SKIN GAME

A Cutter's Memoir

By Caroline Kettlewell

St. Martin's. 178 pp. $21.95

Reviewed by Wendy Law-Yone

If the subtitle of this book gives you the impression that a cutter's memoir is an autobiography of a guild member with trade secrets to reveal, you wouldn't be entirely mistaken. "There are an estimated two to three million `cutters' in America," begins the dust jacket copy, suggesting a growing cadre of obscure specialists. Cutters, however, are not members of an established league or lodge in this case, but an unofficial sorority of self-mutilators, with mostly adolescent girls among its rank and file. Cutters are a breed of unhappy young people who express their malaise by drawing blood for diversion, by nicking or cutting themselves for relief. The cutting goes on not once, or even twice in a lifetime, but habitually, obsessively, until -- with luck -- help arrives in the form of discovery, or therapy, or maturity, or all three.

Caroline Kettlewell's account of her 20-year history as a cutter from her 12th year on delivers as cogent and nuanced a picture of this peculiar disorder as we are ever likely to read. "My skin itself seemed to cry out for an absolution in blood. When I cut, I felt better for a while." "Cutting was my deliverance. I cut, and just like that the itching, anxious restlessness was gone. I cut, and was made paradoxically whole." "Frustration, humiliation, insecurity, guilt, remorse, loneliness -- I cut 'em all out. The only way I could survive them, I thought, was to keep draining them from my blood." "I cut for dread of the future." What is this impulse that seeks wholeness through bodily harm, safety through the courting of danger, salvation through pain? The question occurs as well to bewildered middle-class parents whose kids keep joining the legions of the tattooed, pierced, branded or purposely scarred. Cutters may not have the excuse of art, or the decorative urge as camouflage, but on one level cutting, like tattooing, piercing and such -- or even like anorexia, with which it frequently shares victims -- is supposedly about the need to control chaos.

In his compelling study of self-mutilation, Bodies Under Siege, Armando Favazza describes aspects of the impulse as "a creative act linked with the restructuring of chaos into order." Kettlewell explains her own handiwork with a knife as a need "to lay down a line between before and after, between self and other, chaos and clarity. When I cut, my life no longer overwhelmed me."

What sort of life, with what level of looming chaos, tends to breed a cutter? If there is an answer -- and this is to the author's credit -- it doesn't leap out of the details of her family history, necessarily. Sure, there are dysfunction, repression, and the habit of not noticing glaringly obvious problems. Nobody argues or yells. There is a tendency to look the other way, "like people whistling past a graveyard." There is also the author's misfortune of having a smarter, more artistic and more athletic older sister. Not least, there is the oddity of growing up the daughter of a schoolmaster on the campus of a boy's boarding school. On the other hand, here is a close-knit, intelligent family in which "someone was always sprawled somewhere with a book. It was that kind of home, sprawling and slouchy and easy."

The answer, if there is one, lies less in the family dynamic than in the author's experience of a disease: the painful, dreadful, seemingly incurable disease of adolescence. Chronic worry of impending disasters, fear of the unknown, the facing of school every day "queasy with dread" -- the anxieties of a bright, sensitive teenager magnified to obsession -- lead to the craving for an order and silence that only bloodletting can bring. "I cut to quiet the cacophony," the author explains. "Cutting, if you'll believe me, was my gesture of hope. All the chaos, the sound and fury, the uncertainty and confusion and despair -- all of it evaporated in an instant, and I was for that moment grounded, coherent, whole."

This superbly articulated, at times almost unbearable story of mental and physical distress is enough to convert the sternest skeptic to the benefits of popular psychopharmacology. "Somebody put the kid on medication," I kept thinking, and was mightily relieved when at long last somebody did. Had the treatment begun any sooner, however, this exceptional testimony, with its poetic vision of pathology -- on a par with Lucy Grealey's Autobiography of a Face or Susannah Kaysen's Girl, Interrupted -- might never have come to light. Few of us have the stomach, especially in crisis, to dwell on the dark beauty of blood and arteries, of morbidity itself, on the meaning of "the delicate severing of capillaries, the transgression of veins." Few of us can detach ourselves from the misery of the moment to contemplate the spectrum of blood, "the color of living and dying at once." At once honest and subtle, Skin Game imparts to us the almost unmediated sense that we are one of those probing few.

Wendy Law-Yone's most recent novel is "Irrawaddy Tango."