What if a single missed moment of connection could spark a story that reaches millions? In this episode of Read. Talk. Grow., Dr. Denise Millstine sits down with author Kathleen Glasgow and psychiatrist Dr. Eric Noble to explore the emotional landscape behind Girl in Pieces, a novel that has become a lifeline for readers navigating trauma and self-harm. Together, they unpack the origins of Charlie Davis’s character, the stigma and history surrounding self-harm, the nuances of diagnosis, and the complex ways young people cope when the world feels unbearable. Through personal reflection, clinical insight, and compassionate conversation, the episode illuminates how storytelling can validate lived experience, expand understanding, and open doors to healing.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine:
Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books. Our topic today is self-harm. Our book is “Girl in Pieces,” a novel by Kathleen Glasgow. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.
My guests today are again, Kathleen Glasgow, who's the “New York Times” and internationally bestselling author of “Girl in Pieces,” “The Glass Girl,” “You'd Be Home Now,” and “How to Make Friends with the Dark.” “Girl in Pieces” is her debut novel that became a “New York Times” number one bestseller when it was released in 2016 and has now been reformatted as a deluxe edition with space for writing and an attached journal.
Kathleen, welcome back to the show.
Kathleen Glasgow:
I thank you so much for having me. It's great to be here.
Dr. Denise Millstine:
Our medical expert guest is also returning; Dr. Eric Nobel is double board certified in psychiatry and addiction medicine. He's a staff psychiatrist at the Mayo Clinic in Arizona and now a third-time medical expert on “Read. Talk. Grow.”
Eric, welcome back to the show.
Dr. Eric Noble:
Thank you so much.
Dr. Denise Millstine:
“Girl in Pieces” is a young adult novel about Charlie Davis, who's recovering from trauma and self-harm. We meet her at a psychiatric facility in Minnesota before she moves to Tucson to start over. Charlie struggles with poverty, toxic relationships, and urges to relapse, but she slowly learns to cope and find hope through art and resilience.
Kathleen, I wondered how I would find Charlie on rereading “Girl in Pieces” because I read it when it first came out, and she was maybe even more heartbreaking for me this time. Will you share your inspiration for her character?
Kathleen Glasgow:
First, I'm curious to know why after such a long time, like she is more heartbreaking for you, because I think it's interesting how characters can change for people when you reread a book after time has passed.
Dr. Denise Millstine:
I think when I first read “Girl in Pieces,” I remember thinking of myself as a physician who had seen many patients who had navigated self-harm, and feeling this awakening toward why and what it means and what it feels like. So I felt like this eye-opening experience.
And maybe with the second reading, because I knew what was coming, I really felt like I was with Charlie, and I knew how the novel would end, which we're not going to share today, but I still just wanted to hug her and hold her and find a way to help her out. So maybe it's me, probably not Charlie cause her words on the page haven't changed.
Kathleen Glasgow:
So the inspiration for writing “Girl in Pieces” came from…it was very basic. So I started out as a poet and I thought that I would be a poet, and I published poems in literary journals. I have an MFA in poetry from the University of Minnesota, and I was very happy just writing poems. And then in my late 20s, one day I was on a bus going to my job at the University of Minnesota, and a girl sat down next to me, and she had fresh self-harm scars on her arm.
And when she saw me looking, she pulled down her sleeve. And she was about 15 or 16, the age that I was when I started practicing self-harm. And at the next stop, she got up and got off the bus. I thought about her for weeks after that. I should have said something to her that she was not alone and that things would, in fact, get better.
I know that that's a cliche, but it is true. I do think if you can hold on like the longer you can hold on. If you have experienced something traumatic or experiencing self-harm or depression, things can get incrementally better as you get older and you pick up more tools in your toolbox. But I didn't say anything to her, and I thought that I had never written about my self-harm, even though when I was in my MFA program, people had encouraged me to do that.
But I did not want to do that. It was very private. It was a private thing to me, but I just couldn't get her out of my head. And because I'm a writer, I gave myself a task and I thought I will write about it. But writing about that for me was much bigger than, like a poem or two poems or three.
And I'm a writer. I will write a novel. I don't want to write a memoir. I want to write a novel. I read novels all the time. I know what they look like. I know how to write one. Of course I do. I'm a reader. And so I set myself the task of writing, what I thought at the time, was kind of like a really long letter to that girl on the bus, and to other kids who felt as lost and alone as she did in that moment.
When you are doing something like that to yourself. And I didn't have a plan and I never thought it would get published. And so when I was writing that book, I had so much freedom because no one knew what I was doing, and I wasn't on social media, and I didn't tell anyone. It was just for me. It was for me.
