Cutting Through Silence: Psychoanalytic Reflections on Self-Harm in Adolescence
“Sometimes, the only way to say something is by cutting it into the skin.”
— A phrase echoed in different forms by many adolescents in psychic painPain as Communication
Self-harm in adolescence is often misread as impulsivity, manipulation, or suicidal intent. But psychoanalytic thinking invites us to listen more closely—to see the act not simply as destructive, but as a complex, embodied communication.
For many adolescents, cutting is a way to make visible what cannot be spoken. It can represent a paradoxical attempt at survival: to regulate overwhelming affect, to gain control over a disorganized sense of self, or to feel real when psychic life feels fragmented.
In this sense, the skin becomes a canvas for psychic inscriptions—a site where the unrepresentable finds temporary expression through the body.
The Skin as Boundary and Container
Didier Anzieu’s concept of The Skin Ego (1985) offers a powerful lens for understanding the psychic function of the skin. When early caregiving fails to provide a sense of containment, the ego may struggle to maintain a boundary between inside and outside, self and other. The result can be a psychic vulnerability that makes the body feel both foreign and invaded.
Esther Bick (1968) described the skin as the first container of the self. In adolescence—an already turbulent developmental period—this container is often challenged anew. The body changes rapidly, and with it, the capacity to symbolize and manage emotional states can falter. The cut may then become a way to reassert a boundary, to mark the self’s limits, or to gain mastery over internal chaos.
Clinical Encounters and Countertransference
In therapeutic work with adolescents who self-harm, the clinician may experience strong and sometimes disturbing countertransference reactions: anxiety, helplessness, a wish to rescue, or an urge to withdraw. These reactions can become valuable tools for understanding the patient’s internal world.
Therapists often speak of the importance of tolerating emotional storms without acting out or retreating. This capacity to remain present—to serve as a “second skin”—can offer the adolescent a new experience of being held and understood, rather than shamed or abandoned.
As psychoanalytic theorists such as Winnicott and Ogden have emphasized, it is through surviving these emotional assaults within the therapeutic frame that true transformation becomes possible.
Meaning Beneath the Act
Though it may appear senseless or purely destructive, cutting is rarely without meaning. It may signify a severing of painful identifications, an attempt to evacuate unbearable affect, or a plea to be seen and taken seriously.
The site of the cut often carries symbolic weight: the arm, easily hidden; the thighs or genitals, more private and possibly linked to shame or sexual trauma. In some peer cultures, cutting may also take on ritualistic or communal meanings, forming a shared language of pain and belonging.
Psychoanalysts must ask: What is being expressed through the wound? What cannot be said in words, and why? What intrapsychic or relational trauma is being reenacted on the body’s surface?
Containing Violence Without Silencing the Message
Behind many acts of self-harm lie histories of emotional neglect, loss, or unprocessed violence. The adolescent may feel silenced in their environment, or flooded by unmentalized experiences that the psyche cannot hold.
To work psychoanalytically with self-harm is to approach the symptom with both clinical rigor and deep ethical care. It requires the analyst to bear witness without rushing to interpret, to contain the pain without shutting it down. Supervision, institutional support, and a clear ethical frame are essential in navigating these intense therapeutic encounters.
Final Reflections
Self-harm is not simply a symptom to be eliminated—it is a message, a survival strategy, and sometimes a cry for recognition. When therapy provides a space where this message can be held, thought about, and symbolized, healing becomes possible.
In a world that often dismisses adolescent pain or demands quick fixes, psychoanalysis offers something slower, deeper, and more enduring: the possibility of transformation through listening, containment, and meaning-making.
Recommended Reading
Anzieu, D. (1985). The Skin Ego. Yale University Press.
Bick, E. (1968). “The Experience of the Skin in Early Object-Relations.” International Journal of Psychoanalysis, 49, 484–486.
Favazza, A. R. (1996). Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry.
Hinshelwood, R. D. (1991). A Dictionary of Kleinian Thought.
Ogden, T. (2004). “The Analytic Third: Working with Intersubjective Clinical Facts.” International Journal of Psychoanalysis, 85, 857–877.
Winnicott, D. W. (1960). “Ego Distortion in Terms of True and False Self.” In The Maturational Processes and the Facilitating Environment.
Author’s Note
This article reflects general psychoanalytic insights and clinical experience. No identifiable patient material has been included. All reflections are anonymized, generalized, and offered with respect for ethical guidelines in clinical psychology and psychoanalysis.
