The phenomenon of self-cutting has attracted increasing attention in scholarly and popular venues. Most of the literature is written from clinical, historical, or psychometric standpoints, and what has been missing is an ethnographic understanding of self-cutting as a lived experience. The present discussion begins to fill this gap drawing on data from our project on adolescent psychiatric inpatients in the American Southwest, during which we followed these youths and their families for between one and two years as they moved from the hospital back to their homes or to other treatment facilities. Of the 47 young people (22 females and 25 males) who participated in this project, 27 or 57% had cut themselves at some point. Focusing on illustrations from case studies that highlight their cutting experience, we examine self-cutting as the cultural and experiential locus of a crisis of agency in the relation between body and world and thus as the enactment of a fundamental human process in the context of individual experience. [adolescents, self-cutting, agency, psychiatric care] Self-cutting can be understood clinically as a symptomatic behavior, on the one hand, and as a bodily practice embedded in a cultural imaginary and identity on the other. It is present in a variety of ways including the 1993 memoir of Susanna Kaysen “Girl, Interrupted” (with its 1999 film adaptation), the 1995 acknowledgment by Princess Diana that she identified herself as a “cutter,” and the 2011 video “F**kin’ Perfect” by the pop music performer Pink. The Internet has become a massively popular resource for cutters to share information (Hodgson 2004; Ryan et al. 2008), and one study identified more than 400 message boards about cutting generated via five search engines (Whitlock, Powers, and Eckenrode 2006). Youths may identify with “Emo” or “Goth” culture which lionize depression and cultivate self-cutting as a cultural practice (Young et al. 2014; Zdanow and Wright 2012). Popular concern about perceived dangers of self-cutting has at times been heightened to the point that one cultural historian suggested that “Cutting has become a new moral panic about the dangers confronting today’s youth” (Gilman 2012, 1008). Anthropology has not been disposed toward addressing cutting as a problematic cultural or clinical phenomenon given the disciplinary propensity to understand body mutilation and modification in terms of rituals and cultural practices. This is perhaps because ritual meaning is not so dependent on distinguishing whether harm is inflicted by others or by oneself or on differentiating cultural practice from psychopathology. These distinctions are clear in one ETHOS, Vol. 46, Issue 2, pp. 206–229, ISSN 0091-2131 online ISSN 1548-1352. C © 2018 by the American Anthropological Association All rights reserved. DOI: 10.1111/etho.12200 SELF-CUTTING AND AGENCY 207 of the rare instances in which an anthropologist has addressed the issue of self-injury, here in the context of commenting on an article relating it to borderline personality disorder: [T]he concept of self-injury . . . is problematic in the discipline of anthropology given the significance historically accorded to cultural relativism. Correspondingly, body “modification” is not “self-injury” as long as it is socially normative, for example, a facet of an initiation ordeal or body ornamentation (e.g., circumcision, scarification, piercing). Among the rare examples of acts that seem readily identifiable as “self-injury” are New Guinea practices of cutting off a finger to demonstrate mourning and Baatombu (Western African) male finger amputation to show grief and anger over a wife’s infidelity. Both are, however, considered culturally legitimate and not indicative of pathology. (Sargent 2003, 26) One other anthropological observation has been provided by Lester, who notes that current explanations of self-harm can be grouped into four categories: communicating emotional pain, emotional or physiological self-regulation, interpersonal strategy, and cultural trend. She notes that these categories share the idea that self-harm manifests individual pathology or dysfunction, with the cultural assumption of the individual as a rational actor. In contrast, an anthropological perspective emphasizes the “cultural actor who embodies and responds to cultural systems of meaning to internal psychological or physiological states” (2012, 727). Emphasizing the powerful symbolic significance and long cross-cultural record of self-harm and blood shedding as ritual and even therapeutic practices, she suggests that contemporary cutting may be seen as privatized and decontextualized social rituals affecting transformation parallel to collective initiation rituals that operate in a cycle of self-harm and repair, especially in the case of adolescent girls struggling with the aftermath of sexual abuse and/or with contradictory gender messages (Lester 2012). Sociocultural characteristics of a typical “self-cutter” emerged in the 1960s as Euro-American, attractive, intelligent, and possibly sexually adventurous teenage girls, that Brickman (2004) claimed was partially taken up in medical discourse in a manner that “pathologizes the female body, relying on the notion of ‘femininity as a disease’” (Brickman 2004). Gilman took exception to assumptions of pathology with the provocative claim that “self-cutting is a reasonable response to an irrational world” (2012, 1013). From a clinical vantage point, self-cutting is often viewed as a type of injury or harm to the self. The historical backdrop to this development can be traced to Menninger’s (1938) attention to self-mutilation as distinguished from suicidality. The distinction between “delicate” and “coarse” self-cutting was made by Pao (1969), with Weissman (1975) focusing on wrist-cutting syndrome and Pattison and Kahan (1983) proposing the existence of a deliberate self-harm syndrome. Favazza ([1987] 1996, 1998) provided cases of extreme and highly unusual forms of self-mutilation in excruciating detail, with an attempt to classify types based on severity. With the provisional emergence of nonsuicidal self-injury disorder (NSSID) criteria in the fifth version of the Statistical and Diagnostic Manual of Mental Disorders DSM-V (APA 2013),1 the distinction between self-harm as within a normative or pathological range remains equivocal. This is illustrative of the manner in which conceptualizations of self-cutting continue to be embedded in a complex cultural history of changes in the incidence, popular awareness, and social conditions in which such phenomena occur.

