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This alarming trend among adolescent girls first gained attention in the mental-health sector in the early 1960s, though the practice is known to date back to at least a century before. The term
self-mutilation
first occurred in a 1913 study by L. Eugene Emerson, Ph.D., where he described self-cutting as a symbolic substitution for masturbation. The term cropped up again in 1938 when Dr. Karl Menninger, in his book
Man Against Himself
, concluded for the first time that self-mutilation was not necessarily a form of suicidal behavior but rather an “attenuated death wish.” In his book, he coined the term
partial suicide
to describe the phenomenon.

According to the Cornell University Research Program on Self- Injurious Behavior in Adolescents and Young Adults, “There are important distinctions between those attempting suicide and those who practice self-injury in order to cope with overwhelming negative feelings. Most studies find that self-injury is often undertaken as a means of avoiding suicide.” The institute notes that self-injury can be performed on any part of the body, but most often occurs on the hands, wrists, stomach and thighs. The severity of the act, it concludes, can vary from superficial wounds to those resulting in lasting disfigurement.

Most studies conclude that females make up about two-thirds of adolescent self-injurers, though it is possible that women are simply more willing to admit their self-injuries than men. The Cornell self- injury program’s literature cites in a recent study that between thirteen and seventeen percent of American high-school students engage in self- injury at least once. The Cornell research also states that “early onset self-injury is common around the age of seven, although it can begin earlier. Most often, however, self-injury behaviors begin in middle adolescence, between the ages of twelve and fifteen, and can last for weeks, months, or years. For many, self-injury is cyclical rather than linear, meaning that it is used for periods of time, stopped, and then resumed. It would be erroneous, however, to assume that self-injury is a fleeting adolescent phenomenon.” If Angelina began self-injuring at the age of thirteen, this puts her in the average age range of adolescent self-injurers.

In his book,
Psychological Self-Help
, Dr. Clayton Tucker-Ladd, former director of the Counseling and Testing Center at Southern Illinois University, summarized some of the myriad explanations he had come across while treating adolescent self-injurers:

Young people are sometimes emotionally abused and told they are bad, sinful, selfish, hurtful, hateful, uncaring, crazy, or weird. They may be blamed for their parents’ troubles or divorce, etc. It isn’t surprising they may end up feeling guilty, shame, self-hatred, and wanting to hurt or punish themselves.

Some have grown up in physically and sexually abusive families (beatings, threats & torture) and were called useless, stupid, ugly, slut, and a total failure; many were bullied by peers; some were raped. Some responded with resentment, intense anger, and repressed rage; others adopted the negative evaluations and felt worthlessness, felt no one could ever care for them, and felt like a piece of trash. Some responded to being hated with a defiant attitude, e.g., “You can’t make me change” or “I deserve to be abused but I can hurt myself more than you can.” Some wanted get back at the abusive person by hurting themselves via self- mutilation, i.e., showing visual signs of their feelings. Some physically responded to pain, punishment, and self-punishment by actually feeling better, something like having an adrenalin rush or taking drugs; others found that burning or cutting themselves numbs them to pain.

Others were feeling depressed, helpless and hopeless or were without feelings, almost like being dead. Some responded to self- injury while feeling dead with “The self-abuse showed me that I could feel and was alive.” Others felt alone, uncared for, scared, sad, not just neglected but utterly worthless, rejected by family and friends, placed in foster care, dumped by boy/girlfriend, etc., so, it felt better to hurt themselves and, in that way, escape the hurt from others. Many were well aware they had seriously disabling psychological problems and felt weird, unable to cope, scared, helpless, and inferior. Still others felt out of control, couldn’t do anything right, but were reassured by the courage they had when self-cutting, surprised at what injuries they could force themselves to inflict.

Although in recent years Angelina Jolie has become the poster child for self-injury, she is by no means the first celebrity who has admitted to the practice. Other high-profile practitioners are actress Christina Ricci, Courtney Love, and singer-songwriter Fiona Apple, who admitted to
Rolling Stone
that she cut herself for years. Apple, as her fans know, was raped outside her mother’s apartment building when she was twelve years old, an incident that has haunted her ever since.

