The Twelve Steps and the Cutter: Paper

My Final paper for a class called "Spiritual Wellness and the Addict"

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The Twelve Steps and the Cutter

Since the late 1930s, Alcoholics Anonymous and their famous Twelve Steps have been the leading force for addiction recovery. Today there are well over three-dozen variations of the Anonymous support groups, ranging from Opioid Anonymous, to Debtors Anonymous, to Sex and Love Addicts Anonymous, and hundreds of thousands of chapters across the country. The Twelve Steps of Recovery were written and published in The Big Book of Alcoholics Anonymous in 1939, and have remained unchanged these 80 years. The Steps walk the addict through accepting a problem, turning to a Higher Power, taking moral inventories, and making amends, and is widely regarded as the authority of addiction recovery in the United States. These Steps have been so successful, even as they travel from group to group they undergo no revision, the language being regarded as universal for all addictions. However, there have been some discrepancies, asking whether a program created by middle-aged, middle-class white men during World War II does indeed offer a comprehensive recovery plan for ALL addictions, particularly those dominated by women, minorities, and the younger members of society. With the practice of nonsuicidal self-injury on the rise, the Twelve Steps must undergo a revision to be effectively utilized to meet the needs of the cutting adolescent girl.

Nonsuicidal self-injury (NSSI), more commonly known as “cutting,” initially gained nationwide awareness in the early 1990s after the reveal of a number of self-harming celebrities, and the explosion of the World Wide Web. The most recent edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) acknowledged self-harm as a side effect of other mental illnesses for the first time in 2013. As of 2019 self-harm does not yet have a set definition. Books and websites recognize a disturbing array of methods one might hurt oneself, from burning, picking, breaking bones, and minor amputations. Many with eating disorders place themselves in the category of self-harm. The most famous form of self-injury is “cutting,” or taking a sharp object to the body and drawing blood. I myself spent several years as an active self-harmer, and recently celebrated nine years clean in March of 2019. Over the years I informally worked with other active and recovering harmers to develop a working definition of our addiction. In this paper I will define NSSI as any action that holds all four of the following:

1. The person intentionally causes him or herself pain. An injury that results in a lasting mark or scar (though common) is not required.

2. This action of self-inflicted pain is spurred on emotionally (opposed to compulsive behavior from mental disabilities such as autism or schizophrenia).

3. The harmer feels a sense of emotional relief as a direct result of the painful action.

4. After the first inflicted pain, the person intentionally returns to the behavior (or some variant) for future emotional relief.

This definition is intended solely for the addiction of self-harming, as many other recognized addictions do share several of these characteristics, but rarely manifest all four as does self-harming. For example, Cocaine, though it hurts momentarily, offers relief as a direct result of the introduced substance, not the pain of the needle. Addictive behavior like pornography or the consumption of alcohol does not typically cause physical pain at all, etc.. For the sake of clarity in this paper, the terms “cutting,” “burning,” and “self-harm” will be used interchangeably, and synonymously with the all-encompassing concept of “nonsuicidal self-injury” as defined in the four points above. Though male participation has increased significantly this past decade, for the duration of this paper harmers will be given female pronouns to reflect the overwhelming gendered majority. When referencing The Big Book of Alcoholics Anonymous the generic “addiction” and “addict” will be used when comparing others to the self-harmer.

The question of Twelve Step significance in regards to gender and those more commonly victimized and oppressed is nothing new. Frustrated with AA, Jean Kirkpatrick went on to create Women for Sobriety in 1976, marking this organization “the first women-created, women-centered alternative” (Clinebell, 1968, 245). Certified addiction specialist Charlotte Kasl had a similar encounter with the Twelve Step program, and while she acknowledged its value for many, she found the “parallels to patriarchal... disturbing” (1999, 112). She went on to write

