Caroline Kettlewell survived twenty years of cutting herself with razor blades, glass and once with the saw attachment of her Swiss Army knife. What drove her to do this to herself? What dark secret lurked in her background, threatening her happiness with its shadowy fingers coldly caressing her?

Nothing much, really.

That's the truly scary part of Skin Game. The average upbringing, the feeling of not quite fitting in, the free-flowing anxiety over growing up--there are millions of these stories out there. Fortunately, they don't all end up with gouged and torn skin and blood smeared on bathroom mirrors.

Ms. Kettlewell tells her story in a frank and forthright manner, observing herself and her life situations with a distance that often seems as if she is writing about a character in a novel rather than chronicling her own pain. Her writing is crisp and clear, and it shows a strong sense of humor.

It would have been easy for a lesser writer to turn this book into overly melodramatic, flesh-ripping-disease-movie-of-the-week material. Instead, in Ms. Kettlewell's deft hands, we can easily see that even seemingly average lives often mask a darker side.

Will this book save some poor tortured souls? That's hard to say. As Ms. Kettlewell points out, if a cutter makes it to thirty, she (cutters tend to be overwhelmingly female) has usually made some peace with herself. (Cutting also brings with it other symptoms--a full sixty percent of cutters suffer some form of eating disorder, and that is often more dangerous.)

It's highly unlikely that this book will climb bestseller lists or be the book of choice for that trip to the beach. But it's a vivid look inside the mind of someone fighting hard to stay on top of an increasingly difficult world.