It was a private book, and I said what I had to say about what it feels like to be that girl and to have had those things happen to you and to want some semblance of control over a world that is constantly cruel to you. And it is strange to think about for people who haven't done it. That you would be cruel to yourself to feel better in a world that is cruel to you.
And I don't know that it's something that people really can understand unless they have been in that position. And I did the best I could to put that in literary form on the page. But it was the girl on the bus who was really the inspiration for that book. For me, sitting down and deciding to write it.
Dr. Denise Millstine:
So incredible to me that a missed conversation with one person has turned into a conversation with thousands and thousands of people now. So as much as you wished you had said something to her. In many ways, I think the world is better off that you created “Girl in Pieces” from that conversation.
Kathleen Glasgow:
I think that when I was doing it, it was the 80s in the early 90s, and no one really talked about it. You just wore long sleeves all the time. And then when I saw that girl, so many years later, people were starting to talk about what was happening in the epidemic of self-harm. And I was just going with the times like, you just don't you just hide it.
You don't talk about it. There's something shameful about it. I don't feel ashamed of my scars. I feel like my scars are a sign of not resiliency, because I don't think kids are resilient. If they were like they say, there wouldn't be so many adults in therapy. They are where I have been, and I carry them with me.
They're a sign that I have a strong survival instinct, right? I can get through. I can look at them and say, I can get through this thing that's happening to me right now. I have gotten through quite a bit. Then I have improved my life in many ways.
Dr. Denise Millstine:
I love that. Eric, tell us your reaction to the book, particularly Charlie.
Dr. Eric Noble:
Well, I can't wait to share this book with several of my patients because yeah, I just want to commend you. I think you created just a really honest portrayal, something really nuanced and humane. It comes across, obviously, it's a beautifully written and polished book, but there's a rawness to it which kind of you explained probably how that came to be.
And this compassion, you know, as a psychiatrist, as a doctor, I'm often labeling and diagnosing people. I work with the DSM and that's part of my job. And that can be useful in a lot of ways, a diagnosis sometimes that's really validating for someone to kind of know what's going on with them and it can point to a treatment and a path forward.
But there's also something that gets missed in a label and a diagnosis, and it's the nuance and the humanity. And I love that, you know, this just creates that fuller picture of what it is to self-harm. So that that's what I really appreciate about the book.
Kathleen Glasgow:
It was I think it's really interesting that you said that about like a diagnosis. This book took me like I wrote the book over a period of nine years because like a kids and a job. And I lost some people in my family. So it took some time. And, you know, like I said, it was just for me.
And then when it became not for me and some people had seen it said, oh, no, you should maybe find an agent or something. We don't have to go into that. But when it got to the stage where I had an editor and I will say that she had very little actual editing of the book like itself, like the content, like I thought, oh, they might really take out some of the stuff here that readers might find objectionable.
And they actually didn't. It was interesting the more mundane things that were edited out. But at one point she said, so you'd never say what Charlie's diagnosis is. And I said I did not, because I don't want to put a label on it because maybe someone who's reading it would be like, oh, well, that's not what I have.
So this doesn't apply to my life. I wanted to keep things open so that anybody who is reading it could say, that's me and not say, oh, well that's, I don't think that's me at all. And she's like, well, I do think you have to put something in there that has a name so that someone who doesn't know that there are names for what they're feeling can say, wait, that is what I do, and there's a name for that.
And that if they wanted to, reading this book, they could go to someone and say, I think that this is what's happening to me. I think this is what it's called, and I need help. Because that's when you're really vulnerable. Often you don't have a language to tell people what you're feeling, you don't know the actual words for it or even how to say it.
And sometimes a book can give you the bravery to do that. And so that's why in the book you do see like non-suicidal self-injury is because of my editor. And she said I that she did want some names and labels in there.
Dr. Eric Noble:
Yeah, I know there was that part where Charlie was talking to Mikey as well and kind of talking about her experience in the rehab center, the treatment center. And she brings up kind of impulse control disorder and PTSD. But yeah, I agree with you. I think there is a usefulness to labels, but I think it's also important to complement that with the nuance and the humanity of what's going on.
Kathleen Glasgow:
Yeah, yeah. And there is, there's so many like everyone can have be dealing with something under like a term or an umbrella. But there are all these nuances to their personal experience with it. I think it's important for people to recognize that and feel good about that. Like you said, like there's a humanity, there's a humanity involved.
