Why a Spoon, Cousin?

The shrink wasn't happy to hear that the urge to hurt never really goes away and becomes quite intense rather often. He was glad that I haven't been doing anything about it, but said that it would be better if they weren't there. Tell me something I don't know, Doc. At any rate, he gave me homework for the week. During the times when they get so very strong, I am supposed to write down what thoughts and feelings are associated with it. Today has been a rather bad day and I am drowning in them right now so here goes...

Plain and simple, I hate myself. Everything I am and everything I do... So many things that I've done. I can't take them back. I can't make them go away. Pictures and sounds and stories seem to linger in the background of my mind and they won't go away. And then I think back on the day and all the ways that I screwed up, that I hurt people. I hurt them and I want to hurt me. Maybe if the blood drains from me, it will drain away the evil. If I burn away the skin, will it count as credit for time served in hell? All the pain I give to others I should be feeling for myself. All sins of my past should be laid bare on my skin for everyone to see.

These are the thoughts that circle through my mind. Endless repetitions of my past and my present swarming about my head, telling me I should pay for all that I've done. Mocking me for everything that I don't know how to do right and all the things that I know and didn't do anyway. Writing them down seems to make them more intense as if by giving them words I am making them more than someone else's memories.

Is this what he wants me to write down? Is he going to ask me what I wrote? Does he want to know this stuff? Is he going to ask for more details? Oh god - it hurts!

"Why a spoon, cousin?"
"Because it's dull. It'll hurt more!"
(Robin Hood Prince of Thieves)