Abstract
At the start of the 1970s, the number of people recorded as ‘self-poisoning as communication’ is still rising. Typical is a 1972 report from Dunfermline that claims acute ‘poisoning has reached epidemic proportions … [t]he number of poisoned patients increases year by year and there is no evidence that the trend is altering’.1 In the same year, a bleak study issues from Sheffield, entitled ‘Self-Poisoning with Drugs: A Worsening Situation’. This study claims that the rate of self-poisoning in Sheffield has doubled in the last decade and now accounts for almost one in ten medical admissions and one in five emergencies. Studies from Edinburgh, Oxford and Cardiff are cited as nationwide support for these truly alarming statistics.2 By the late 1970s however, it is reported from the Edinburgh RPTC that rates of self-poisoning are falling for men and levelling off for women. Keith Hawton and colleagues in Oxford report five years later that overall ‘the recent epidemic of deliberate self-poisoning may have reached a peak’ around 1973.3 Work on this phenomenon of self-poisoning, parasuicide or overdosing continues throughout the decade; clinicians marvel at the seemingly endless increase, and then wonder at the abrupt levelling-off. There are three major research centres for these studies: in Edinburgh, at the MRC Unit and Ward 3 of the Royal Infirmary of Edinburgh; in Bristol, at the Accident Emergency Department of the Bristol Royal Infirmary; and in Oxford at the John Radcliffe (General) Hospital.
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Notes
A.A.H. Lawson and I. Mitchell, ‘Patients with Acute Poisoning Seen in a General Medical Unit (1960–71)’ British Medical Journal 4, 5833 (1972): 153
A.J. Smith, ‘Self-Poisoning with Drugs: a Worsening Situation’ British Medical Journal 4, 5833 (1972): 157–9
T.A. Holding, D. Buglass, J.C. Duffy and N. Kreitman, ‘Parasuicide in Edinburgh — A Seven-Year Review 1968–1974’ British Journal of Psychiatry 130 (1977): 534;
K. Hawton, J. O’Grady, M. Osborn and D. Cole, ‘Adolescents who Take Overdoses: Their Characteristics, Problems and Contacts with Helping Agencies’ British Journal of Psychiatry 140 (1982): 118–23
S. Chaney, ‘Self-Mutilation and Psychiatry: Impulse, Identity and the Unconscious in British Explanations of Self-Inflicted Injury, c. 1864–1914’ PhD Thesis, University College London (2013)
N. Kessel, ‘Attempted Suicide’ Medical World 97 (1962): 312
H.G. Morgan, Helen Pocock and Susan Pottle, ‘The Urban Distribution of Non-Fatal Deliberate Self-Harm’ British Journal of Psychiatry 126 (1975): 320
N. Kreitman (ed.), Parasuicide London, John Wiley & Sons (1977): 8
See C. Millard, ‘Self-Mutilation: Emergence, Exclusions and Contexts 1967–1976’ MA Thesis, University of York (2007);
C. Millard, ‘Making the Cut: The Production of “Self-harm” in Anglo-Saxon Psychiatry’ History of the Human Sciences 26(2) (2013): 126–50;
B.J. Brickman, ‘“Delicate” Cutters: Gendered Self-mutilation and Attractive Flesh in Medical Discourse’ Body and Society 10(4) (2004): 87–111
M.A. Simpson, ‘Self Mutilation and Suicide’ in Suicidology: Contemporary Developments E.S. Shneidman (ed.) New York, Grune and Stratton (1976): 310
The most cited articles are: H. Graff and R. Mallin, ‘The Syndrome of the Wrist Cutter’ American Journal of Psychiatry 124 (1967): 36–42;
L. Crabtree Jr., ‘A Psychotherapeutic Encounter with a Self-mutilating Patient’ Psychiatry 30 (1967): 91–100;
H. Grunebaum and G. Klerman, ‘Wrist Slashing’ American Journal of Psychiatry 124 (1967): 527–34;
P. Pao, ‘The Syndrome of Delicate Self-cutting’ British Journal of Medical Psychology 42 (1969): 195–205;
J.S. Kafka, ‘The Body as Transitional Object: A Psychoanalytic Study of a Self-mutilating Patient’ British Journal of Medical Psychology 42 (1969): 207–12;
S. Asch, ‘Wrist Scratching as a Symptom of Anhedonia: A Predepressive State’ Psychoanalytic Quarterly 40 (1971): 603–13;
R. Rosenthal, C. Rinzler, R. Wallsch, and E. Klausner, ‘Wrist-cutting syndrome: the meaning of a gesture’ American Journal of Psychiatry 128 (1972): 1363–8
