TLP 143: How to Know if Your Child is Cutting | Dr. Mark Shaw Interview

When I was a child, I thought I was a child, when I'm adult, I think as an adult. So kids don't always deal with it as on an adult level.

Introduction to the Problem of Self-Harm

Welcome to Truth, Love, Parents, where we use God's word to become intentional, premeditated parents. Here's your host, A .M. Brewster.

Welcome friends, I hope you're having a wonderful day. I feel like I gotta be super chipper this morning because the content of today's show sounds so very dark. But our topic today is extremely important and it needs to be discussed.

It's so important that I brought on a special guest to help equip us for the task. Today's discussion is about self-harm and more specifically, the practice commonly known as cutting. Now, before I continue, I wanna encourage those of you with younger children to stay with us today, and this is for a couple of reasons.

The first is that your children may be young now, but as they grow and are exposed to various forms of negative influences, you're gonna need to be aware of what's out there and be prepared to help them interpret that information biblically.

A lot of parents are surprised, all of a sudden their kid's cutting themselves and their parents didn't even know that was a thing. The second reason is that statistically, self-harm is most common among teenage girls.

Now as a side note, that observation alone might be important enough for us to dedicate a whole show. But back to the stats, some studies have shown that 40 of college students self-harm in one way or another, that 20 of high schoolers participate as well, and additional research suggests that 7 of third grade girls and 8 of third grade boys said they had self-injured at some point in their lives.

My point is this practice is not merely the go-to for broody teenage boys. Any child can be tempted in this arena, and that's why I've asked Dr. Mark Shaw to join us today. I met Mark at the Annual Association of Certified Biblical Counselors Conference.

I attended one of his many workshops specifically about self-harm, and I knew he'd be great help for you premeditated parents out there. How are you doing, Mark?

Doing great, great, great, great, thank you.

Awesome, well, for all you listeners out there, Mark and I have been really trying to connect here to make this work, and honestly, I'm very hesitant to ever put my thoughts out there. The devil is trying to stop this from happening, but it's interesting when I'm trying to connect with certain people for interviews and whatnot, how many issues and stuff come in, and it's just technological issues and all that kind of stuff.

So Mark and I have been battling this morning actually getting connected, and we're so happy to be together, we're almost giddy, but it's actually working. But let's go ahead and jump in here and just get the chance to know you, Mark, give you a chance to introduce yourself to the audience.

Tell us a little bit about yourself, tell you about your family, and tell us about what your ministry is.

My wife and I have been married over 20 years. She would know the exact number of those years, but we have four wonderful children, and we now live in Indianapolis, Indiana, and I am restarting a ministry that I started, I founded 10 years ago, called Truth in Love Ministries, and we are a local church partnering organization.

We go into local churches and start counseling. We have a turnkey operation. We have an office manager who manages counseling appointments, and then as we counsel, we teach a class at night, and it's very interactive, it's lively, it's not just content-driven.

I think there's a lot of great content out there, but what I'm trying to focus on is giving people an opportunity to mix it up a little bit, to work on case studies and role plays and listening skills and learn how to ask good questions and follow the breadcrumbs, so to speak, of what people are saying back into their heart motivations and so we do that at night, try to find people in the local church who want to do counseling and then enfold them into our ministry and we counsel in teams of two, so we always have two counselors in every session and we put those church members with our more seasoned team of counselors in our ministry and we hope to raise them up from maybe a second chair counselor to a first chair counselor, meaning they become a disciple maker, a leader, and we constantly replicate, so we're trying to always counsel in teams of two for the purpose of replicating more counselors and growing the ministry in a local church.

So that's what we do in the Indianapolis area and then I teach on addiction and nationally and internationally and so forth, so really excited about the days ahead of ministry for Truth and Love Ministries.

Well, first of all, you got a great name, just saying.

Yeah.

Second of all, I think that what you're doing is amazing because it's getting counseling back into the church, back to the people who the Lord has equipped to be doing that work, which is awesome. But I also, you made a little comment there about speaking and whatnot on addictions and stuff and I'd love to hear a little bit more about your experience in that, how does a person come to the place where they're invited to come talk about addictions?

Hey, we need someone to talk about cutting. Let's get Mark Shaw.

Yeah.

Well, I have a very gifted wife who edits all of my writing and my books and so I have 20 published resources and I have that many because of my wife. She edits and does a great job and gets it ready for the publisher to where it's almost publisher ready when they receive it.

