Our Gemara on Amud Aleph discusses the prohibition of tearing or cutting skin out of grief. The verse states (Devarim 14:1):
“You are children of your God. You shall not gash yourselves or shave the front of your heads because of the dead.”
Tosafos in Yevamos (13b, “Deamar”) asks: If so, how can it be that Rabbi Akiva hit himself until he bled over the death of Rabbi Eliezer (see Sanhedrin 68a)? Tosafos offers two answers: (1) Perhaps only tearing skin by cutting is forbidden, while here he was hitting himself out of grief without using a cutting action, even though he bled. (2) He was injuring himself over the loss of Torah, not specifically the death of Rabbi Eliezer. The prohibition applies only to cutting as part of a mourning ritual, presumably an idolatrous custom that the Torah forbade.
Based on this, Shulchan Aruch codifies the law (YD 180:5) that it is forbidden to cut out of grief over a death or as an idolatrous ritual, but not for another loss. Despite this, many poskim hold that there is still a rabbinic prohibition to cut for any reason (see Shach ibid. and Kitzur 169:2).
We see that cutting oneself out of overwhelming pain is a basic human response, not a new phenomenon. However, in different eras and cultures, mental illness manifests differently based on perceptions, beliefs, and ego defenses. While the response seems somewhat instinctive, it may represent something different psychologically today than in another time. For example, in ancient times, a person might consider himself possessed when overcome with overwhelming urges or intrusive thoughts. Today, a person might experience that as addiction, delusional thoughts, or obsessive thoughts, depending on their severity and behavioral process. The humanity of it has not changed—only the narrative and mythology we tell ourselves. Instead of being overcome by demons, we now speak of chemical imbalances.
In a modern psychological sense, people cut as a way to ground themselves. The physical pain or blood might serve as a distraction from greater psychic pain, prevent dissociation, or assuage guilt through self-flagellation. Dissociation arises as an ego defense to shield a person from overwhelmingly painful memories or feelings. While this is a mental health issue requiring treatment, it is noteworthy that it is part of an ancient human instinct and behavioral pattern.
This issue raises two somewhat contradictory points for consideration. First, it is often difficult for us to place ourselves within the ancient mindset, and even things that appear similar may not be. As inhabitants of the modern world, we can learn to empathize and imagine the psychological conditions under which a person might engage in cutting. This might resemble the ancient practice of cutting out of grief, or it might be something entirely different. Second, our generation tends to overpathologize broad variances in human behavior. A child who can’t sit still, finds lessons boring, too complex, or too lengthy, is often medicated to cope with the curriculum. In another era, such a child would not be expected to sit behind a desk; he might have started an apprenticeship earlier. In my family’s lore, my grandfather was thrown out of cheder at age seven for throwing a desk at the melamed. Zeidy Avraham, who became a painter by trade, produced fine offspring, many of whom became academics. I especially think of my father, who spent over a sixty-year career as a professor of education and served as headmaster and principal of several Jewish institutions. I don’t think Zeidy Avraham would have appreciated being told he had ADD; he was obviously an independent, feisty spirit who new how to take care of himself just fine. That’s not to say that, practically, we shouldn’t give a child every tool needed to compete in an intellectually complex, demanding, and competitive society. But let’s be realistic: the child might not have any disease, and yet, in a competitive school environment, a stimulant might help him concentrate or boost neurotransmitter activity. Why must we call this a disease? As one researcher famously said, “Just because Tylenol works for a headache doesn’t mean you’re suffering from a Tylenol imbalance in your brain.”
Likewise, with cutting, we need not attach deep stigma or pathology to all instances of this behavior. In certain vulnerable populations, inflicting pain through cutting or burning is a sign of extreme psychic distress and possibly a red flag for body image or personal boundary concerns. However, the cutting itself is a behavior, not the disease. If a person is in great distress, they shouldn’t be shamed for cutting — it’s an instinctive way to cope with pain. By reducing the pathology and stigma related to cutting, individuals in distress may be more forthcoming about why they do it, when they do it, and what lies behind it, enabling better, more informed treatment.
Translations Courtesy of Sefaria, except when, sometimes, I disagree with the translation 
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Rabbi Simcha Feuerman, Rabbi Simcha Feuerman, LCSW-R, DHL is a psychotherapist who works with high conflict couples and families. He can be reached via email at simchafeuerman@gmail.com