Thirty-five minutes into the movie The Piano Teacher, there occurs an indelible scene. In a dim bathroom cluttered with drugstore label sprays, lotions, and other feeble concoctions designed to fend off decay, a middle-aged woman in a silk robe briskly zips open her pocketbook and removes a folded slip of paper, which she unfolds to reveal a razor blade. Armed with this instrument, she turns around, slips off her flip flops, opens her robe, and sits on the edge of her bathtub with her legs splayed. She moves resolutely but without authority, with a kind of robotic resolve, as if she were complying rather than presiding, mechanically obeying an inner necessity. The camera displays her in profile. A pink hand mirror rests on a ledge by the tub among bottles of various shapes and sizes. She snatches up the glass and holds it out between her knees with one hand, still gripping the blade in the other. Then Erika Kohut, the piano teacher, leans forward intently, carefully adjusts the mirror until she appears satisfied with her view, moves the knife towards her groin, and slices inside herself several times with strained and steady force. A curtain of flat auburn hair conceals all her face except her lips, which are puckered perhaps in pain, perhaps in concentration. She breathes heavily, apparently exerting great effort. Rivulets of crimson liquid spill out of her and into the porcelain basin. Then the mutilation is halted abruptly by banality. “Erika, dinner is ready!” her aging mother, with whom she lives in a cramped apartment, summons her from the other room. “Coming, Mother!” replies the dutiful daughter while snatching a thick menstrual pad from an open bag beside her and pressing it to the wounds between her legs. It has been reported that at the press screening for The Piano Teacher at the Cannes Film Festival in 2001, members of the audience guffawed at this scene. Their laughter in response to the self-mutilation just witnessed was as sickening as it was unwarranted — significantly more discomfiting than the blood in the bathtub. If the director, Michael Haneke, had intended the mortification to be funny — he does in fact have a profoundly twisted sense of humor — he should not have cast Isabelle Huppert as Erika. Huppert possesses a ferality which somehow does not mitigate her natural sophistication. And in the scene in the bathroom Huppert is feral in precisely the way that a woman’s hatred of her own womanhood is feral. Yes: a woman’s hatred of her own womanhood. It exists, it snarls in our bellies; and Huppert’s peerless performance is among its rare open expressions. She brilliantly communicates in the bathroom scene the gravity of her ferocious behavior. Owing to her marrow-deep conviction, conscious or not, of the significance of that drawn blood, the savagery that Erika Kohut perpetrates against herself is exhilarating. I do not mean to deny that it is also grotesque, revolting, and wrenching. And yet it is at the same time emphatically thrilling in the way that it is always thrilling when a person acts openly upon a perplexing, wounding, and unacknowledged truth. The blood is a shibboleth and the truth that it communicates extends beyond the inner torments of this piano teacher. Her action is symptomatic of the cruel reality that there is a long tradition — longer than most contemporary women know — of womanly self-mortification. Those streams of crimson encapsulate a common and time-honored and baffling compulsion: a woman’s compulsion to attack herself. 
What accounts for this propensity is a mystery, but the evidence for the compulsion is plentiful. Of course, most women, or more women, casually contract or stunt themselves rather than slice and starve themselves. But the slicing and the starving are hardly unheard of, and they are manifestations of the same proclivities, and are emphatically more common in women than men. Women are three to four times more likely to suffer from anorexia and bulimia and to cut than men are. Those numbers are strikingly reminiscent of another grizzly statistic: men are four times more likely to be murdered and to commit murder than women. It would seem that men brutalize one another and women brutalize themselves. (There are holes in such generalizations, of course.) In his learned and compassionate book Cutters, the psychotherapist Steven Levenkron describes these tendencies so well he seems to explain them: In the case of girls, they will absorb the blame for most behaviors directed against them. Whether it’s a natural component inherent to femininity, a sense of physical helplessness, or a combination of both, disorders of self-harm, for the most part, affect girls and women. These include cutting, anorexia, bulimia, and other self-harming behaviors. Males, for the most part, tend to externalize blame and emotional discomfort by acting out on others, from street fights to rapes and homicide… While we see crossovers in both genders, the patterns favor the classic models for aggression. In ordinary places such as locker rooms, sidewalks, and shopping centers, or in moments of intimate confidence, if you have been paying attention, you will have caught glimpses of forearms riddled with slashes of pale pink flesh, or dark red grooves, thick and deep. The character is familiar: the “fucked up” over-achiever; the type-A freak with a 5.00 GPA and a razor blade in her backpack; or a calorie counter pulled up on her iPhone. “Fucked up” is hardly a useful clinical description or a worthy literary appellation, but it is the term that, shamefully, often comes to mind. The reason is that generally we have not bothered to consider her charitably or deeply. We have squandered abundant opportunities to develop compassion for her. To outsiders she seems crazy, even selfish, depriving herself of the sustenance offered her, and forcing her friends and family to agonize over her poor choices. But strictly speaking she has not made choices, and her actions were not catalyzed by mere melodrama. Of all mental illnesses, eating disorders have
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