And, you know, the treatment center. When I was in a psychiatric hospital, I was between when I was 16 and 22. And that was a long, long time ago. And you do have to think about when you're writing the book, like, what time period does this take place in? Because treatment centers had obviously, I think, changed from the time in the late 80s and early 90s when I was in them.
And when I went to the treatment center for the first time as a teenager, the teenagers were with adults. They did not have a separate wing in the facility that I was in, and that was a really not safe environment at all. So when I was coming up as well with Creeley Center. I looked up some programs for kids like Charlie and then adapted them later when I was write, revising the book to what I needed the fictional treatment center to be in my book. Because nothing can mimic something 100%, and all programs are different.
Dr. Denise Millstine:
And when we talked on Episode 73 about “The Glass Girl,” we talked about the treatment center there as this truly, the best ever, not perfect, but best ever imagined treatment center which, readers could look and compare. We're using the term self-harm, Kathleen. And you do actually define this in your author's note at the end of the book.
But I wonder for our listeners who are kind of trying to get their head around what that encompasses, will you share what that is, or do you want me to read the definition and then you can respond? Either way is fine.
Kathleen Glasgow:
You can read the definition.
Dr. Denise Millstine:
So Kathleen wrote, self-harming is the deliberate act of cutting, burning, poking or otherwise marring your skin as a way to cope with emotional turmoil. It can be the result of many things such as sexual, physical, verbal and emotional abuse, bullying, helplessness, sadness, addiction. Self-harm is not a grab for attention.
Kathleen Glasgow:
It isn't. It is not, I will say, like some, you know, still, people will say, because I'm on TikTok and I know I see these videos and I see kids out there who are using TikTok to tell people how they feel about self-harm, however you feel about them using a video as their diary. And some people will say, well, you just want attention.
And my answer to that is, is that so bad to want some help? Someone is literally telling you they're having a hard time and you're telling them they don't deserve to be seen or attended to for that. It's a real bone of contention for me is that we somehow are like, well, you don't. You're just you're just whining about that.
And it's like when you cut yourself that it hurts. It hurts. That is not something someone does lightly. It is a real thing. And if people are asking for your attention and they're in a bad way, you should give them that attention.
Dr. Eric Noble:
Yeah, I think there's so much stigma around self-harm. And I think, you know, there's an interesting history about self-harm. It's existed, you know, throughout human history.
Kathleen Glasgow:
Yeah.
Dr. Eric Noble:
There's a great book called “Psyche on the Skin” by Sarah Chayney that kind of looks into the history of self-harm. But it was really in the Victorian era where it started to get stigmatized, associated with women, and to be viewed as this manipulative, attention seeking tactic that women were using to screw over men.
And it exists to this day, even in movies like “Fatal Attraction” with Glenn Close and Michael Douglas. You know, it's a way for her to manipulate his character in that movie. So this stigma persists. But I think at its core, there are a lot of reasons and pathways of why someone might engage in self-harm. But at the end of the day, I think it's a coping strategy.
It's a way to manage intensely negative and difficult emotions and thoughts. And with that, I think there's some other things that go along. So there is a relief and a release and an endorphin and dopamine hit, and you hit on that in the book, you know, Casper says that you feel high like the world is cotton candy. And so there is, you know, some overlap with addiction and that, that reinforcing high that someone gets from cutting.
So that's one element. I think there's also this shame and vicious cycle. You feel unworthy or unclean, so you need to blame or punish yourself. I think there is also this sense of control. And you had that in another line. I need to hurt myself more than the world can hurt me. So you're sort of taking a sense of control back.
And then I think there is sometimes a communication mechanism and strategy you're trying to tell someone or, you know, people that you are in pain, and that's not attention seeking or manipulative. That's the tool that, you know, at that time of how to communicate the distress that you're in.
Kathleen Glasgow:
I think all of that is spot, it's spot on. I can also see that as a parent, I can see the other side of it too. Like, why is my child doing this to themself, right? And why? Like what have I? Your first reaction is going to be like, what have I done? And a lot of times the call is coming from inside the house.
But historically speaking, I like I'm going to look up that book. So after “Girl in Pieces” came out, I was checking that place on Facebook where the messages from people you don't know go and they just sit there for a long time. And there was a woman who wrote to me and said, I am a 68-year-old woman and I live in Canada, and I just read your book, “Girl in Pieces.”
And Charlie is me, and I have been harming myself since I was a kid. And then in the 60s, what they did with you was, they said, just take these pills and stop doing that to yourself and you'll feel better. So I started doing pills, and I would drink wine and I would wear long sleeves. And that's just what they told you back then.