Like Angelina, Apple has tended to downplay the significance of her self-injuries. “I have a little bit of a problem with that [self-injury],” she said in one interview. “It’s a common thing.” Asked by the interviewer if it made her feel better, she responded, “It just makes you
feel
.” She is quick to point out, however, that self-injuring doesn’t mean she is crazy. “The most annoying thing for me to hear about myself is that I’m trying to make people have a pity party for me,” she told
Rolling Stone
. “Everything that I’ve gone through has been dramatized by the people who’ve written about it, not by me. I’m just saying, ‘This happened to me, this happened to a lot of people.’ Why should I hide shit? Why does that give people a bad opinion of me? It’s a reality. A lot of people do it.”

Probably the most famous self-injurer of all was Princess Diana, who talked about it and other disorders in a 1995 interview with the BBC. She revealed that she had frequently cut her arms and legs over the years. “You have so much pain inside yourself that you try and hurt yourself on the outside because you want help,” she explained at the time. According to Andrew Morton’s definitive biography,
Diana: Her True Story
, the troubled princess—who also acknowledged a struggle with bulimia—had often thrown herself into a glass cabinet at Kensington Palace and cut herself with the serrated edge of a lemon slicer. Once, during a heated argument with Prince Charles, she reportedly picked up a pen knife and cut her chest and thighs. Another time, during a fight with Charles on an airplane, Diana locked herself in the bathroom, cut her arms, and smeared the blood over the cabin walls and seats.

The actress Christina Ricci has also publicly discussed her history of self-injury. In a 1988 interview with
US Weekly
magazine, Ricci showed the interviewer a small, smile-shaped scar on her hand. “I was trying to impress Gaby [Hoffmann, her best friend]. So I heated up a lighter and pressed it on my hand.” Revealing a number of other burn scars on her hands and arms, she explained, “I wanted to see if I can handle pain. It’s sort of an experiment to see if I can handle pain.” In a different interview, she revealed that she sometimes puts cigarettes out on her arms. Asked whether it hurts, she replied, “No. You get this endorphin rush. You can actually faint from pain. It takes a second, a little sting, and then it’s like you really don’t feel anything. It’s calming actually.” In
Rolling Stone
magazine she went further. “It’s like having a drink. But it’s quicker,” she told them
.
“You know how your brain shuts down from pain? The pain would be so bad, it would force my body to slow down, and I wouldn’t be as anxious. It made me calm.”

Perhaps the most surprising celebrity self-injurer, however, is Johnny Depp, who has scars up and down his arms from the days when he used to cut himself. “It was really just whatever; good times, bad times, it didn’t matter,” he told
Talk
magazine about his former habit. “There was no ceremony. It wasn’t like ‘Okay, this just happened, I have to go hack a piece of my flesh off.’” In another interview in 1993 he explained the still-visible scars: “My body is a journal in a way. It’s like what sailors used to do, where every tattoo meant something, a specific time in your life when you make a mark on yourself, whether you do it yourself with a knife or with a professional tattoo artist.”

Over the years, the mental health profession has struggled to figure out how to classify and treat self-injury, especially among adolescents. The most frequent diagnosis appears to be borderline personality disorder (BPD), though critics insist that such a label is a rush to judgment. One of the foremost researchers into the disorder is Marsha Linehan, director of the Behavioral Research and Therapy Clinics at the University of Washington. She believes that, while self-injury often fits into this category, diagnosing a personality disorder requires an understanding of a person’s long-term pattern of functioning, which often gets ignored. “That this does not happen,” she writes, “is evident in the increasing numbers of teenagers being diagnosed as borderline … One wonders what justification is used for giving a fourteen-year-old a negative psychiatric label that will stay with her all of her life?

In the case of Angelina Jolie, the official diagnosis was considerably more serious. Sitting in her Beverly Hills High School file to this day is a troubling description, delivered by a psychotherapist who had been treating her for some time: “Angelina Voight is unrestrained, inclined to antisocial psychopathy.” In other words, while still in her teens, Angelina was labeled a psychopath.