So that's why I get invited is I have a lot of resources. I've worked in the addiction field since 1991 and I take a deep breath when I say that because it's hard to believe A, that I'm that old and B, that I've done this kind of work because it's hard, as you know, just residential living with people, you're dealing with everything from they need a toothbrush to they need to be counseled due to some traumatic event in their lives.

So it runs the gamut and it can wear you out if you're not careful, but I love it and I'm thankful people allow me to consult with them, help them in their ministry or teach their church, train people on how to do effective heart ministry for the issue of idolatry, which as you know, is just a self addiction is really what most people have.

So true, so very true. All right, see, I told you Mark knew what he was talking about and he does. Like I said, I had met him in one of his workshops and I was blessed, so blessed and helped in that workshop and I'm really looking forward to him sharing his knowledge and his research and his learning and experience with you, which is why we're all here, we're here to grow as parents.

Now, I just threw out some statistics in my introduction, but I'd like you to take a moment to kind of define self harm broadly. And what I always do, and I always do this to my interviewers, I always throw a bunch of questions at them and then hope they remember most of them, but this is kind of what I'm wanting from you, kind of to define self harm broadly, try to define cutting for us specifically, and then just share some of your observations you've made in your ministry to people with this self harm temptation.

Like, I'm just curious, you might ask among young people, who's predominantly affected by this? Do these young people have anything in common? Stuff like that, kind of help us understand the big picture of this.

Defining Self-Injury and the Addictions Behind It

Sure.

Well, self injury, the definition of self injury is injuring yourself on purpose by making scratches or cuts on your body, usually with a sharp object, enough to break the skin and to make it bleed, it's termed self harm, self mutilation, self abuse.

SIB, self injurious behavior is a term you hear for this. And then there's non suicidal self injury. So NSSI is another abbreviation that you hear linked to this, but it's basically injuring yourself, hurting yourself.

And there's a number of ways to do that. And if you think about it, Aaron, we all injure ourselves. I mean, we all make choices day in and day out. Some of ours are smaller scale, but what we eat, what we choose to do or fail to do if we don't exercise or we don't take care of ourselves.

I mean, there's a little tiny forms of that. But for the kids that we're talking about, it's normally younger people who struggle with this. Although I've met with late 20s, early 30s, that age range, but very immature thinking behind that.

But self injury is just, it can be burning your fingers, cutting your skin to the point of bleeding, which is typically what's most heard of, what's known out there. Scratching your arms. You see kids that dig into their arms and they have little scars all up and down their arms.

I remember a young lady at a drive through restaurant and she reached out to hand us our meal in the bag and we're looking at her arm and I just saw scars all up and down her arms. And I knew exactly what it was.

It was from self injurious behavior.

And I think too, like one thing, actually this is really, it is huge. Cutting seems to be the predominant thing. But one thing that I was actually recently introduced to is Heath Lambert did one of his podcast episodes on his podcast, which is called Truth and Love.

And they did an episode all on hair pulling. I think it was episode 130. So if those listeners out there wanna check that out, that's a great podcast to listen to. But it was all about hair pulling. It's a similar thing where people are pulling hair out of their heads for these same reasons.

Is that right?

Yeah, yeah. I mean, same heart reasons, plucking your eyelashes, slamming shoulders into a wall until bruises or punching something for guys. I mean, picking scabs. And people would even argue the extreme tattooing and the piercings and all that kind of stuff.

I mean, you'll see people who have hundreds of piercings and all over their bodies. And that is considered a form of, even though, a form of self-injury, even though a lot of people in the world wouldn't wanna call it that.

I mean, it really, that is what it is.

Yeah, I completely agree. I especially, you get to the more extreme piercing stuff, like the gauging and stuff like that. It's just, it goes to a lot of extremes. And I think you mentioned something that's important to remind all of us.

We did an episode, it was 114. This was back in December, I believe. It's called, How to Know if Your Child is Addicted. And in that episode, I think we showed what you're saying, that everyone is, in fact, addicted to what I said was really the most damning substance on the planet.

And that substance is self. And we talked about how every other addiction, really, in a big way, is kind of a secondary addiction to feed that first one. And so that, sometimes, when we look at someone who's cutting, and we say, oh man, they have an addiction to cutting.

Well, really, they're just cutting themselves because of their worship of self. And that looks like it's a huge problem. But in the same way that people cut themselves, somebody else over here is, has an eating disorder, or this person over here is eating a lot of tattoos.

And those things are kind of like a little bit more, quote unquote, commonly accepted, but they still are secondary addictions that are being used to feed the primary one of that looking for satisfaction in myself.