American Psychiatric Association, ‘Non-Suicidal Self-Injury’ Diagnostic and Statistical Manual of Mental Disorders (5th ed.) Washington, D.C., American Psychiatric Association (2013): 803
D. Tantam and N. Huband, Understanding Repeated Self-Injury: A Multidisciplinary Approach Basingstoke, Palgrave Macmillan (2009): 1
L. Fagin, ‘Repeated Self-Injury: Perspective from General Psychiatry’ Advances in Psychiatric Treatment 12 (2006): 193
B. Walsh and P. Rosen, Self-mutilation: Theory, Research and Treatment Guildford, Guildford Press (1988): 32, quoted in
A. Favazza, Bodies Under Siege: Self-Mutilation, Nonsuicidal Self-Injury, and Body Modification in Culture and Psychiatry 3rd ed. Baltimore, Johns Hopkins University Press (2011): 198–9
J. Sutton, Healing the Hurt Within: Understand Self-Injury and Self-Harm, and Heal the Emotional Wounds 3rd ed. Oxford, How To Books (2007): 14
N. Pengelly, B. Ford, P. Blenkiron and S. Reilly, ‘Harm Minimisation after Repeated Self-harm: Development of a Trust Handbook’ Psychiatric Bulletin 32 (2008): 63
Royal College of Psychiatrists, ‘Self-harm, Suicide and Risk: Helping People Who Self-harm’ College Report CR158 (2010) online at: http://www.rcpsych.ac.uk/files/pdfversion/cr158.pdf accessed 30 January 2015: 6
K. Hawton, K.E.A. Saunders and R.C. O’Connor, ‘Self-harm and Suicide in Adolescents’ Lancet 379, 9834 (2012): 2373–4
P.A. Adler and P. Adler, The Tender Cut: Inside the Hidden World of Self-Injury New York, New York University Press (2011);
T. McShane Blades, Blood and Bandages Basingstoke, Palgrave Macmillan (2012);
P. McCormick, Cut London, Collins Flamingo (2009);
C. Rainfield, Scars Lodi, New Jersey, Westside Books (2011)
Shelly A. James, ‘Has Cutting Become Cool? Normalising, Social Influence and Socially Motivated Deliberate Self-Harm in Adolescent Girls’ Doctor of Clinical Psychology Research Project, Massey University, Albany, New Zealand (2013)
S. Chaney, ‘“A Hideous Torture on Himself”: Madness and Self-Mutilation in Victorian Literature’ Journal of Medical Humanities 32 (2011): 280. Some twentieth-century clinical studies deal with self-mutilation by people labelled as ‘subnormal’ or ‘defective’ (what would now be called learning difficulties) characterised by repetitive head-banging or self-biting. There is also significant literature on self-mutilation in people with Lesch-Nyhan or Cornelia De Lange syndromes, which are serious and severely inhibiting chromosomal and genetic conditions. This is significantly different, with only minimal relevance to the emergence of the contemporary self-mutilation stereotypes.
A. Strauss, L. Schatzman, R. Bucher, D. Ehrlich and M. Sabshin, Psychiatric Ideologies and Institutions London, Collier-Macmillan Limited (1964): 12
D. Offer and P. Barglow, ‘Adolescent and Young Adult Self-Mutilation Incidents in a General Psychiatric Hospital’ Archives of General Psychiatry 3 (1960): 194
See A.H. Stanton and M.S. Schwartz, The Mental Hospital London, Tavistock Publications (1954)
M.E. Staub, Madness Is Civilization: When the Diagnosis Was Social, 1948–1980 London, University of Chicago Press (2011)
T.F. Main, ‘The Ailment’ Medical Psychology 30(3) (1957): 129–45
P.D. Moss and C.P. McEvedy, ‘An Epidemic of Overbreathing Among Schoolgirls’ British Medical Journal 2 (1966): 1295–1300;
C.P. McEvedy, A. Griffith and T. Hall, ‘Two School Epidemics’ British Medical Journal 2 (1966): 1300–2
C.P. McEvedy and A.W. Beard, ‘Royal Free Epidemic of 1955: A Reconsideration’ British Medical Journal 1, 5687 (1970): 7–11
For example, K. Skegg, ‘Self-harm’ Lancet 366, 9495 (2005): 1471–83
An article on this subject from the late 1960s argues that ‘we feel that this [prison mutilation] is less a reflection of a personality pattern of turning anger inward than it is a reaction to confinement’. J.L. Claghorn and D.R. Beto ‘Self-Mutilation in a Prison Mental Hospital’ Journal of Social Therapy 13 (1967): 140
D.W. McKerracher, D.R.K. Street and L.J. Segal, ‘A Comparison of the Behaviour Problems Presented by Male and Female Subnormal Offenders’ British Journal of Psychiatry 112 (1966): 891–7;