That's how they dealt with it. But I have never seen myself in a book, and I have finally seen myself in a book, and I'm going to wear short sleeves tomorrow. And that, like, was really eye opening and profound for me. And I started, there's something about women in particular when they're experiencing mental struggles. It's somehow like when you mention “Fatal Attraction” and Victorian times and self-harming being seen as a way to manipulate men.
I was like, why do men always have to come back into this? Because, well, well “Girl in Pieces” is not, you know, that's that is a novel and that is not my experience. The things that Charlie has, like I had a different life, but I will tell you one thing that did happen to me that I put in that book is I did have a nurse who looked at my arms and said to me, why would you do that to yourself, you have such a pretty face?
Because girls and women are commodities and we don't belong to ourselves, we belong to men and we are seen by how attractive or useful we can be in that way. In the world, and like the ways that our body are tools for other people's consumption. And it is really, really, really, really, really hard to be a girl in this world.
And to realize that one day you don't actually own yourself. And so I think that some self-harm is an attempt to take back a little bit of that control from the world or from other people who are harming you. I also have thoughts about other forms of self-harm that people can slip into as they get older, like drinking, because that's more socially acceptable, right?
And it can be like the cycle, and then you feel bad, you have a hangover and you do it again and it's hair of the dog and it just keeps repeating itself. And I'm curious to know if both of you have thoughts about that.
Dr. Eric Noble:
I think at the end of the day, these are all, like I said, coping mechanisms and ways to manage intensely negative emotions. And they work at first, but the issue is that they cause more distress than, than benefit and so the goal is to help people find newer, healthier coping mechanisms. And I think that's what this book is, Charlie's journey to find her voice.
And I think the trajectory is she starts out, you know, selectively mute, not able to talk, and she blossoms into being able to find this avenue through her art, through caring relationships, to find a voice. And so, that's her journey of finding healthier coping mechanisms. But going back to, yeah, I think that it's such an umbrella term, this idea of self-harm that so many things can land under it, drinking for sure.
And where do we draw the line? I mean, nail biting. I've had many patients struggle with hair pulling and trichotillomania. One patient who would pull out all of her eyebrows and eyelashes, is that considered self-harm? And so where do we draw the line? But again, I think at the core of it, it's all just how is someone trying to cope with and manage these negative emotions.
Kathleen Glasgow:
I do think it's interesting. You know, I don't mean to say like only girls can self-harm. I think that boys self-harm in different ways that are socially acceptable to them. Did either of you ever watched that TV show “Friday Night Lights?”
Dr. Eric Noble:
Oh, yeah.
Kathleen Glasgow:
So remember Tim Riggins, right. the football player, when his dad comes back into his life and he is so happy to have his dad back. Like, now his dad is finally going to be a decent guy and love them and take care of them. And then his dad just does the thing his dad always does and like breaks Tim emotionally again.
And what is Tim do? This big football player guy, he goes to the bar because it's Texas. Of course they're going to let their football star in to drink and he drinks and he picks a fight with those guys in the parking lot. Those older, beefy men who beat him to a pulp. And that I got into a fight with someone on Twitter at that time because I'm like, that is self-harm.
Tim did that on purpose. He incapacitated himself so he couldn't fight back. And he picked a fight with these guys and he let them beat him because he is telling himself, I am never going to do this again. I am never going to let someone else hurt me like this again. He is self-punishing and it took a long time until finally that person was like, you know, you might be right.
Dr. Eric Noble:
Absolutely.
Kathleen Glasgow:
That was a self-harm representation in a mainstream TV show, but no one thought it because really, that's just a kid blowing off steam and getting beat up for his big mouth. And I was like, that is not what is happening there.
Dr. Eric Noble:
And I think the commonality between Tim's situation and Charlie's is, is this invalidating environment. And I think that's just one of the most essential core risk factors for someone developing these self-harm coping strategies, is growing up in an environment where they didn't have the space or opportunity to learn the language of how to voice their emotions.
And they were often invalidated when they attempted to. And so I think that's one of the core things and that's a commonality between those two characters. But going into the gender differences, I mean, cutting in some of the more typical quote unquote self-harm things that we think of, the prevalence in incidences is higher with women. And this is a vast generalization, and there's a lot of nuance here.
But I wonder out loud just whether there's a tendency more for girls and women to internalize negative and painful emotions, whereas men, it's more common and acceptable to externalize those. And you see that in the difference between Tim and Charlie as well.
Kathleen Glasgow:
I think that, I think that's really true because we're told you should be nice still, like, you should be nice and neat and quiet. But it's expected that boys are rambunctious and rowdy and can be angry. And, you know, like recently, my daughter goes to, like, a fairly progressive school. She was telling me about, they were put in groups and she was put with a boy who sometimes acts out quite a bit.
