Disclaimer:  Paramount owns all things Star Trek Voyager.  I don’t.  Only borrowing                 

                     them. Etc. Etc. Etc.

Rating:          NC17.

Summary:     Kathryn reaches breaking point and copes with her inner pain, guilt and

                      loneliness by self-injury.  When Chakotay discovers her secret,  he and

                      the Doctor come together to help her overcome it and get her through.

NOTE:  This story involves the subject of self-injury and for this reason only I have

              given it the NC 17 rating.  I have tried to ensure that the facts contained

              within are as accurate as possible and most have come from people who live

              with this but if any offence is caused, it is not intended and I apologize.  

              There is  no shame involved with this subject.  Sufferers are as sane as you 

              and I.  They just deal with their emotions differently.                          

              See also note at end of story.



Chakotay sat wearily and faced the Medic.  “Doc, talk to me.  Tell me just what the hell is happening here.  What’s going on?  I don’t understanding this…”  The Doctor held up a hand and leaned forward.

“Commander, I’ll try and explain briefly but understand that I’ll have to research this myself.  There’s only so much room in my own memory…  Basically, she’s self harming, inflicting these injuries on herself.”  Chakotay looked shocked.  Hearing the Doctor speak the words confirmed what he had seen but hoped he had misunderstood.

“Why would she do that?  She seems rational, I mean she’s not insane or anything.  She seems in control and runs the ship…  I know she’s seemed… well as if something was wrong but…  Was she trying to kill herself?  What is…”  Once more the Doctor interrupted.

“Commander please.  This has nothing to do with being ‘insane’ or wanting to kill herself.  Those are popular misconceptions.  This is about having found a ‘coping mechanism’, I admit a rather self-destructive one, but a way of coping none the less.  From what I remember of this, they are never trying to kill themselves.  Look, she’s safe for now and I’ll get right onto researching this and I’ll speak to you again in the morning when I know more.  In the meantime, I suggest you try and get some rest yourself.”  Chakotay shook his head in disbelief at what the evening had thrown at him.  The Doctor touching his arm brought his attention back.

“I’m going to have to relieve her of duty, you know that.”  The Medic saw the understanding in the First Officer’s face but also his deep concern.

“Don’t worry Commander, I’ve simply entered that she’s anaemic and needs some rest.  I had to enter that in the logs to explain the use of the blood.  At the moment, that will cover it.  I would however, suggest that you share this with Mr. Tuvok.  You’re going to need his assistance over the coming days and weeks.”  Chakotay nodded, knowing he could trust the Vulcan, especially where their Captain was concerned.  “Speak with him this evening if you can and I’ll meet you both back here in the morning when I should have more answers for you.”  Chakotay nodded slowly and got up.

“Is this down to me?  I haven’t exactly been there for her lately…”  The Doctor shook his head.

“Commander from what I do recall, this has nothing to do with anyone except the person themselves.  As I say, I’ll have more for you in the morning.”  Chakotay nodded again and left, his face a mask of pain.

Chakotay sat in his quarters for almost half an hour studying the carpet and tried to get his mind to cooperate with him.  Finally he placed a call to Voyager’s Security Officer and asked him to come to his quarters.  As usual the Vulcan showed no surprise and simply stated that he would be there presently.  When he arrived, he just sat and waited to hear what his Commanding Officer had to say.

“Tuvok…”  Chakotay tried to organize his thoughts and word everything right.  “What I’m going to say…well I’d like for this to remain in this room for the moment.  I know I’m asking a lot of you, wanting you to leave this out of the logs but…”  Tuvok nodded.

“This has to do with Captain Janeway?”  Chakotay nodded.  “You have my word then.  If it doesn’t concern the safety of this ship and her crew, then I see no need to write it up.”  Chakotay sat down again, his relief showing.

“It only concerns Kathryn herself.”  The Vulcan nodded, not showing any surprise at Chakotay’s use of his Captain’s name.  He sat and listened as Chakotay related the events of the evening and his concerns which had led up to it.  Finally Tuvok  spoke.

“I have heard of this…condition…before.  I believe there are many forms of it.  I recall reading of holy men in various societies flogging themselves and similar cases although they are not exactly related.  Does our Doctor believe he can help the Captain?”  Chakotay looked at the man before him, amazed at his calmness and acceptance and was grateful for it.

“He wants to see us both in the morning.  He wants to research this more himself.”  Tuvok nodded his understanding.