In the righteousness of AA, I found a “blame the victim” stance. If addicts didn’t succeed it was their fault for not working the Steps hard enough. “Rarely have we seen a person fail who has thoroughly followed our path.” I never heard anyone question the efficiency of the Twelve Steps, especially in their application for people with different addictions, cultural backgrounds, religions, and customs. While the AA approach was obviously a great support to many people, aspects of it seemed counter to the needs of women, especially those who had been abused or battered and needed to build their ego, strength, and feel positive about themselves. (112)

Kasl responded to this gap with the “Sixteen Steps for Discovery and Empowerment” (1999, 130-134) a process which counteracts the “powerless” language of AA with stronger word choices including “create,” “seek,” and “grow.” As the majority of self-harmers are female, frequently have prior histories of childhood or sexual abuse (and use cutting as a means for expressing their pain), language focusing on the fault of the addict and the wrongs they have committed to others may only further victim blame. This is not to condone the harmer’s choice of coping, but rather a caution to those who may be tempted to swear by the ultimate power and authority of the Twelve Steps as they are currently written. For the self-harmer, the process of recovering from the addiction cannot be separated from the addressing and healing of the inner trauma that made cutting such a viable option. Taking what I have read on addiction, pastoral care, and counseling, as well as my personal experience as a recovering cutter, and interactions with others who self-harm, I offer a revision of the Twelve Steps for the Christian cutter.

Step One

Original: “We admitted we were powerless over [self-harm]—that our lives had become unmanageable.”

Revision: “I acknowledge self-harm served its purpose for a time, but now there is a better way to take care of my needs.”

Richard Rohr, author of Breathing Under Water, wrote how the first step “is probably the hardest, the most denied, and the most avoided. So the whole process never takes off! No one likes to die to who they think they are. Their ‘false self’ is all they have.”(6) And how very right he was, especially for the self-harmer! Between the troubles of adolescence and the emotional stressors throwing her life into constant upheaval, the harmer may genuinely believe her destructive behavior is as the only thing she does have control over. Common justifications will include her knowledge of human anatomy “I’m avoiding the veins.” Her safety precautions “I’m sterilizing the blades.” She may even call upon the greater good: “It’s better than hurting others.” or “It’s better than the alternative.” Her life so emotionally compromised, she believes the only thing preventing her from slitting her wrists is the compromise of a lesser wound. In this twisted way, the blade is seen as the dark, protective guardian who is protecting her from suicide. This in mind, waiting for her to want to stop cutting will never happen. Instead, Rohr further speaks to the heart of the addict by observing:

Our inner blockage to “turning our will over” is only overcome by a decision. It will not usually happen with a feeling, or a mere idea, or a religious Scripture. . . . It is the will itself, our stubborn and self-defeating willfulness that must be first converted and handed over. It does not surrender easily and usually only when it is demanded of us by partners, parents, children, health, or circumstances. (19)

Rather than forcing her to “betray” the thing that kept her alive, language acknowledging she recognized no other alternative but can now explore better options can both validate her previous struggle, and offer hope for a future.

Step Two

Original: “Came to believe that a Power greater than ourselves could restore us to sanity.”

Revision: “I was created for a purpose by a loving God who doesn’t want me to cut, and I can trust Him to show me this new way.”

A self-harmer can counteract every proposed reason not to cut. “You shouldn’t cut, because it hurts you” is dismissed with “It doesn’t hurt, I enjoy it.” “You’re beautiful” is easily challenged with “Does that mean ugly people can cut? Or if I was in a car accident and had my face smashed in, it would be ok then?” “Your friends love you and don’t want to see you hurt” is similarly reasoned away: “So if we had a big fight, or you died, I would be allowed to cut at the funeral?” Simply put, nothing on this earth that can change, cannot in turn be used as a reason to cut again. She needs a Higher Power that never changes, that she cannot outsmart. That power is found in the unconditional, never changing love of her Creator. She can argue she doesn’t want Him. But she can’t deny Him, if she already knows Him. Psychotherapist Lee Jampolski described the vital presence of a loving figure beautifully: “Taking a jackhammer to addictive behavior does not work; love is the only force that can penetrate the walls of the addictive thought system. . . This is not to say that confrontation has no place, but that the individual must experience loving compassion beneath any intervention.” (1999, 67) Gerald Mays described this love as an overwhelming grace. “Grace is love happening.” He joyfully reflected. “Love in action, and I have seen so much grace in the midst of so much brokenness in myself and others and I know we are all in love. .. For me, the fact that we are in love is far more important than the best of functioning.” (1991, 6) The self-harmer will need to trust in this God she worships, and live in the faith that He wants more for her than the hell she has accepted, and give Him permission to lead her despite what she wants.