中文翻译：

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千刀万剐的生活：青少年的自我切割、代理和精神疾病

自剪现象在学术和流行场所引起了越来越多的关注。大多数文献都是从临床、历史或心理测量的角度写成的，缺少的是将自我切割作为一种生活体验的民族志理解。本次讨论开始利用我们关于美国西南部青少年精神病住院患者的项目的数据来填补这一空白，在此期间，我们跟踪了这些青少年及其家人从医院搬回家中或搬家到家的一到两年时间。其他处理设施。在参与该项目的 47 名年轻人（22 名女性和 25 名男性）中，27 名或 57% 的人曾在某个时候割过自己。专注于案例研究中的插图，突出了他们的切割经验，我们将自我切割视为身体与世界之间关系中能动性危机的文化和体验场所，从而作为个人体验背景下基本人类过程的制定。[青少年，自我切割，代理，精神科护理] 自我切割一方面可以在临床上理解为一种有症状的行为，另一方面可以理解为一种嵌入在文化想象和身份中的身体实践。它以多种方式呈现，包括 1993 年苏珊娜·凯森 (Susanna Kaysen) 的回忆录《被打断的女孩》（1999 年改编成电影）、戴安娜王妃 1995 年承认她自称为“切割者”，以及 2011 年的视频“F **kin' Perfect" 由流行音乐表演者 Pink 创作。互联网已成为切割者共享信息的大受欢迎的资源（Hodgson 2004；Ryan 等人，2008），一项研究确定了通过五个搜索引擎生成的 400 多个关于切割的留言板（Whitlock、Powers 和 Eckenrode 2006）。年轻人可能认同“情绪化”或“哥特”文化，这些文化崇尚抑郁并将自我切割作为一种文化实践（Young et al. 2014; Zdanow and Wright 2012）。对自我切割危险的普遍担忧有时会加剧，以至于一位文化历史学家认为“切割已成为对当今青年面临的危险的一种新的道德恐慌”（吉尔曼，2012，1008）。鉴于从仪式和文化实践的角度来理解身体残割和改造的学科倾向，人类学并没有倾向于将切割视为一种有问题的文化或临床现象。这可能是因为仪式意义并不那么依赖于区分伤害是由他人还是自己造成的，或者依赖于将文化实践与精神病理学区分开来。这些区别在一个 ETHOS, Vol. 46，第 2 期，第 206-229 页，ISSN 0091-2131 在线 ISSN 1548-1352。C © 2018 美国人类学协会版权所有。DOI: 10.1111/etho.12200 自我切割和代理 人类学家解决自伤问题的罕见例子中的 207，这里是在评论与边缘型人格障碍相关的文章的背景下：[T]he自伤的概念。. . 鉴于历史上赋予文化相对主义的重要性，人类学学科中存在问题。相应地，身体“改造”不是“自伤”，只要是社会规范的，例如，开始磨难或身体装饰（例如，割礼、划伤、穿孔）的一个方面。似乎很容易识别为“自伤”的罕见行为包括新几内亚的做法，即切断手指以表示哀悼，以及巴托姆布（西非）男性截肢以表达对妻子不忠的悲痛和愤怒。然而，两者都被认为在文化上是合法的，而不是病理学的指示。(Sargent 2003, 26) Lester 提供了另一项人类学观察，他指出当前对自我伤害的解释可分为四类：交流情绪痛苦、情绪或生理自我调节、人际交往策略和文化趋势。她指出，这些类别都认为自残表现为个体病理或功能障碍，个人作为理性行为者的文化假设。相比之下，人类学的观点则强调“体现并回应文化系统对内部心理或生理状态的意义的文化行动者”（2012, 727）。她强调自残和流血作为仪式甚至治疗实践的强大象征意义和长期的跨文化记录，她建议当代切割可以被视为影响转变的私有化和去语境化的社会仪式，与集体启动仪式并行自我伤害和修复的循环，尤其是青春期女孩在性虐待和/或矛盾的性别信息中挣扎的情况（Lester 2012）。典型的“自我切割者”的社会文化特征出现在 1960 年代，她们是欧美、有吸引力、聪明、可能还有性冒险的少女，布里克曼 (2004) 声称医学话语中部分地采用了这种方式，“病态女性身体，依赖于“女性气质是一种疾病”的概念”（Brickman 2004）。吉尔曼反对病理学假设，并提出“自我切割是对非理性世界的合理反应”（2012, 1013）的挑衅性主张。从临床角度来看，自我切割通常被视为对自我的一种伤害或伤害。这一发展的历史背景可以追溯到 Menninger (1938) 对与自杀不同的自残的关注。Pao (1969) 区分了“精致”和“粗糙”的自切，Weissman (1975) 关注割腕综合症，Pattison 和 Kahan (1983) 提出存在蓄意自残综合症。Favazza ([1987] 1996, 1998) 提供了极端和极不寻常的自残形式的案例，其中包含令人痛苦的细节，并试图根据严重程度对类型进行分类。随着《精神疾病统计和诊断手册 DSM-V》（APA 2013）第五版中非自杀性自伤障碍 (NSSID) 标准的临时出现，标准或病理范围内的自我伤害之间的区别仍然存在模棱两可。这说明了自我切割的概念化继续嵌入在发生这种现象的发生率、大众意识和社会条件变化的复杂文化历史中的方式。