“I suggest you try and get some rest until then.  It is only logical that we have all the information we require at hand before making any decisions.”  Chakotay smiled softly despite the situation. 

“You’re the calm in the storm as usual, Tuvok.”  The Vulcan simply raised an eyebrow, accepting the compliment.

Early the following morning, the two men sat in the Doctor’s small office and listened as the hologram passed on his findings.  Chakotay had checked on Kathryn and saw little change in her, except some colour starting to show on her face from the transfusions. 

“I’ll explain this as simply as I can so please bare with me gentlemen.”  They both nodded but remained silent.  “This condition is hard to explain but I’ll do my best.”  He sat back and activated a padd in his hand.

“Self injury, also referred to as self harm, self abuse or self mutilation, is basically an attempt to deliberately cause harm to one’s own body and the injury is usually severe enough to cause tissue damage, as we’ve seen here.  It is not a conscious attempt at suicide though.  There are three types of self-injury.  The rarest and most extreme form is Major Self Mutilation which results in permanent disfigurement like castration or limb amputation.”  The Doctor looked up briefly and saw the shocked faces before him.

“Another form is Stereo Typic Self Mutilation, mainly consisting of head banging, eyeball pressing and biting.  The third form, which I believe we are probably dealing with here, is Superficial Self Mutilation and this usually involves cutting, burning, hair pulling, bone breaking, hitting, interference with wound healing and basically any method used to harm oneself.”  He lay the padd down and continued.

“It has been reported that many people who self injure and this goes back far into history, but they usually have a history of sexual or physical abuse but that is not always the case and I don’t believe we are dealing with that here.  Some come from broken homes or have had emotionally absent parents, again I don’t believe that applies here.  In short, there are many factors that could cause someone to hurt themselves as a way to cope and that is the bottom line here.  It’s about coping, blocking out, releasing built up feelings and emotions.  People who self injure are usually perfectionists, perhaps unable to handle intense feelings or are denying them and they often can’t express their emotions.  Understand that when I say ‘can’t,  I mean that they either cannot show them because they are physically unable to or because their situation will not allow it.  In our case, I believe the latter applies.  The Captain can’t be seen to be weak or show emotion.  At least that’s how she sees it.  I believe she’s doing this as a way to show that emotion and those feelings and also as a way to punish herself.”  Chakotay leaned forward.

“What the hell would she be punishing herself for?”  The Doctor held his hand up.

“Please.  I don’t think it’s any big secret that the Captain blames herself for us being here.”  Tuvok nodded.

“Guilt travels with her constantly.”  The Doctor agreed.

“That fits with all this.  They punish themselves for many things, sometimes just to feel alive.  This is usually done to relieve intense feelings such as anger, sadness, loneliness, shame, guilt and emotional pain, most of which applies to the Captain.  They cut and bleed themselves in an attempt to try and relieve all the emotions they are feeling internally.  External pain overrides the internal or perhaps they feel nothing on the inside and this way, feeling pain externally is better than feeling nothing.  They can feel so numb that seeing their own blood helps them feel alive because they feel so dead on the inside.  Dealing with physical pain is far easier than dealing with emotional pain.  Afterwards, they are usually left with a peaceful and calm feeling.  Since those feelings are only temporary, they will continue to self injure until they deal with the underlying issues and find healthier ways to cope.”  Chakotay sat back in total shock.

“I can’t believe this…I just…  Can we help?  What can we do now?  How…”  Once more the Doctor silenced him.

“It’s very difficult for someone with this to ask for help, to admit that they are doing this at all, mainly because they feel shame and guilt about it.  Of course in this case, it’s now out in the open.  She’s going to have to be taught that there is no shame in this, that it’s all right for her to ask for help and accept it.  Not easy I know, but that’s what has to happen.  She has to want to stop also and we have to give her a reason to do that.  At the end of the day, she must know that she has to stop.  She also has to understand that she is not insane, crazy or evil or whatever other term she will use.  People who do this are in fact very normal and sane and just have a lot of emotional pain.  They do this just to cope because they may never have learned any other way to do that and so we have to teach them other ways.  They often suppress their emotions and then this arises, no pun intended Mr. Tuvok.”  The Vulcan nodded his understanding.

“I discovered during my research that 97% of people who do this are women and around a thousand in every hundred thousand will exhibit some form of self harm.  They are often depressed and in a lot of cases there are eating disorders involved.”  Chakotay leaned in.

“You think she also has an eating disorder?  She’s so thin…”  The Doctor cut in.