Step Three

Original: “Made a decision to turn our will and our lives over to the care of God as we understood Him.”

Revision: “I will entrust God with my desire to cut, the pains that drove me in the past, and anything I might encounter on this new journey.”

This step, deciding to meet God in the midst of her pain, can be beautifully paraphrased by Henri Nouwen as he discussed that it means to live the Life of the Beloved:

The deep truth is that out human suffering need not be an obstacle to the joy and peace we so desire, but can become, instead, the means to it. The great secret of the spiritual life, the life as the Beloved Sons and Daughters of God, is that everything we live, be it gladness or sadness, joy or pain, health or illness, can all be part of the journey toward the full realization of our humanity.(77)

Suffering, particularly in the process of withdrawal and the journey of recovery, is not evil. In such situations, recognizing that this pain is refining, and bringing her closer to humanity and tenderness once lost, can be a source of comfort. The self-harmer will need to remember this, frequently, as she is suddenly forced to face her demons without the protection of her razors.

Step Four

Original: “Made a searching and fearless moral inventory of ourselves.”

Revision: “I will take necessary steps to get professional help, and working with them I will begin to make sense of my story, willing to be shown that my preconceived notions could be wrong.”

Ever the perfectionist, the self-harmer will realize the error of her ways and vow to address it... all by herself. But this she cannot do. Isolation is the sugar upon which the bacteria of shame and addiction feed. I dare say the self-harmer must seek a professional above a group, because things uncovered during her moral inventory will likely be more than a group is equipped to handle. From sexual assault to the addictive and potentially harmful personalities in the home, to possible mental illnesses, and her overwhelming perfectionist codependency, all this and more will rise to the surface without her cutting to re-suppress it. This soul-searching will challenge every preconceived notion she’s ever had of herself, and she will need the guidance of a professional. Though not speaking directly of addiction, Nouwen helpfully wrote how the integration of who we are compared to who we think we are is a universal struggle:

Becoming the Beloved means letting the truth of our Belovedness become enfleshed in everything we think, say or do. It entails a long and painful process of appropriation or, better, incarnation. As long as “being the Beloved” is little more than a beautiful thought or a lofty idea that hangs above my life to keep me from becoming depressed, nothing really changes. What is required is to become the Beloved in the commonplaces of my daily existence and, bit by bit, to close the gap that exists between what I know myself to be and the countless specific realities of everyday life. (39)

Many things presumed to be her fault (incest, abuse, constantly being shamed) will gradually be revealed to have been wrong. Things thought to be outside her control (asking for help, exercising other strategies for coping, speaking up for her needs) may have always been in her realm of agency and she either didn’t see it or chose not to believe it. Both discoveries will be incredibly painful. “‘The truth will set you free.’” Rohr remembered Jesus declaring in John 8:32. “But first it tends to make you miserable.” (31) The self-harmer, who is both addict and codependent, will wish to reject these discoveries, clinging desperately to the security of the world she had once known, where things made sense and perfection was achievable. Jampolsky described this addictive perfectionism as an ever constant, ever condemning force where “the belief that constantly analyzing, comparing, criticizing, and condemning are traits that bring security and peace. In contrast, the love-based thought system sees that peace of mind is obtained through the art of practicing acceptance.” (1999, 69) Without knowing precisely what will be uncovered, the self-harmer needs to understand that it will hurt, she will learn things she would rather not know, and yet God will be present the entire time. Rohr agreed “Without confidence in a Greater Love, none of us will have the courage to go inside, nor should we.” (31) This is a dark, tempestuous journey, and it should not be taken alone.