So, for you listeners, today's episode, really, for me, was specifically born from a desire to equip parents, you, to discover the core and the peripheral symptoms of a cutter. So you can see, if you try to understand if your child is having this temptation.

However, before we jump into that, Mark, I'm wondering if you'd help us understand, really, the mind of a person. And I think you've done that a little bit, but really kind of broaden this out. Who, the mind of a person who would struggle with this temptation to cause themselves pain.

I work with a lot of cutters, and honestly, I think working with them sometimes is easier than helping their parents understand why they cut in the first place. Sometimes the parents are going, Aaron, I don't get why a person would do that.

So a lot of people struggle with this concept. What would you say to a parent who asks, why would my child even do that? How would you help that parent kind of put themselves into their kid's shoes?

Why Children Cut: Pain, Control, and Misunderstood Hearts

Yeah, you had a great point. It's often the family members who really don't understand why would my kid do this? And with kids who cut, I mean, they are a misunderstood group. Oftentimes, it's how they see themselves.

They see themselves as ignored, appreciated, that kind of thing, by their parents or by friends. And you think about the Bible makes a distinction in our maturity level. When I was a child, I thought as a child, when I'm adult, I think as an adult kind of thing.

So kids don't always deal with things, know how to deal with it on an adult level. And I often think of abuse kids, too, sexual abuse, for example. Kids are kind of thrust into an adult world before their bodies are physically able to deal with.

I mean, maybe in some, we're talking about a seven, eight-year-old, they're not able to have children at that age, but their spiritual understanding, their emotional understanding is like a child. So they don't know how to deal with this stuff that happens to them.

And I think it doesn't have to be that severe with cutting. I think people often think, oh man, this is a very serious mental illness. We need to get them to a psychiatrist fast and do all that. And I think, I mean, it depends on where people are, where they find their child in the progressive state of this.

But I think there's so much that we can do as parents, we can do as friends who come alongside or biblical counselors or pastors or just anyone in the body of Christ. We can sit down and help these cutters who are seeing themselves as ignored or unappreciated, overpowered maybe sometimes, and cutting gives them a chance to feel control.

Sometimes they feel overwhelmed by all the stress in their lives. And I think that's a big thing with kids now, right now is the anxiety. They see all this stuff on Instagram and in social media, and they're seeing a perfect version of everything.

And so they're looking at their own nose and saying, oh man, my nose is too long or too wide or too this, or my hair is this, or I wish I had that pair of shoes or that purse, or for boys, it's similar kinds of things.

And so kids are anxious, they're wanting to strive to be perfect. And that creates the stress, the overwhelming feelings that they have. And then being bullied or degraded by other teenagers, I mean, that's common in the teenage realm, it can happen in other ages, but then just strongly disliking themselves.

So I think that's where the cutter goes, they go to a place where they can control it, and we'll talk about that more in a minute, I'm sure, but that's kind of how they're seeing themselves. And so parents can step in and help.

One thing I do real quick, I mean, with our kids, we went to a counseling training conference, it was open to the whole church, and I took my two youngest kids, we have four. And afterwards, we always try to stop somewhere and just talk about it.

And usually I have to kind of unpack wrong theology or things that I heard that I really don't want my kids to believe if they're not biblical. So we stop and we talk, and I listen to them, and I just ask questions at first.

And then I kind of bring in my agenda, well, when this person said this or said that, this is what the Bible teaches, and I'm not sure that's true. And I try to say it in a way that, this person loves the Lord, they're just, they don't know this yet, they're in the process of learning.

So I try to unpack that for my kids and help them to think and understand more in a more mature adult-like way without making them into adults, that's not the point, but helping them to understand things in a bigger way is what I'm trying to explain.

And so I think with kids, they're just emotional, they don't know how to deal with things that are hurtful and dealing with suffering and all that. And so they go to this place of self-harm and parents wonder what's going on, but this is a place that they can control.

I think that's fantastic insight, and I think it's helpful because we don't all respond to things the same way. Some people are more sensitive to certain things and other people, that doesn't bother them.

And I think that's helpful, and we really do, I think it's so beneficial for us to try to understand what our kids are going, what they're experiencing. I read an article recently that said that so many of the symptoms and the things that kids are doing nowadays are similar to PTSD.

Our kids are experiencing some of the same pressures and stresses that people coming back from war are experiencing. And why they're experiencing that is really, I think, a big part too, not really the emphasis of this show, but for a good part for us to try to understand why is my kid feeling what they're feeling?

