in finding additional help. Say something like, “I know that for you, cutting seems to help. I also think we can find healthier ways to cope if we work together. Let’s walk over to the health center.”

4.      Contact the caregivers. After consulting with the camp nurse or doctor and describing your rationale to the camper, contact the primary caregivers and inform them of the behavior. For a camper who fears the parents’ anger, consider saying “I know this is upsetting for you, and your parents may also be upset. But I’m going to help them understand this is not something you did wrong or that you should be punished for. Instead, this tells me that something inside hurts, and we’ll work together to help you.”

5.      Obtain a mental-health history. Ask the parent or caregiver whether cutting or other forms of self-harming existed before camp. Determine what mental-health care the person has received to date.

6.      Arrange for a consultation. In all cases, the camp nurse, doctor, or director should arrange for an immediate mental-health consultation. The following questions should be answered: “Will this person be safe at camp with himself or herself?” and “How can we be most helpful?”

7.      Resist the temptation to treat. Unless you are a mental-health professional, resist the temptation to try to treat this behavior or the underlying distress of which it is surely a symptom. Instead, understand that the behavior serves a function. It can be understood as an expression of distress, a way of coping with emotional pain, or, in some cases, a compulsive behavior that is like an addiction.

8.      Model and monitor. If the camper or staff member is deemed safe to remain at camp, continue to model healthy, adaptive emotion-regulation, and coping skills. Be sure the person knows who the adults are at camp and to whom he or she can turn if the temptation to cut arises. Monitor the person’s behavior for improvement or decline, and bring any concerns to the camp nurse, doctor, or director.

Planning Ahead
As with other rare situations that arise at camp, being prepared for possible cutting helps everyone respond supportively, calmly, and intelligently. The case studies in the sidebar are included as a way to help your camp community feel more prepared. Directors should give thought to their role in these scenarios and clarify what they expect of front-line staff and the health-care team. Front-line staff should give thought to how the members will collaborate to put care principles 1-8, outlined above, into practice.

Finally, remember that self-harm, and the distress that underlies it, may not have been left off a camper’s health form. It is quite possible that camp is simply the first place any of this percolated to the surface. And although it is always upsetting to discover that another person is suffering, it is also a wonderful first step that a person in pain is now connected to a person who cares. Truly, the human connections we make at camp are the core of the good work we do there.

Dr. Christopher Thurber is the Strategy Director at Camp Belknap. He is a psychologist, author, and professional educator who co-authored The Summer Camp Handbook and co-founded ExpertOnlineTraining.com. Reach him via his website, DrChrisThurber.com.

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Sidebar

Case Studies To Consider
Help your front-line staff to be more prepared to handle a situation, such as camper cutting. Use the scenarios below to discuss the steps that staff members should take:

Table 1

Case Study 1
Saralina, a first-year cabin leader, returns to her cabin after general swim to find one of her 12-year-old campers, Lexie, alone in her bunk. Lexie doesn’t respond when Saralina greets her, but just stares into space. “Hey, kiddo, what’s up?” Saralina inquires. Then she sees that Lexie has two long scratches on her left arm. They are slowly oozing blood.

What should Saralina’s first move be?

What should she do next?

Case Study 2

After a meeting with other counselors in her unit, Becky returns to her cabin to psych up the campers for the special evening program. To her surprise, all nine girls are sitting in a circle. One of them stashes something behind her back when she sees Becky. Four others pull down the sleeves of their sweatshirts. “What have you got there, Meg?” Meg sheepishly produces a razor blade while another girl, Anne, says calmly, “We were just cutting to see what it was like.”

How can Becky know that her campers are safe?

What can Becky do to prevent her campers’ parents from finding out?

Case Study 3

During free time, Scott is the roaming supervisor. He’s there to make sure that everyone is having a good time. As he passes the embankment at one end of the area he covers, he detects the unmistakable sulfur smell of a recently lit match. Looking down the embankment toward the small creek that bisects the camp, he sees three campers, one of whom is holding a lit match underneath his leg and wincing.

What are Scott’s biggest problems at this moment?

How will Scott know whether it’s safe for these kids to be at camp?