“I can’t say at this moment in time but I don’t think so.  I believe her weight loss and not eating is mainly self-neglect and not caring.  This is a fairly recent problem with the Captain, the last two months or so…”  Chakotay cut back in.

“How do you know that?  Can you tell from the scars?  Wouldn’t previous ones have healed themselves by now?”  The Doctor shook his head.

“I know because two months ago is the last time I saw her for medical reasons.  She’d broken a glass in her bathroom and slipped with it in her hand.  She fell on some of the glass and cut her arm.  She came to me immediately.  I examined her arm closely and I would have seen any evidence of other wounds.  I believe she experienced something that night which stayed with her and later on, tried to recreate it.  The seeds were probably sown at that time and it became a place she visited again and when the same feelings came, a pattern established itself.  We’re lucky in the sense that this is so recent.  This usually affects females in their late twenties or early thirties who have been doing this since their teens, in some cases as young as eight years old.  They are almost always intelligent women, well educated, from good homes and backgrounds.  I believe that as women are often socialized to internalise anger, this is the reason why it shows in the female so much.  Men are socialized to externalise their anger, fighting, sports like boxing and so on.  You also have to look at the Captain and see that in her position she has this appearance to maintain, the cool and calm leader, in total command and control.”  The Doctor leaned back in his chair.

“72% of self injuries involve cutting like this.  The bleeding is rarer but is also about release.  Understand that bleeding was at one time used as a medical treatment.  An alarming one third of patients however, expect to be dead within five years.”  Chakotay jumped up.  “Commander please sit down.”  He did.

“Look, I know all this is difficult to take in.  Why anyone would do this is almost impossible for you to understand but you just have to accept that she has done this because she was faced with strong emotions and overwhelming situations alongside her guilt.  This was her way to cope and while she would feel guilty or angry, even disgusted at her actions afterwards, it wouldn’t be the oppressive feelings which she had had before she cut herself.  Basically it calms the body and this is what she needed most.”  Chakotay rubbed his hands over his face.

“Why didn’t I see this…notice it sooner…?”  The Doctor smiled sadly.

“Because she hid it well.  We’re lucky here because some sufferers carry on for years before anything is discovered.  It’s also easier in this day and age.  In former times, injuries and scars were a lot harder to hide.  She had a dermal regenerator but thankfully she wasn’t skilled enough with it.  This could have gone unnoticed for a long time.  People like this become masters at hiding it.  Also Commander, why would you even consider it or think to look for this?  Mind you, I have no idea how she planned to pass her physical although I’d say she hadn’t thought of that.  Gentlemen, you have to understand that this is an addiction.  Someone can literally become dependent on the ‘rush’ if you like, which they get from cutting and bleeding themselves.  It becomes a habit that must be broken and she must be made to understand that while this gives her temporary relief, it can do nothing but severe damage in the long run.  She probably even had a ritual involved with this, laying out what she needed.  I’m hoping in this case that the addiction hasn’t been too ingrained, that it’s easy to break at this stage.” 

Chakotay was still blaming himself.  “I should have noticed before now how thin she was becoming.  I should have seen…”  The Doctor was having none of it.

“Commander, I checked her quarters and I noticed the clothes she had taken off.  There were quite literally several layers which would have hidden her frame quite well.  If you had worn what she was probably wearing every day, you’d have most likely suffered heat stroke.  In her condition, I imagine the extra clothing would have been welcome.  She’d have had a hard time controlling her body heat, would probably have felt cold most of the time.  Look, bottom line here, this has probably been building up for some time, these feelings, no way to express herself, internal pain, depression, guilt, all of it.  It’s possible she was close to a complete emotional breakdown and instead found this way to deal with it.”  He sighed.

“You also have to look at her past and I checked through her personal files and I really had no choice on this.  We have a woman here, the daughter of a top Admiral who followed in her father’s footsteps so a lot was expected of her.  I imagine earning her father’s approval was very important to her.  When she entered Starfleet, she had some big shoes to fill.  She is as we know a perfectionist anyway and I imagine a great deal was expected of her, by her family, by Starfleet and living up to that would have been difficult.  In a way, she’s still doing that, living up to what she believes this crew expects of her.  When her father died along with her fiancé, again guilt in her life, she pushed herself on more.  I understand that she was the protégé of Admiral Paris and from what I can see with our Mr. Paris and the way he thinks he failed the man, well if the Admiral himself felt that, he would have transferred that expectation from his son to the Captain.  Once more, having to live up to the almost impossible.  With us being here now, she feels guilty for that and blames herself most likely.  She sees it as her sole responsibility to get this crew home and can’t fail them.  She tries to be what they expect of her and in her eyes, that probably means not being seen to be weak or herself or even human.”  Chakotay rolled his eyes.