And she expressed to the teacher, I don't want to be mean, but I don't want to sit with him because he is this way and it makes me uncomfortable. And the teacher said, I have to put you there because you're one of the nicer girls in class, and he just needs someone to be nice to him.
There are a lot of nuances to this situation too, but I told her that she doesn't. She should not feel or be put in like the position that she needs to be good to make a boy feel better about whatever distress he's feeling. So I think that we do reinforce these types of behaviors, and we sort of slot girls and boys into these areas very early on, sometimes without realizing it.
Dr. Denise Millstine:
Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
So I really like the term self-harm because it's so encompassing. I hear the term cutting or somebody who's a cutter fairly casually but frequently. But I think in the book you do draw out how several of the girls at the care facility with Charlie when the book starts are actually self-harming in a variety of different ways.
But another element to self-harm that I want to distinguish is that typically, so self-harm is dangerous for many reasons, but typically it is not a suicide attempt. Do you both agree with that?
Dr. Eric Noble:
Yeah. I think definition-wise, it is the case. I think the reason that we do care about self-harm and want to address it, though is because it's one of the stronger predictors of completed suicide, a huge risk factor. So while self-harm, cutting or burning or skin picking might typically not in those moments be an attempt to end your life, it could be related later on to a big risk factor for that happening.
Dr. Denise Millstine:
Kathleen, you were reacting to that too. And I know you say in the book that it's not suicidal, but I want to make this point for people who are listening and maybe know somebody who has self-harm behaviors.
Kathleen Glasgow:
I think it is a risk factor. Like I, I agree with Eric. I think, you know, you're in the moment and you're doing it and you're like, I don't, in fact want to commit suicide at this moment. But it's a risk factor because there might come that moment when you're like, you know what, this is the moment. That's the reason is that you could accidentally go too far, or you could, on purpose, go too far.
It's a risk factor. It is a risk factor.
Dr. Eric Noble:
And that happens to some of the characters in “Girl In Pieces.”
Kathleen Glasgow:
Yeah, it happens to some of the characters in the in the book. I was going to wonder if Eric was referencing the character of Louisa.
Dr. Eric Noble:
Louisa, Ellis and Charlie.
Kathleen Glasgow:
Yeah. So specifically Louisa who, or as Blue says, because they think it's, like, set herself on fire near the end of the book and she's still in the facility. I am writing a book about Louisa and her origin story, and how she came to be the person who wrote those composition books for Charlie, and sort of I'm a mentor to her in some ways.
Dr. Denise Millstine:
Fascinating. We can't wait to read that, for sure.
Kathleen Glasgow:
Which will, because Louisa in “Girl in Pieces” is older than Charlie. She's in her late 20s, which means that it will actually be a historical novel taking place in Minneapolis, Minnesota and Saint Paul. So I might have to go there to visit and do some more research, even though I lived there for quite some time. But self-harm is, it does put you it should be considered at risk for suicide. It is that dangerous.
Dr. Denise Millstine:
Yeah. Thank you for clarifying that. We've already mentioned this briefly, but I want to talk about it again. Eric, this is people's reaction to scars from self-harm. In the book, we see everything from shaming to dismissing to even glorifying with one of the artists that Charlie interacts with. Why do you think these reactions are so varied?
Dr. Eric Noble:
I think it brings up a lot of discomfort for any human to be confronted with someone, another human, who is inflicting harm on themselves. That kind of brings up a lot of existential questions for someone, whether they're aware of it or not. Yeah, it's just very hard to know how to react to that. And I think there's a lot of people that are either disgusted or angered by it or freaked out and want it to go away.
So we see that intense reaction from Riley in the book where he's, you know, really freaked out about it and yells at Charlie when she reveals this. And I was curious, Kathleen, you I mean, your experiences interacting with doctors and medical staff in particular, you shared that anecdote about the nurse. But I think our role as people in general, but especially medical staff, is to react and address self-harm with compassion and curiosity, to try to get to know what's going on and the nuances of some someone's story and why that's the case, and be open-minded to hearing about it and not trying to just knee jerk, make someone stop, but at the same time trying to help someone develop healthier coping strategies where they can manage these really negative emotions and thoughts in a more healthy manner. So I think that's the job and that's how I approach it from a mental health standpoint.
Kathleen Glasgow:
I think that teaching people coping mechanisms that work for them, that are non-detrimental to their physical and mental health is the way to go. And then sometimes that can take quite a long time for them to find something that works for them. And for me it's always been like practicing art or writing like that's my place as a person with scars.