Jolie has tried to downplay her mental health issues as well as her mandatory thrice-weekly sessions with the school therapist. “They enrolled in there everybody whose parents were divorced,” she recalls. “Our psychotherapist used to say that it was our [parental] ‘units’ who were guilty of everything. It seemed to her that we, poor children, would never be able to adapt to life.”

But according to one of Angelina’s former classmates, who now works in the television industry, her explanation doesn’t ring true. “You’ve got to be kidding me,” he says. “This was Beverly Hills High. Most of the kids in the school came from so-called broken homes. Everybody’s parents were divorced, mine included. If they made us all see a school therapist, it would have been like an assembly line a mile long. I have no idea what Angie did to be sent to therapy. I don’t even think I knew at the time that she was going, though it was a given that lots of kids saw some sort of therapist privately. I never did personally, except for some family therapy when I was younger, but it was kind of in vogue in those days.”

In a 2000 interview, Angelina appears to contradict the explanation that she gave earlier about being forced to attend therapy. She also emphatically denied that her problems had anything to do with her parents’ divorce. “I was in school, and you could get extra credit for going to a therapist,” Jolie told
Marie Claire
magazine. “It was just a part of life studies, psychology. So I went. And I realized how dangerous these people could be. This person kept talking about my feelings for my father. I’d say, “No, I’m not angry. I understand. I think my parents are both wonderful individuals.” And she just couldn’t believe it wasn’t a problem for me. I can remember coming in one day and saying I had a dream. I totally lied. I said I dreamt that I stabbed my father with a fork, and she said, ‘Aha, I see.” And I thought, ‘You fucking asshole.” My therapy is my films; my therapist is everybody who goes to see a movie and tells me whether I’m completely off.”.”

Short of locating the therapist that came up with the original diagnosis, it’s difficult to determine what it was based on.

According to experts, it is highly unusual for a fourteen-year-old to be diagnosed with an antisocial psychopathic disorder, since most of the literature suggests reserving such a diagnosis until at least the age of eighteen. In his 2006 book,
The Psychopathy of Everyday Life
, Dr. Martin Kantor makes a clear distinction between the kind of disorder that Angelina was diagnosed with and the kind of severe psychopathic behavior of serial killers and other extreme examples. “One of the biggest problems in understanding psychopathy,” he writes, “is the literature’s tendency to lump serious but rare psychopaths like John Wayne Gacy and Ted Bundy with the less serious but common psychopaths, the many in our midst who suffer from a milder and less obtrusive form … [clinical psychologist and author] Martha Stout calls these less serious, more common psychopaths ‘the sociopaths next door.’”

Most experts agree that one of the defining characteristics of psychopathy is a lack of empathy. Given Angelina Jolie’s present day status as a philanthropist and humanitarian, it is hard to believe that she was ever given this diagnosis in the first place. Could it have been the rash assessment of a lazy therapist? Or did the rebellious teenage Angelina deliberately act crazy during her sessions to get a rise out of the shrink?

“Growing up, I actually wished I was insane,” she has said. “I remember being very upset that I wasn’t. I think there’s a romance to going insane. I wanted my mind to take me away, but it couldn’t tell me where to go.” It’s possible that it was all an act, but at the time there was clearly plenty of reason for those around her to suspect that there was something desperately wrong.

While she has described the period she spent with her live-in boyfriend as “very sweet, almost like a marriage,” her penchant for knives and self-mutilation was intensifying every day. It soon became an integral part of their sexual relationship. “[Normal sex] didn’t seem primal enough, nor satisfy me,” she later explained. S & M became her chosen kink, but even that wasn’t enough for her: “S & M sex can be misinterpreted as violence,” she explained to
Vanity Fair
in 2004. “It’s really about trust. I like to push boundaries, both emotional and sexual, with another person. That’s when I’ve felt the sexiest. I’ve been in both submissive and dominant roles because I want more. I was always the top until I read somewhere that the bottom controls the top so I thought, ‘Wait a minute, that’s right. I’m doing all the work!’ I’ve never been tied up though. I have a feeling the person that does it will be The One. I think that’s what I’d like.”