“Doc, she knows that’s not the way it is.  This crew only want her to be happy…”  The Doctor smiled.

“Commander, listen to me.  I didn’t say it was that way.  I said it was the way she sees it.  She was probably as I say, close to breaking point and this accident happened and opened a door to her, a way out, a release.  I don’t have all the answers and only she can tell us how she feels.  All we can hope for is a solution to this.”  The Doctor looked at both men in turn.

“I’ve kept this out of the official logs and I’d prefer to keep it from the crew.”  Both men nodded their agreement.  “I’ve entered in a recommendation for a leave of absence, citing anaemia and overwork etc.  I take it I have your full cooperation with this.”  They both nodded again.  “Good, because she is going to have enough to face as it is.  I suggest that you take command for the present with Mr. Tuvok backing you up.”  He looked at Chakotay who nodded his head, Tuvok silently agreeing also.  “I’m going to keep her sedated for a few more days and at that time, I’d like you to take over basic care Commander.”  Chakotay’s head shot up.

“Doctor, I know nothing of this.  I’d only fail her and what if she doesn’t want…”  The Doctor threw his eyes up.

“You two are closer to her than anyone else on this ship, especially you Commander.  You also have more experience of counselling than anyone else.  Take these few days to read up and learn how to handle this, a kind of crash course.  I know it’s not much but it’s all we have.  I’ll tutor you as best I can.  I think she will also benefit with some help from you, Mr. Tuvok.  Meditation techniques, anything like that.  We are all in the dark here and we have to give light to each other.  What’s important now is that we all know that none of us is to blame for this.  We concentrate on getting her through this and nothing else and keeping it as quiet as we can.  Are we all in agreement gentlemen.”  Chakotay looked at Tuvok and the Vulcan nodded.

“I agree completely.  I’ll take over command when the Commander is taking care of the Captain.  We will work this out.”  Chakotay smiled his thanks at the Vulcan.

“Thanks Tuvok.  You’re a good friend to her.”  Tuvok merely nodded.

Over the next three days, Chakotay spent every spare minute studying and reading everything he could lay his hands on and the Doctor schooled him in between.

“First off, don’t avoid the subject with her.  Let her know that it’s perfectly all right to talk about this but try and follow her lead.  Let her know you have no aversion to speaking of this but she must also know that you respect her space.”  Chakotay nodded, making notes.

“You will have to make the initial approach.  Let her know you know what’s been happening and ask her to help you understand.  It is vital that she knows you will never judge her over this.  You must be available constantly for her.  If she needs to cut herself, let her know that you can’t see her do this because you care too much to see her hurt herself but let her know that you won’t stop caring if she does it.”  The Doctor smiled softly and Chakotay looked puzzled at him.

“Sorry Commander, this one is just…  I’m quoting here now so don’t think…  You should make it clear from your behaviour that the person doesn’t need to injure themselves to get displays of love and affection from you.  Be free with loving and caring gestures even if they aren’t returned.  Don’t withdraw your love.  The way to avoid reinforcing self injury behaviour is to be consistently caring so that taking care of the person after an injury is seen as nothing special or extraordinary.”  Chakotay smiled too now.

“All right, I get it, a perk of the job.”  They both smiled at this and the Doctor read on.

“You need to provide distractions.  Get her talking by all means and the more she opens up the better.  As I said before, I’m hoping this is the early stages or that it’s not a severe case and we can pull her back quickly by providing what she needs in her life.  I’d be more worried if this had been going on for years.  However, if she feels the need to cut or bleed, go to the holodeck, play games, read to her, talk about other things, anything at all.    She can learn about deep breathing exercises, relaxation techniques, probably from Mr. Tuvok and it’s best if she’s not alone very much.  A hot bath, listening to music, other good ways to relax.  I’d also encourage her to write about how she feels, in a journal or somewhere and taking up a sport or something later on would be good.  It’ll teach her ways to relieve her tension in a positive manner.  If she’s depressed, talk to her.  You can’t cajole her out of it or ignore it but you can acknowledge how she feels and still do something distracting.”  Chakotay nodded, feeling he’d never remember all this.