I've seen lots of reactions in the world to my scars if I wear like a short sleeve shirt. Like if I go in just to go to the doctor for a checkup or like urgent care and they're doing blood pressure or whatever. I've gotten like quite a few reactions to my scars, like, most of them are just very non-committal because my scars are really old.
But also, how are you? Or so what happened there? And then you discuss it and depending on what kind of appointment you're having, you have to kind of like temper the whole situation and hopefully not get someone who's going to be to maybe like go a little too far because I've had doctors who are like, and do you have kids?
And then they think I might not be a fit mother or a good mother. You can sort of tell that. And so, you know, it's something that you are going to live with your entire life. I know people who have had, who have tattooed over their scars so that they don't have to face that in the world. And like, for me, whatever you need to do to make yourself comfortable as you move around in the world is up to you.
And if you feel like at some point you want to tattoo over them because you've found other coping mechanisms, if you feel like you just want to wear long sleeves when you're with people that you don't know for the first time, then do that. If you feel like you are like, I'm going to wear whatever I want to wear when I want to wear it, you should do that.
Like do whatever you want that makes you the most comfortable moving around in the world. Because the important thing is that you know that you are a valued person and you have value, and you deserve compassion and respect. And again, I will go back to writing the book and having those depictions of scars in the book and the reactions to people, to Charlie, and to her friends.
And there reactions are, I think sometimes are based on her gender. How could you do that to yourself? You're a girl. It's like based on how could you make yourself less attractive and less of a commodity in this society for us to look at. And there is a page in the book, page 31, which is very popular page with some people who have experienced self-harm.
When I write a book, I write through the character's voice and how they see the world. And page 31 in particular, where it's wash, rinse, repeat and the world will never see you, not as a creepy freak. Freak is the way that Charlie feels, that the world will see her because of her scars. That is not the way I feel about the world.
I write the way Charlie feels. But when a reader reads a book, they read the book as themselves, with all of their stories and their biases and the way that they're feeling, and they might see that page and think things like, no one is ever going to accept me, but if they get to the end of the book, they will see that Charlie's outlook has changed through experience and finding the right kind of friends, even ones like Lou, who starts out not as her friend, but turns out to be a great friend to Charlie.
Dr. Denise Millstine:
I keep thinking about people who love others who are self-harming and a lot of that is in terms of, you know, what's the best reaction? And I think you just shared with this that it's one that comes from a place of compassion and love and kindness and maybe openness and curiosity, if that's the right space.
But another part that's hard is in Charlie's case, she has this tender kit, she has a kit that she's created that is for cutting, and it's the things she uses to cut, but then also her bandages and ointments, and it's really reassuring to her at one point to recreate that kit so she knows she has it, which she then packages away and hides as far from herself as she can.
Can you talk about the tender kit and how that's important to Charlie? And also maybe Eric could then comment on, you know, if you love somebody who's self-harming, your reaction might be to toss away the tender kit, but that might not be the right thing to do. That's complicated.
Kathleen Glasgow:
So the tender kit in the literary senses was me wishing that we could all have a little kit we could carry around whenever we needed it just to soothe ourselves. Like, wouldn't it be nice if we just had that box of our favorite stuff. And whenever things were bad, we could rub that piece of fabric that always calmed us down or something like that, which is something I did as a kid with, like the particular sheet that I had on my bed.
It's her way. It's her coping box. It's her self-soothing mechanism. It's the same as someone who might use needles when they're taking their drugs. You have a little kit, you have your stuff, you take care of it, and you make sure that things are clean. And it's a way of taking care of yourself in a way that no one took care of you.
Especially for Charlie, whose mother is physically abusive and whose father is gone and she has just had such physical and emotional trauma. Her kit is very special to her because when she's harmed herself and she's wounded, she knows how to take care of herself, to bandage that wound, and to soothe herself. And I think it is important sometimes to have that thing close by. You like having that option.
“The Tender Kit” was the original title for the book as well, and it sold as “The Tender Kit” and then they changed the title because they thought they actually like the phrase the tender kit. Readers would not understand it if they saw it on a particular type of book.
Your first reaction might be for someone. It's like, I should get rid of all their stuff. Like you might say to your teenager in your house like, well, I'm taking the door of the room and now you've taken away their privacy. You can't take everything away. Like, I know people have a lot of opinions about this, but you're punishing someone for having mental health issues. You're punishing them.
And what is that teaching them for their future life when they are in relationships and dealings, people or even have children? That that's the way you treat someone who is having a problem is to punish them for feeling that way. That is the thing. And I know people who, when they were kids, like when they were sick, their parents made them go to school and didn't take them to the doctor and acted like they were an inconvenience.