Step Five

Original: “Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.”

Revision: “I will admit to God, myself, and to another person the exact nature of my situation.”

This addictive behavior shares the stage with codependency, something present long before drawing blood. “Codependents end up being just as unhealthy as the addict, while thinking of themselves as strong, generous, and loving.” Rohr wrote. This mindset further fuels the self-imposed need of keeping her addiction and struggles to herself. However for this individual “it is necessary to give up on the search for perfection. The individual needs to learn how to live with the various imperfections, the divisions, that lie within each person’s soul.” (Kurtz and Ketcham, 1992) As a codependent shrouded in shame, seeking the love and support of others can be seen as more daunting than facing the addiction alone. Self-harmers work in absolutes. In her eyes she is either right OR wrong, and if she’s a little wrong she is ALL wrong. Dedicating a step to telling people her faults is like turning on the garden hose when the yard has already flooded. She is the person who apologizes for sharing her opinion, even if others agree with her. Dwelling in Step Four, naming years of victimization, followed directly by a Step where you are to confess the nature of your wrongs, is counterproductive. This is NOT to suggest a self-harmer is free of blame for everything they do. Rather, she needs more time focusing on healing and seeking the help of others. In the task of introspection, May suggested the addict instead “Be always gentle. . . do not make too much of a struggle of it. . . Look for the light rather than fighting the darkness. Seek love directly rather than doing battle with the things that distract you from love.” (153) A revised Step Five can be that sorely needed opportunity to reach out to loved ones to explain her black, white, and grey situation.

Step Six

Original: “Were entirely ready to have God remove all these defects of character.”

Revision: “I am ready for God to lead me through the work necessary to heal the hurts my cuts were trying to embody.”

If you want to know what drives someone to cut don’t ask “why.” Instead, ask “What did this cut say?” She knows. Unlike a drug user who can “shoot up” for the sheer mindless enjoyment of it, each cut says something. It is not uncommon for a harmer to carve words into her flesh. “UGLY” “FAILURE” “WORTHLESS” and other labels are etched into her arms and legs. Often such actions is the attempt to embody and accept what she believes about herself. Step Six is an opportunity for God to rename her, and address the pain she was trying to hard to express. “People only come to deeper consciousness by intentional struggles with contradictions, conflicts, inconsistencies, inner confusions, and what the biblical tradition calls “sin” or moral failure.” (31) Rohr wrote of this step. For the self-harmer, one of the most prominent struggles will be facing what she has come to believe about herself that in turn made cutting such a logical and reasonable option. Within this step is another opportunity for surrender. She was willing to give her cutting to God, and willing for Him to show her who she truly was. Now she must choose whether or not to surrender to God everything she has ever believed about herself. Such a task is of course daunting. But as Rohr tenderly noted “It is easy to surrender when you know that nothing but Love and Mercy is on the other side.” (27)

Step Seven

Original: “Humbly asked Him to remove our shortcomings.”

Revision: “I will humbly ask God to remove my shortcomings, and teach me to treat myself and my flaws with kindness.”

Change is perhaps one of the greatest fears of human beings. No one likes change, and no one wants to face the unknown. And for the self-harmer who has scrambled to avoid this unpredictability, and fears asking for help, in Step Seven she must blatantly ask God for both. And yet, by trusting in this God whom she loves and knows loves her, this may be one of the first times she will find herself wanting to ask. May wrote of this surrender:

Living for love requires openness to love itself, a radical vulnerability to consciously being in love. To claim this is to enter a gentle warfare against immense internal and external forces. The enemy is that which would stifle your love: your fear of being hurt, the addictions that restrict your passion, and the efficiency worship of the world that makes you doubt the value of love. It is warfare because these forces are very real and very threatened by love. They will fight to keep their power. But the warfare must be gentle on your part; your only weapon is love itself. . . Love does not conquer all, because conquer is the wrong word entirely.” (11-12)

And she will surrender herself to Him. Not because she thinks God will love her more if she does, but because the two of them are on a journey and this step is the next way He wishes to love her. Rohr reflected on this moment of surrender.:

God shocks and stuns us into love. God does not love us if we change, God loves us so that we can change. Only love effects true inner transformation, not duress, guilt, shunning, or social pressure. Love is not love unless it is totally free. Grace is not grace unless it is totally free. You would think Christian people would know that by now, but it is still a secret of the soul. (41-42)

As ever, alongside the addiction must remain the request for God to work in the origin of the pain, something the harmer invites God to do in this revised step.