Sometimes I don't know that they have a histogram account, I don't know what they're seeing on there. And so we are gonna talk about that later, but I just wanna get your feedback on this too because in my experience with the students I've worked with who attempted to cut, I've found that some of them kind of feel the need to pay penance.

I like the old Catholic view of self-flagellation and whatnot, I've sinned, so I need to hurt myself. I've encountered some people who are like that. Some people, I think, are just trying to distract themselves.

A lot of adults do that, they'll turn to alcohol. For me, when I was younger, I actually, one of my distraction things was sleep. I would go take a nap if I just wanted to escape the stress and the pressure of the situation, and I think some kids use cutting in a similar way.

I also read once in some research that I had picked up after the conference that you and I were at about the fact that really the physical process of harming yourself, if it's not an extreme type of a harm, but it actually has a biological response that can be mildly enjoyable, is that right?

Oh, yeah.

I mean, the body is wired to deal with pain internally, and so when you injure yourself, your body creates these natural pain-relieving mechanisms to relieve that and to bring some kind of desired effect, and I think it's the anticipation of cutting, the excitement, the, man, I can't wait to do this, that's going on, that excitement, physiologically, inside of the body, and then when they do it, again, the pain receptors, the way God's wired our bodies, that relief comes in, and it can be more powerful than any opioid that's on the market today.

Yeah, wow, and that's an important thing for us to acknowledge. I also wanna throw out there that in the same podcast that I mentioned earlier, Truth in Love with Heath Lambert, it was episode 137, Mark was just on that podcast, and he gave a lot more fantastic information about cutting, too, so I would encourage you to listen to that to get some more information, but I think the big key for us is that whether or not we can kind of, quote-unquote, fit into our kids' shoes, we just need to understand that some people are tempted to hurt themselves when they're under pressure.

That's just a reality, whether we comprehend it or not. So we first, like I mentioned earlier, we need to realize that this behavior is motivated by, I think, their greatest addiction, which is addiction to self-satisfaction.

You know, some people self-medicate, some people steal, some people overeat, some people cut. So whether it's thieves or cutters, we as parents know they're worshipers who are worshiping the wrong gods, all right?

But many times, unless we see the cuts, we might not know our children has a problem with self-harm if they can kind of veil it from us. But I guess my question is then, and maybe a lot of people have the same question, well, can I just look for the cuts?

Or will our children do a good job covering them up? I mean, imagine a younger child. It would be a lot easier to see during bath time or something like that if you're helping them in that process, but when they get older, it's harder.

So how hard is it normally? I mean, you saw that girl's arm as she reached your food out to you, but how easy is it to see the cuts sometimes?

Hidden Cuts, Deception, and the Need for Careful Questions

Yeah, that is a great issue. And I think it shows, too, the desire of the cutter to cover it up, to deceive, to lie about it, if you will. I mean, it sounds like, it looks more like manipulation or whatever, but it's a planned deception.

They know that it's wrong. That's my point there is, anytime we're trying to cover something up, and I think kids really do cover it up well. They hide it. They know it's wrong. They have a sense of that guilt.

They might not know why it's wrong, and they might not be Christians yet to know why it's wrong from a biblical perspective, but they know it's wrong. They hide it. They wear long sleeves. They try to cut in places that no one could see.

I remember counseling about a 27-year-old young lady who had done this for over 10 years, and her parents, her husband, no one had any idea because of where she cut. It was always in a place that you couldn't see.

She always did it in private, Proverbs 18, one, the seeking your own desire and doing things in private, and so she hid it so very well, but what brought it out was she used a knife and was really, really in an emotional fit of anger and cut very deeply and just about died due to bleeding out, and they had to rush her to the hospital, and so it all kind of came out, but he or she had been doing this habitually for 12, 13, 14 years, and so yeah, they hide it.

It's difficult to find. It's difficult to know because they'll say, well, I just bumped my head on some, or bumped my arm on something. You know, usually it's not on the head, but I bumped my arm on something, and I did, you know, and they have a planned, deceptive answer.

They're ready with their plan. That's why when the world deals with it as impulsive, there might be an element of it that in an emotional fit of anger or real depression that they act out in a way that looks impulsive, but there's a lot of planning that goes on before, during, and after.

So true. I actually am familiar with that. Did you write about that incident in a book? Because I think I read that some place. Yeah, I read that, and when I saw that, I thought to myself, man, oh man, think about that.