And it's been really hard for them to even get themselves to a doctor as an adult, because I don't want to go. I'll just be bothering them. It's a doctor. It's literally their job. Like they can't. They do not know that they can take care of themselves because they were punished for feeling that way. Right. And that they didn't deserve care.
I'm not a fan of like those things like, well, we have to get rid of everything that you had that could possibly harm you because you, you know, if someone took away Charlie's kit, just find something else. I mean, there are many, many ways to hurt yourself in this world and if you want to do it, you will find a way.
Dr. Eric Noble:
So I think the really good news is that there's actually great treatment for people who are struggling with self-harm. And the most research and well known is Dialectical Behavior Therapy, DBT. And what is DBT? Dialectical, that's kind of a funny word, but basically that just means balancing two opposing things at the same time. And in this case it's acceptance and change.
So accepting and understanding difficult emotions and thoughts, and at the same time working to change behaviors and coping strategies. And so we can talk a little bit more about the details of DBT. It was actually developed in, I think, the 1980s or 1990s by a psychologist named Marsha Linehan, who she disclosed later on that she actually struggled with self-harm and borderline personality disorder and we can talk a little bit more about that.
But I think the key takeaway is that that has been shown to really address self-harm in a healthy way. And there's four different modules for DBT, so four different domains. So one is mindfulness; how to stay grounded and present without judgment. The second is distress tolerance; how to manage high stress situations without making them worse. So basically your crisis survival skills.
The third domain is emotion regulation; learning to identify, understand and manage emotions. And the fourth is interpersonal effectiveness; how to ask for what you need, how to say no, how to cope with conflict while maintaining your self-respect. So it's a comprehensive treatment that entails both individual and group therapy.
And there's also a component of home coaching. When a patient is really in a crisis situation, they can reach out to their counselor to get some guidance on how to navigate a really stressful situation. But after a year of that treatment, most people don't meet criteria for borderline personality. Self-harm reduces tremendously. So I think there's hope and there's good treatment for this.
Kathleen Glasgow:
There's a lot of hope and there's a lot of treatment that people can do that I think is really healthy and beneficial and can change their lives in incredible ways. I think sometimes the people around them expect a quick fix, and there isn't a quick fix. You can't just say to someone who's suffering from self-harm, you can’t say, I'm going to get rid of your kit and all this stuff that could hurt you.
And here's 30 minutes of a yoga app that they've read on the internet that's going to help you, and it will help them, but they have to keep at it. You have to replace some of the stuff that you have been doing with this other stuff, and it's going to take some time for you to adjust because. Because for me, you really have to rewire the entire way that you think about yourself and approach like every single thing in your life.
Because like Eric was saying, like there's catastrophic thinking and there are intrusive thoughts. There are just so many different aspects of living this way that you have to address. And it's not going to take like a week, six weeks. It's going to take like a year and sometimes longer. And it's going to take every day and a lot of attentive care from people around you, to you and also towards yourself.
Dr. Denise Millstine:
And another element of healing is finding art that moves you. For Charlie, that's drawing, that's creating these portraits particularly is how I imagine them. And for you, Kathleen, that was writing. Will you talk about the importance of humanities in healing?
Kathleen Glasgow:
I think a lot of times when people are struggling, they feel like they don't have a voice and that no one cares what they have to say anyway or how they feel. And I am a big fan of using art, any kind of art, as a therapeutic tool. If you sit there and draw for five minutes, your blood pressure is going to lower and you're going to feel like that much better.
And if you write down your thoughts like we were talking about in the beginning before we started the podcast, you know, you don't need my permission or anyone's permission to write in a journal and say whatever you want to say about the things that are happening to you, or even if you have to say mean things about people. That is your space, and you are allowed to have a voice and to use it in whatever way that you want.
And expressing yourself is a big part of the healing process. And being able to find the words or the means, whether it's visual art or music or writing, to say what you want to say about your existence and the way that you're feeling. So I, I'm a big fan of art in general as like a healing tool and giving yourself that space to create something and seeing what happens and how it impacts you.
We're little and we're in school. We are drawing all the time and the people are reading poems to us. And, you know, we're making funny things. We're reading stories and we're writing little stories. But then somewhere along the line, you take a class and your creative work is suddenly graded, and that means it's good or it's bad, right?
Someone subjected you to their opinion and then everybody splits off, right? Do you both write? Do you both draw or paint? Was there a period of time as a kid where you're like, well, I don't do that anymore because I'm just not good at it. So you stopped and maybe you started doing something else. I think that's a problem that we don't have so much art and music in school anymore, and that when you do, it's something that you have to test in to or audition for.
