One of the more puzzling aspects of human psychopathology has always been the tendency of disturbed people to harm themselves in any number of ways. Psychiatry has focused on those whose self-harm ends up largely focused on their own bodies. The penal system and the political system have largely taken jurisdiction or those whose self-harm ends up hurting other people. Because our reaction to the latter is largely one of punishment, we know relatively little about what makes them do the things they do, or what could prevent it. For those who harm themselves the picture is becoming somewhat clearer as we understand more about the long-term effects of severe trauma.
The endorphins our bodies produce are not just painkillers. They reduce anxiety, rage, depression, and fear. They are vital to attachment behavior from birth to death. They increase when social support increases; they decrease when social support is withdrawn. Lack of early care in animals effectively reduces endorphins and may do so in people as well. Not surprisingly, given their powerful analgesic and calming effects, large amounts of endorphins are released as an integral part of the fight-or-flight response (Bremner, Davis, Southwick, Krystal, & Charney, 1993; B. A. Van der Kolk, 1987, 1996; B.A. Van der Kolk, Greenberg, Boyd, & Krystal, 1985). After all, if we are running from an enemy and sprain an ankle, it is far better if we are unable to feel the pain until we have reached safety. But what happens to the normal endorphin response when people are exposed to chronic and repeated stress, when their bodies are repeatedly exposed to these powerful agents? Stress-induced analgesia has been described in animals following exposure to inescapable shock. In severely stressed animals, signs of opiate withdrawal can be triggered by stopping the stress or by giving the animal a drug that counteracts the effects of the endorphins. One theory is that some chronically stressed people may become addicted to their own circulating endorphins because of overexposure and impaired regulation of the endorphins as a result of chronic stress. Whenever the stress is relieved, they feel worse, not better. They go into an opiate withdrawal syndrome that is similar to heroin withdrawal. They feel anxious, irritable, depressed, and miserable (B.A. Van der Kolk et al., 1985). In order to feel better they must do something to get their endorphin level back up, and that means doing something stressful. What they end up doing is determined by what works, their own experience and inclinations (Stanley et al., 2010).
Stress-addicted children are often those children in the classroom who cannot tolerate a calm atmosphere but must keep antagonizing everyone else until the stress level is high enough for them to achieve some degree of internal equilibrium again. Violence is exciting and stressful, and repeated violent acting out, gang behavior, fighting, bullying, and many forms of criminal activity have the additional side effect of producing high levels of stress in people who have grown addicted to such risk-taking behavior. People who self-mutilate, who literally cut and burn their arms, legs, and torso have always puzzled psychiatrists because this self-mutilation did not seem to be aimed at suicide. People who self-mutilate report a rising sense of internal tension that is relieved when they cut themselves. People who self-mutilators are frequently those who as children were abused, often sexually abused and have learned that hurting the body will evoke a calming response because of endorphin release (Stanley et al., 2010). They have not been able to find comfort from other people and instead must rely on their own methods, even if that means self-harm. Many people appear to seek out high-risk jobs or forms of recreation and talk about the "high" they feel, even at risking their lives. An important element of these behaviors is control. All of these examples are ones in which people have the opportunity to overcome and defeat helplessness by taking control. No one else is hurting them, risking their lives, threatening them-they are playing with life and death themselves; they are in charge.
Bremner, D., Davis, M., Southwick, S. M., Krystal, H., & Charney, D. S. (1993). Neurobiology of posttraumatic stress disorder. In M. Oldham, M. B. Riba, & A. Tasman (Eds.), Review of Psychiatry: Volume 12. Washington, D.C.: American Psychiatric Press.
Stanley, B., Sher, L., Wilson, S., Ekman, R., Huang, Y.-y., Mann, J. J., . . . Sahlgrenska, a. (2010). Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters. Journal of Affective Disorders, 124(1), 134-140. doi:10.1016/j.jad.2009.10.028
Van der Kolk, B. A. (1987). The separation cry and the trauma response: developmental issues in the psychobiology of attachment and separation. In B. A. Van der Kolk (Ed.), , Psychological Trauma (pp. 31-62). Washington, D. C.: American Psychiatric Press.
Van der Kolk, B. A. (1996). The body keeps the score: Approaches to the psychobiology of posttraumatic stress disorder. In V. d. K. B., L. Weisaeth, & M. A. C. (Eds.), Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society. (pp. 214-241). New York: Guilford.
Van der Kolk, B. A., Greenberg, M., Boyd, H., & Krystal, J. (1985). Inescapable shock, neurotransmitters, and addiction to trauma: Toward a psychobiology of post traumatic stress. . Biological Psychiatry, 20(314-325).
Excerpt from Bloom, S. L. (2013) Creating Sanctuary: Toward the Evolution of Sane Societies. New York: Routledge