It should be no secret by now that I suffer from a number of mental disorders, the most prominent and diagnosed being Bipolar Type II. I’ve written before about the difficulties in diagnosing, assessing and understanding mental illnesses, because unlike physical disease they alter the very chemistry of the brain and the thoughts and behaviors of the sufferer, and the illness becomes the new ‘normal’.

I’ve also written about the early years of my depression, and while I’m still working on how to write out the rest of my story (soon to come), one of the major components of my teenage depression was self-harm. I hurt myself, extensively, and the reasons why were, even then, difficult to explain, never mind understand.

How difficult must it be for someone who doesn’t suffer from depression to understand the compulsion to willfully damage one’s own body? To inflict wounds that are obvious, visible, painful and indelible? I can’t pretend to speak for everyone who’s ever deliberately hurt themselves, but I can at least give some insight into what it was like for me.

Perhaps the greatest influence on my depression, especially at a young age, was feeling out of control, of feeling that no one cared, and no one understood, and no one wanted to listen. I’d like to think this is common enough for many teenagers, and all the harder for those suffering from a chemical imbalance on top of it. Throw into the mix the surging hormones of a young adult, and it all-too-easily starts to feel like even your own body has no regard for your feelings, for your thoughts.

I first cut myself with a dull pen-knife, leaving hardly a mark. It hurt, but didn’t really even break skin. But there was something fulfilling, a sense of emotional release, in the sudden sharp pain. When I moved to a pencil sharpener blade, I was able to split the skin much more easily, and things took a shift. When you cut yourself with something genuinely sharp, there’s no real initial pain; so sense of being torn open. Instead, the skin just parts, pure white beneath, before the blood wells, fills the cut, and—depending on the depth—overflows. The pain comes after, a dull, unpleasant ache around the wound as the wound inflames and your body tries to react.

This pain, this ache, was never what I sought. I didn’t like it, and could have done without it. But the compulsion, the need for release, kept me going. And it soon became not about the pain, but about the blood. Seeing my life flowing out of me, trickling down my arm, staining my sleeves, made me feel alive, made me know that I was real—somehow that I mattered.

And I can’t pretend there wasn’t a part of me that wanted people to know, to see. I admired the beauty of the cuts, the patterns and criss-crosses of scars as they accumulated on my arm. I would compare cuts with my best friend in high school, who would also hurt herself, and admired the depth of her cuts, and was proud of the number of my own. It was an outward expression of my internal turmoil, the bleak despair and self-hate that felt so painful inside that any wound on the outside was nothing in comparison.

The very worst of my scars, then, are from a period when I was isolated from all my friends, kept alone in a small apartment and forced into intensive therapy. I hurt myself so badly then because I didn’t have anyone to talk to, I didn’t have anyone to listen to me. I couldn’t share. I couldn’t express.

And ultimately, of course, the self-harm was superficial. I never did nerve damage, I never cut an artery; just hundreds of cuts and scars. Now, over a decade later, most people don’t even notice unless I show my upper arm. My arm hair (rather plentiful) obscures the finer scars, and the larger ones are more sporadic. I stopped when I met my wife, because I didn’t want to hurt her with my own pain, and I haven’t hurt myself again. I sometimes think about it, in my darkest moments, but I haven’t picked up a razor in almost fifteen years.

So what can you do if you know someone who’s hurting themselves? What can you do if you are hurting yourself? To those who are suffering, I would tell you this: be careful. Self-harm and suicide ideation are not the same thing, and I know most of you aren’t looking to permanently damage yourself or die. I’d be remiss if I said you should continue doing it, but I also understand the compulsion only too well.

For those who are watching from the sidelines … take a moment to listen. Even if you’re listening to silence. You can ask to see the scars, but don’t judge; you can listen, but don’t speak. And then … ask us to grab a coffee. Go to a movie. Something easy, something simple. Because often that’s all we’re capable of.

And try to understand—we hurt ourselves for a lot of reasons, but it doesn’t mean we’re suicidal, and it doesn’t mean we’re insane. We’re just hurting on the inside, and sometimes we need an external release.