It should just be open to everybody. I was counseling a girls group, at a high school here, and half of the girls had open music. The first part of the day. So when they came into counseling, they were really happy because they just been singing and listening to music in this choir class. And the other girls were slouched over and upset and fidgety because they would not have their session of that class until the afternoon, and they had to wait.
They had a way to be happy. What if you started every school morning just letting, kids listen to music for 15 minutes in the classroom while they free wrote, and they might be nervous about it in the beginning, but then they're going to get into it in their zero hour, and they're going to be like, actually, this is really cool because I have some time to chill out, and we're just listening to these songs and I'm just writing what I want in this composition book.
That has gone away in education for the most part. And I think that the mental health of kids has suffered because of that. They don't have that breathing room anymore. And you often don't get that capacity for trying art again back until you're an adult.
I used to write in Barnes and Noble, and one of the joys of that was looking over and seeing this group of women in their 70s who had coloring books, remember the coloring book thing. And they were just coloring in these, they were like, so happy. I wanted to be with them. And I looked over them like, you guys are having a great time. They're like, we love this so much, and we're taking a painting class. Like they had it back.
Dr. Eric Noble:
Yeah, I took up knitting to get through medical school.
Kathleen Glasgow:
Right, you know what it feels like because you get lost in that practice. And just like that physical activity and your blood pressure lowering and you're moving and you're also thinking about things in your head, like you can be knitting, but you're also probably thinking about some of the stuff that you were thinking about for medical school. And that was a good way for you to do two things at once in a non-stressful manner.
You know the book “Speak” by Laurie Halse Anderson. And so she, as a teenager, studied abroad in I think it was Norway. And she said the first time when she went to her first class, it was so shocking because the teacher was talking. But there are kids who are like knitting and drawing or sketching. They were doing other things.
Because over there they let the kids do that in class because they are listening to what the teacher is saying, because that's the best way for them to learn. And there were some kids who weren't doing that. They were just listening and taking notes because the other kids were doing just fine. But here in a class, be quiet, listen, don't say anything.
Dr. Eric Noble:
What this makes me think of is you wrote Kiefer stage, and you said that Charlie was going through a Kiefer stage. I had no idea what you were saying. So, I googled it.
Kathleen Glasgow:
Yeah.
Dr. Eric Noble:
You can explain a little bit more, but I think it references an artist and this idea that, and Felix I love his character and he has a great quote that every person at one point or another has this momentum, momentous occasion that rips your being into small pieces. And our job is to fit them back together, but in a different way.
And I think that's what humanities and art can do. It can help you reassemble these pieces in a new way. It makes me think of the analogy of metamorphosis and a caterpillar going to a butterfly. That is, if you think about it, caterpillar going into a cocoon.
It basically dissolves itself into this like liquid. And it is a very intense, like gnarly transformation. So this is painful. It's not like a joyous rainbows putting this puzzle pieces back together. It's painful. But when you take the time and then do that in a supportive manner, you know something different and beautiful can come out of that.
Kathleen Glasgow:
Yeah. When you have that support, something beautiful can come out of that. And I think that the arts are, they are a definite part of that process. And I put a lot of art into “Girl in Pieces” because I love art. And, I minored in art history in college, and it was one of the best things I ever did.
I had the best time. Like, I love art. I think everyone would really benefit by having more art in their lives and going to museums every once in a while and taking a look at things around them and try your hand at it. Try your hand at it.
Dr. Denise Millstine:
I have loved this conversation. We talked about a challenging topic which was self-harm, but we came all the way around to hope and some strategies, including finding your art, finding the thing that allows you to feel more free to move forward. It's really been my pleasure to talk to you again, Dr. Eric Noble, and to talk to you, Kathleen Glasgow about “Girl in Pieces.”
Thank you both.
Kathleen Glasgow:
Thank you as well. Can I say one last thing. So the things that have happened to me, self-harm and psychiatric issues and addiction. I do have some people because I am a semipublic figure now who are like, that’s really inspiring because then you became you’re a “New York Times” bestselling author.
The author part is not…the inspiring part should just be that I am here, that I made it this far. And I think that that's the part that people should take away after this conversation is that you can get to that place. That's a good place for you, and it might just take some time.
Dr. Eric Noble:
Thank you both. It's awesome. And sincerely, I'm really looking forward to sharing this with. I have several patients in mind who I think are just gonna really benefit a lot by reading this. So yeah, it's going to be very useful for me as well.
Dr. Denise Millstine:
Thank you for that.
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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