“If she does feel the need to hurt herself, keep a supply of ice near by, preferably made from red dye.”  Chakotay looked at the hologram as if his program had just malfunctioned.  The Medic just smiled.

“Let me explain.  Holding ice in the hand and squeezing it can be painful but it won’t injure.  Placing red ice on the arm or area she wants to cut in…well it melts and runs off, looking like blood, or an elastic band around the wrist which can be snapped against the skin or even using red ink on herself to make marks.  Let her smash up the holodeck, slash at cushions or other object with her blade.  Commander, these are just tools, help aids if you like.  What you don’t do is hide every sharp object or take her replicator off line.  It would only encourage her to use alternative methods.  What you also can’t do is ever lose your temper with her or let her see that this makes you angry, even when you feel it.  Let her know her removal from duty is temporary until she gets better.  Take her flowers, show you care.”  Chakotay smiled again at this.

“She’d hit me with them.”  The Doctor’s face remained serious.

“I’m not so sure about that.  Commander, she’s one lonely woman even when she doesn’t have to be.  She needs to be trained into having people in her life, into letting them close to her.  Personally I think…  Commander, I prescribe you for the Captain’s treatment.”  Chakotay laughed out loud at this.

“Commander, I’m actually quite serious.  In basic form it’s like this.  There are areas of the Captain’s life, holes there if you like, these gaps where she has no one and other spaces filled with the wrong things, her guilt for example.  She cuts and bleeds herself to feel something if there’s nothing there or to feel something which will replace that inner pain.  We have to re-educate her and fill in those gaps.  Remove the causes of the problem and the problem won’t be there to be dealt with.”  Chakotay stood and paced slowly.

“Do you really think all this will work?”  The Doctor looked up him.

“I hope so and yes I believe so too.  Our first problem is going to be her reaction when she wakes.  I’d prefer to let you handle that.  She’s going to be embarrassed and ashamed but your matter of fact manner will make all the difference.  Let her know there’s nothing to be ashamed of, that this is a problem which can be dealt with and most importantly, that you feel no differently about her because of it.”  Chakotay closed his eyes, running through it all in his mind.  “Let her know that you’ll be staying with her full time when I release her to her quarters, that I insisted she remain under your care but that this is to help her and not because we don’t trust her.  It’s also vital that she understand that you can separate who she is from what she’s done and that you care about her independently of this, outside of it.  She has to know there’s no shame in this and that you’re there for her unconditionally.  She needs to know that you love her.”  Chakotay sat heavily.

“I should tell her that?”  The Doctor patted his arm.

“Maybe not in words and straight away but in everything you do.  Anyway, if you think about it, would it really be such a surprise to her?  If everyone else knows, isn’t it logical that she would also know?  The fact that nothing has happened between you…well there’s time now.  She needs you and she needs to fill her life with friends and learn that it’s all right to drop the mask and still have everyone’s respect.  I also for the record, believe she loves you too.  I may be just a program but the eyes work and I can process information, actually think for myself if you understand what I mean.”  Chakotay looked at him.

“I don’t know Doc.  I know I love her but…I hope you’re right.  I always thought she didn’t want a relationship between us because she didn’t feel love for me or even close to it.  Maybe she was just afraid or…I don’t know.  I guess we’ll see.”  The Doctor stood and smiled.

“Well, I’ll let her waken slowly.  I’ll administer the last sedative tonight and let her come round slowly in the morning and I’ll release her to your care by early afternoon.”  Chakotay thanked the Doctor and left.  He spent the rest of the evening in Kathryn’s quarters, clearing up and preparing them for her arrival home the next day.

Voyager’s First Officer reported to sickbay the following morning, having met with Tuvok and ensured that all was under control.  The Doctor approached him as he entered.

“She should wake within the next ten to fifteen minutes.  I’ve left the privacy screen in place and I’ve put a chair beside her for you.  Just take your time with her and reassure her.  I’ll be in my office if you need me.”  Chakotay sucked in a deep breath and nodded.

“Thanks Doc, I’ll do my best…”  The Medic patted his arm and left him.

Chakotay walked behind the screen and studied the woman lying on the bed before him.  He saw how much more colour she had to her face and she didn’t look quite as thin.  He knew she’d gained a little weight while under the Doctor’s care and that her anaemia was no longer a problem.  He sat down and picked up her hand, turning her arm towards him.  Running a finger along the soft skin, he could find no trace of any scarring and smiled softly to himself when he thought of the good work the Doctor had achieved.  He only hoped he could do as well.  He sat back, still holding her hand and waited.