A husband didn't know that his wife was struggling with this for years, and that's why we're doing this episode. We gotta know. We have to have our eyes open. We have to be paying attention. We have to be asking the right questions, looking at the right things, and this is why this is so valuable.

So you might not be able to see the cutting, okay? You might not be able to see the evidence of it, especially if your child is older. You could just ask if they're self-harming, but from my experience, and kind of like Mark alluded to, you know, they may like talking about it to their friends.

They may actually even post pictures of it on Instagram, but unless you, the parent, already knows about the cutting, generally the child isn't gonna open up when asked. Asking is not a bad start. I mean, it does show you care.

If you already have a concern, if you've already noticed some things, at some point, you know, you're gonna have to ask a question. So what are your experiences with that, Mark? You know, whether they're asking out of complete ignorance, I'm not sure, but you know, they might just say to their kid, hey, have you ever been tempted to cut?

Or maybe they say, hey, I've seen this, and I'm kind of concerned. What do you suggest we do when it does finally come time to ask?

Asking About Cutting and Looking for Preoccupation

Yeah, I think parents shouldn't be afraid to ask. I mean, how you ask, I mean, can kind of close the child down. I mean, if you ask in a fit of anger, or where you, you know, or ask in a way that the kid knows, man, this is gonna be bad.

I think just kind of talking about it, maybe even asking about, you know, do you have friends who are really struggling and cutting? What are they cutting for? You know, what's driving them? And have your kids talk about it, you know, in a third person avenue.

I mean, it's a little sneaky, but I think parents need, I think parents need to be wise as serpents, you know, and harmless as doves. And we do need to ask our kids, and sometimes kids are waiting to be asked that specific question, you know?

And that's when they'll answer it, but they're kind of playing a game. And so parents, I don't think, need to be afraid of asking the question, because of the answer they may hear. It may be very discouraging to hear that, or the parent might think, oh no, I've got a child who's mentally ill.

That's not it at all. The child needs to talk, they need counsel. Who better to get it from than their parents, or a biblical counselor, a pastor in the church, somebody like that, who can really encourage the child to think biblically about these issues.

That's so true. And also don't not ask, because you're afraid of possibly introducing these ideas to your kid. You know, like, you know, we talked about this when we've discussed previous episodes, pornography and things, and sexuality.

Some parents don't wanna talk about it, because they don't wanna be the ones to give their kids the ideas. That's likely not going to be the issue. And so if you're asking your kid, hey, you know, have you ever heard of cutting?

Have your friends ever talked about cutting? Don't not ask, because you're concerned that they're gonna hear it first from you. What you're able to do then, is actually lay a foundation for what it is, and how we should think biblically.

Just like Mark was saying, about how he and his kids, after going to a spiritually focused event, they sit down and they debrief. You know, they talk about what was true, and what was false, and things like that.

And we need to be doing that with our kids. So, you know, it may be hard to spot the cuts, and asking may or may not reveal anything, okay? But don't lose hope. I believe there are some things for which we can look, that they may betray that your child has a problem with self-harm.

Again, on episode 114, we discuss that addictions have core symptoms, and peripheral symptoms, okay? The primary addiction we know is self-worship. We know that. The core symptoms are behaviors that point directly to the secondary addiction, okay?

A core symptom that all addictions share is preoccupation. We talked about that last time, for example. If you look at your child's Instagram account, and you see that she's posted a bunch of images, featuring, you know, cutting paraphernalia.

Words, and ideas, and song lyrics that refer to cutting. Images of people with, you know, prominent scars and such. Well then, what you're probably witnessing is a preoccupation with cutting. They may not be doing it, but it's definitely a preoccupation, and it's probably gonna lead in that direction.

And you start to see that what their main struggle is. So, Mark, help us out, you know, as parents, as we're looking for these other types of preoccupations, what can we be looking for that will help us deduce if our child may be having this struggle?

The desire is to remove unpleasant conditions from life. I remember a quote from Princess Diana. You have so much pain inside of yourself, and you just try and hurt yourself on the outside, because you need help.

So, I think that is what they're trying to do, is transfer emotional pain into something that they can control, they think, and they hope, they can control, and they can feel on the outside. So, these peripheral changes often are, you know, getting away, getting alone.

I think of Proverbs 18 .1 that talks about that. So, they might escape from family conversations, and kind of be in a place where they're brooding, or thinking about being bullied that day at school. And they're just afraid to, I think fear's a big thing, too.

And so, they're afraid to tell people about it. They're afraid of not being perfect, or being, you know, something's wrong with me. And again, not knowing how to deal with it, being kind of overwhelmed by that, and anxious.