Step Eight

Original: “Made a list of all persons we had harmed, and became willing to make amends to them all.”

Revision: “I am not merely a victim to my emotions or the actions of others. How I chose to respond to my hurts negatively impacted others, and I am willing to do what I can to make it right.”

Having graduated to Step Eight, the self-harmer will have several weeks of recovery under her belt. Working closely with her counselor, journaling, and strengthening her spiritual life with God, who she is as a person will be more clearly defined. The chemical effects of withdrawal will have simmered down, and for the first time she may even begin to feel comfortable and safe in her own skin. She can now safely look at how her previous actions have impacted others without falling into a shame spiral. Having spent her life as a codependent, she can now exercise what she has learned regarding healthy boundaries and look at her actions, differentiating between what feels wrong (saying “no,” voicing her needs...), versus what was actually harmful to others (manipulating, lying...).

Step Nine

Original: “Made direct amends to such people wherever possible, except when to do so would injure them or others.”

Revision: “I will find the people I have hurt and do what I can to make things right, except when to do so would harm or injure someone. This includes myself.”

It may be necessary for the harmer to place herself on the list of people to whom she must make amends. While contemplating apologies and forgiveness, Rohr concluded “Forgiveness is to let go of our hope for a different or better past. It is what it is, and such acceptance leads to great freedom, as long as there is also accountability and healing in the process.” This forgiveness must be extended from the harmer to herself: For not allowing the healthy expression of emotion, for physically abusing herself. “Nothing new happens without apology and forgiveness.” Rohr continued. “It is the divine technology for the regeneration of every age and every situation. The “unbound” ones are best prepared to unbind the rest of the world.” (49)

Concerning making amends to others, The Big Book recognizes the addict may need to face the consequences of stealing, ruthless behavior, and run the very real risk they may not be forgiven. The harmer too must be ready for these unpleasantries. HOWEVER. It is important the self-harmer understand there is a difference between apologizing and accepting consequences for her actions, and placing herself in a harmful position. Survivors of all kinds of abuse routinely feel a sense of loyalty to their abusers, and the distinction must be made that these people, for the harmers own safety, are not to be contacted. Though healthier, the codependent self is still lurking, and ready to say her needs are not as valid as the feelings of others, while the cutting self assures her she can handle the pain. Even in Step Nine, the harmer must practice placing herself in the group of people who are worthy of love and protection.

Step Ten

Original: “Continued to take personal inventory and when we were wrong promptly admitted it.”

Mine: “I will continue to work with my counselor as needed, and cultivate healthy relationships. When I feel myself spiraling, I will avoid isolation and seek the help of God and others.”

Again, to address the addiction of the self-harmer is to take on the past that cultivated such a lifestyle. The ongoing inventory includes continued professional counseling (though at this point it might just the the occasional check-in), and intentional cultivation of friendships (a constant must). Part of the personal inventory at this point will include recognizing danger signs of anxiety or depression, and having safety plans in place that they have practiced and honed. Constant introspection is also an important factor at this stage of recovery. May suggested one might take this moment to ask “What do your reflections say about how God might be inviting a more conscious, intentional relationship right now? (183) Having spent so much time learning more about herself, her addiction, trauma, and God, she will now be at a new place where she can listen to her God in a more intimate way.

Step Eleven

Original: “Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.”

Mine: I will continue to love, serve, and be with my God through church, ministry, and prayer.

