Making the cut

Some of the most popular videos on YouTube are of youngsters injuring and cutting themselves without wanting to die. That's 2 million viewers of 5,000 graphic videos. Alarmed? It gets worse. 'Cutters' exist in Mumbai too

It's the stuff of macabre horror movies. Deep cuts, dripping blood, and dark mood music. Except that this isn't a horror film. It's a bunch of videos, 5,000 in all, of people cutting themselves or talking about cutting themselves. And it's up for free viewing on YouTube.

Following a recent study published in journal Pediatrics that analysed 5,000 videos of self-injury posted by people on the site, Canadian researchers found that the videos had been viewed over 2 million times, and liked as 'favourite' over 12,000 times.

While several of these could include comments by Indian viewers, the fact that individuals in this city mirror the actions of 'protagonists' on screen makes it more immediate.

Self harm or the process of injuring oneself without intent to commit suicide, most commonly by cutting oneself, is commonly seen among young patients, Mumbai psychiatrists claim.

"Maybe not as much as in the West, but it's certainly very common here too," says Dr Parul Tank, consultant psychiatrist with Fortis, Asian Heart and Rajawadi Hospitals.

Indian teenagers may not film themselves and post videos, but that doesn't mean they don't do it.

While Dr Tank pegs the numbers at "two or three patients a week at Rajwadi Hospital," Dr Nilesh Shah, professor and head of department of Psychiatry at Sion Hospital, gives us a figure of "two adolescents a week who have slashed their wrists to cause self-injury." Most self-injury patients are aged 13 to 19.

The trouble with this group that identifies itself as 'cutters' is that it lies in the domain of the largely unknown, unlike other conditions that are often discussed in the media. "Several individuals self-injure themselves, and don't seek help. In India, we see cases involving young adults, both, male and female, while in the West, you see more women attempt self-injury than men," says Dr Tank.
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People who self-injure are not usually suicidal. The injuries are usually in response to stress or trauma, and can vary from minor cuts that heal quickly to serious wounds that leave permanent scars.

Self-injury is usually kept secret, with individuals finding ways to conceal the scars, and the "cutter" is often left with deep shame at having undergone the ritual.

While earlier this behaviour was classified under Emotionally Unstable Character Disorders or EUCD, today, self harm is seen as more of a borderline personality disorder, say psychiatrists. That means, typically, a person who would injure himself would have a sensitive temperament and low threshold for pain and difficulty.

"Self harm, self-injury and self mutilation describe ways in which people inflict wounds on themselves, intentionally and physically hurt themselves. The most common is cutting the skin on various parts of the body (commonly arms and legs). But pinching and burning the skin, biting and hitting oneself and ingesting toxic substances is also common. The intention is never to kill oneself," explains Dr Tank.

A fallout of an inability to deal with negative emotions like anger, frustration, anxiety and guilt or an extreme, disproportionate reaction to an event they cannot cope with, makes cutters believe self harm helps them "release negative emotion for a pseudo sense of comfort.

When such an individual experiences anger, the deep limbic system of the brain is inflamed. It's a dysfunction of the temporal lobe of the brain. "In people who can handle stress, anger is controlled by the pre-frontal cortex, called the seat of civilisation, which inhibits the impulse to cause violence. This is weak in people with this personality disorder, leading to the idea of self-injury," says Dr Shah.

The filming of the act, posting it and viewing it is seen by Canadian professor Stephen Lewis as a way for young people to reach out to others, draw attention to themselves, and perhaps seek help. He worries that vulnerable minds watching the videos could find themselves part of a virtual community in which self-injury is reinforced, triggering the behaviour in themselves.

The videos range from showing cutters who sagely dole out advice on how to hide scars by wearing arm warmers and chunky bracelets to others who use limited first aid experience to list dangerous areas that you should avoid so that you don't die.

All matter-of-factly done, it is alarming. There are graphic videos of self harmers showing you their scars to "warn" you of potential implications of marks you are left with on your body, even after they have healed.

There is hope, though. Comments alongside the videos as well as descriptions of the videos by those who have uploaded them often say they are not here to glamourise self-injury, but to cope and help others cope with it, whether by advising them to keep out of danger or to cover up scars.

The trailer of an under-production movie called Cut: Teens and Self-hurt produced by Wendy Schenider, looks to address the issue through talking to experts and victims.

In addition, YouTube also asks users to flag inappropriate content and takes action, as well as moving all such videos to an 'above 18' category that can't be randomly accessed.

"Online viewing is for voyeuristic pleasure. Unfortunately, it might trigger a copy cat phenomenon among vulnerable youngsters who either try it for a thrill, or are fed with more ideas if they are already doing it," says Dr Shah.

But it is little more than curiosity for the odd that leads people to view such footage. "People who post such videos might have an anti-social personality and will take pleasure in posting footage of anti-authoritarian activity because it gives them a sense of power. But surfers watch it simply out of curiosity."

Acknowledging that self-injury isn't easy to treat since it's a personality disorder ("it's in a person's nature"), Dr Shah recommends anti depressants along with a mild dose of tranquiliser and counselling to stabilise the individual's moods.

The handbook

Tell tale signs
"Mood fluctuations, mild paranoia, self-defeating activities, and micro psychotic episodes with extreme reactions to trivial matters," says Dr Nilesh Shah are signs that could point to self harm.
& what can be done

"Online viewing can be used in a positive manner to have experts give information on self-harm by highlighting that it's a psychiatric problem that can be treated. It is an illness that can be dangerous and often lead to a near fatal or fatal outcome. Education and awareness will help people recognise it, and convince patients to seek help," says Dr Parul Tank.

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