So, fear is a big thing that expresses itself in these transformational peripheral symptoms,.

As you call it.

And I really like that podcast, or that episode, 114, I thought it was really excellent. I thought it was great information. And that's what parents need to be looking for. You know, are they withdrawing?

And I think as parents, you know, I think about God, the Father, who sent his own son to be with us. I mean, God sent his son to be at our level with us, to enter in. And I think as parents, especially as fathers, we need to enter into our kids' world.

Now, that doesn't mean playing video games all of the time. Although, I do enjoy that, you know, with my kids, or whatever, playing basketball. But entering into their world, and trying to understand them and the pressures that they're under.

Because it's different than when I was a kid. I mean, there were pressures when I was a kid, but they were different. And so, understanding my kids and their struggles, and so forth, I think is important.

And so, yeah, I mean, any of these peripheral symptoms, any of these things that are going on with them, where they are making changes that are significant, withdrawing, or getting in with the wrong crowd.

I think parents, we have to be so careful about the kids that we have our children, you know, be around. I mean, not that there's no perfect kid out there, you know, and I like for certain conflicts and things to arise so that we can try to resolve them biblically, you know, with the kids.

But there are kids that I think are already immersed in a lifestyle of wickedness and addiction, in terms of chemical addictions, and that kind of thing. And so, as parents, we need to lay down the law and make sure our kids understand, hey, you don't need to be around this person or that person, you need to be careful who you're surrounding yourself with, or I really don't want you to be around that person.

Yeah, and I think that kind of exposes two issues that we have. One issue is that sometimes, we're just not paying attention enough. We're not noticing those transformational symptoms, where this kid is making this change, and he's hanging out with a new group, or he's just acting differently, he's spending more time in his room.

Sometimes we just go, oh, he's just in a phase, or that's just what happens when they hit the teen years, and things like that. And I think all of that's really dangerous. I think it's foolish when we parents miss those key things that are going on.

But also, sometimes, too, I think something that happens is that we address the peripheral symptom without realizing that it may be a symptom of something deeper. It's not a core thing. The core thing is something else.

I've met parents who, they address the self-deprecating speech, they address the secretive behavior, but they address it like it's the core issue, like there's no other issue beyond it. They don't realize that it's just a symptom of a deeper issue.

So I think those are two temptations we as parents face when we see these other issues in our kids' lives. We don't realize that A, it's potentially pointing to something much deeper, which ultimately is going to be self-worship, and then B, when we just kind of deal with that surface thing and we move on, or I guess the other side of that is that we just don't see it at all.

And that's, I think, huge issues. But in order to kind of round out our list a little bit more, I think some more things that you parents can be listening and watching for is what is their music promoting?

Man, we've talked a lot on this show about knowing what your kid's music is all about. I really think you need to do that because sometimes they're just filling their minds with these ideas that they never thought of before, and it just kind of becomes cool.

And it becomes cool because their music told them it was cool. Also look for implements. This is an interesting one. I once had a boy who took a knife, but he didn't take the knife to cut himself. He took the knife so that he could sharpen a golf tee.

He found a wooden golf tee, and he took the knife, sharpened the wooden golf tee so that he could use the golf tee to cut himself. I found, and like Mark already alluded to, there's a very systematic, there's oftentimes a very planned-out type of approach to cutting.

It's almost like a worship service in a way. Everything's set up. It's all right where it needs to be. So look for those things. Look for things that kind of seem out of place. Why would there be a sharpened golf tee in your child's room?

Things like that. Also, I think it's really important to see if your children are drawing on themselves. I know it's like second nature. Kids doodle on themselves and whatnot, but I found, I don't know about you, Mark, I found that some people draw on themselves to actually mask that they've been cutting.

They may use a red pen or a dark Sharpie or something like that to kind of cover that up. And like you mentioned earlier, too, the wearing of long clothes. These are all just things I think that we can be looking at to say, hey, my kid, he's wearing long-sleeve shirt and long pants in the middle of summer.

I guess, depending on where you live, that might be normal, but in most places, I think we kind of be like, huh, what's going on with this? So any other things on your list, things that hopefully could stick out to a parent as being something that really should grab their mind and have them ask the next question?

Signs of Preoccupation, Withdrawal, and Risky Influences

Well, you hit on a big one, I think, with music and just thinking about a lot of rap artists promote pill-popping and drug money and all that kind of stuff. So what they're listening to and how they're starting to wear their clothes and their look and the long-sleeve shirts, all that kind of stuff is great.