Telling her story, God is the knight in battle-tainted armor who saved her. Through her newly integrated story she has learned to love and trust her God all the more. “Suffering people can love and trust a suffering God.” Rohr wrote of this moment. (125) She recognizes that to continue the path of recovery, nurturing this relationship is key. She “prays as if it all depends on [her], and works as if it all depends on God.” (56, pronouns altered) This may not match the kneeling-by-the-bedside image of prayer, but a loving connection with God is constant none the less. “A slightly deeper probing of spiritual growth shows that as people deepened in their love for God and others, they become ever more open.” May reflected. “Not only more appreciative of the beauty and joys of life, but also more vulnerable to its pain and brokenness.” (102) How true this is for the recovering cutter, and she herself will be wholly aware of the metamorphosis she has undergone.

Step Twelve

Original: “Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs”

Revision: “Having learned to integrate who I am as a self-harmer in the greater picture of being a beloved daughter of Jesus Christ. I will seek out ways to share my story and bring hope to others like me, remembering that I cannot save them, but I CAN tell them of my God who saved me.”

“Only people who have suffered in some way can save one another.” Rohr reflected. “Deep communion and dear compassion is formed much more by shared pain than by shared pleasure. I do not know why that is true. We are not saved by any formulas or theologies or any priesthood extraneous to the human journey itself.” (123) The recovering self-harmer does not confine her mission exclusively to cutters. As stated before, it is likely the reason for her addiction was as a result of a troubling life. This, more than the addictive means she expressed herself, will be what she seeks to minister to. Indeed, for many in recovery it will be triggering and dangerous to be involved in the support of someone in the clutches of self-harm. But loving and bringing the message of healing and hope to other abuse victims, other codependents, other addicts in general, and others with struggles and backgrounds like her will be within her ability. And she will gladly meet them there. May pondered the meaning of integrating the pain of our own story into our mission and concluded “If we really want to be loving, if we truly wish to respond to the call of justice and freedom, we must first have the courage to look into our own emptiness. We must somehow even come to love it.” Of course, the notion of loving her addiction was something she had to previously work to break or ignore. But she will have a new understanding of the addiction, and appreciation of the God who did indeed save and led her through this pain to something better.

In conclusion, Alcoholics Anonymous and their various chapters have indisputably saved many lives over the past century. But when approaching self-harm, one must be aware that the language encompasses neither the cutter’s immediate or primary needs: the potentially traumatic reason behind her cutting. Without addressing this gap, the Steps run the risk of further victim blaming and may potentially plant harmful thoughts that could lead the cutter down even darker paths. It is my hope that as more people grow to understand the unique mindset of self-harm, more resources will become available. Just as they have addressed alcohol and most other addictions, perhaps the Twelve Step programs may in turn lead the charge.

Work Cited

Clinebell, Howard, Ph.D. (1968). Understanding and Counseling Persons with Alcohol, Drug, and Behavioral Addictions. Nashville Tennessee: Abingdon Press.

Jampolsky, Lee, Ph.D. (1999). Healing the Addictive Mind. In O. J. Morgan & M. Jordan (Eds.), Addiction and Spirituality, a Multidisciplinary Approach (pp. 55-74) St. Louis, Missouri: Chalice Press.

Kasl, Charlotte Ph.D. (1999). Many Roads, One Journey, One Woman’s Path to Truth. In O. J. Morgan & M. Jordan (Eds.), Addiction and Spirituality, a Multidisciplinary Approach (pp. 111-135) St. Louis, Missouri: Chalice Press.

Kurtz and Ketcham. (1992). The Spirituality of Imperfection. New York: Bantam Books.

May, Gerald G. M.D. (1991). The Awakened Heart: Living Beyond Addiction. New York, New York: HarperCollins Publishers.

Nouwen, Henri J. M. (1995). Life of the Beloved: Spiritual Living in a Secular World. New York, New York: Crossroad Publishing Company.

Rohr, Richard. (2011). Breathing Under Water: Spirituality and the Twelve Steps. Cincinnati, Ohio: St. Anthony Messenger Press.

W. Bill. (1939). Alcoholics Anonymous Big Book, First Edition. New York City, New York: Works Publishing Inc.