D.W. McKerracher, T. Loughnane and R.A. Watson ‘Self-Mutilation in Female Psychopaths’ British Journal of Psychiatry 114 (1968): 829–32
F. Graham ‘Probability of Detection and Institutional Vandalism’ British Journal of Criminology 21(4) (1981): 361
The terms ‘psychopath’ and ‘psychopathy’ are broad and loosely defined both in the 1960s and today. Martyn Pickersgill has written of the ‘profound uncertainties and ambivalences [that] are evident even within expert discourse’ on psychopathy. M. Pickersgill, ‘Psyche, Soma, and Science Studies: New Directions in the Sociology of Mental Health and Illness’ Journal of Mental Health 19(4)(2010): 388; see also:
M. Pickersgill, ‘Between Soma and Society: Neuroscience and the Ontology of Psychopathy’ BioSocieties 4 (2009): 45–60
P.C. Matthews ‘Epidemic Self-Injury in an Adolescent Unit’ International Journal of Social Psychiatry 14 (1968): 131
G.A. Kelly, The Psychology of Personal Constructs 2 Vols, New York, Norton (1955)
J. P. Watson, ‘Relationship between a Self-mutilating Patient and her Doctor’ Psychotherapy and Psychosomatics 18 (1970): 67–8
B.R. Ballinger, ‘Minor Self-Injury’ British Journal of Psychiatry 118 (1971): 535
For example, A.R. Gardner and A.J. Gardner, ‘Self-mutilation, Obsessionality and Narcissism’ British Journal of Psychiatry 127 (1975): 127–32;
Alec Roy, ‘Self-Mutilation’ British Journal of Medical Psychology 51 (1978): 201–3
D. Bhugra, Culture and Self Harm: Attempted Suicide in South Asians in London London, Psychology Press (1994)
S.S.A. Waldenberg, ‘Wrist-Cutting: A Psychiatric Enquiry’ MPhil Thesis, University of London, Institute of Psychiatry (1972): 12.
S. Crown and A.H. Crisp, ‘A Short Clinical Diagnostic Self-rating Scale for Psychoneurotic Patients: The Middlesex Hospital Questionnaire (M.H.Q.)’ British Journal of Psychiatry 112 (1966): 917–23;
J. Sandler, ‘Studies in Psychopathology using at Self-Assessment Inventory. I. The Development and Construction of the Inventory’ British Journal of Medical Psychology 27 (1954): 147–52
M.A. Simpson, ‘Phenomenology of Self-Mutilation in a General Hospital Setting’ Canadian Psychiatric Association Journal 20(6) (1975): 429–34;
M.A. Simpson, ‘Self-Mutilation and Suicide’ in Suicidology Contemporary Developments E.S. Schneidman (ed.) (1976): 286–315;
M.A. Simpson, Medical Education: A Critical Approach London, Butterworths (1972);
M.A. Simpson, ‘Self-Mutilation and Borderline Syndrome’ Dynamische Psychiatrie 1 (1977): 42–8
Alec Roy, ‘Self-mutilation’ British Journal of Medical Psychology 51 (1978): 201, 203.
For example, K. Hawton, K. Rodham, E. Evans and R. Weatherall, ‘Deliberate Self Harm in Adolescents: Self Report Survey in Schools in England’ British Medical Journal 325 (2002): 1207–11;
K. Hawton and M. Goldacre, ‘Hospital Admissions for Adverse Effects of Medicinal Agents (Mainly Self-Poisoning) Among Adolescents in the Oxford Region’ British Journal of Psychiatry 141 (1982): 166–70
D. Pallis, A. Langley and D. Birtchnell, ‘Excessive Use of Psychiatric Services by Suicidal Patients’ British Medical Journal 3, 5977 (1975): 216
K. Hawton, ‘Excessive Use of Psychiatric Services’ British Medical Journal 3, 5983 (1975): 595
K. Hawton, ‘Deliberate Self-poisoning and Self-injury in the Psychiatric Hospital’ British Journal of Medical Psychology 51(3) (1978): 257–8
M.D. Enoch and W.H. Trethowan, Uncommon Psychiatric Syndromes 2nd ed. Bristol, John Wright and Sons (1979): 87–8
H.G. Morgan, Death Wishes? The Understanding and Management of Deliberate Self-Harm Chichester, John Wiley and Sons (1979): 115–16
This includes five groups (plus an ‘other’ category): cuts to the wrists or forearms, other cuts, gunshot/drowning/asphyxiation (including hanging), jumping from a height, and jumping in front of a moving vehicle. K. Hawton and J. Catalán, Attempted Suicide 1st ed. Oxford, Oxford University Press (1982): 117
Hawton and Catalán Attempted Suicide 2nd ed. Oxford, Oxford University Press (1987): 16
H.G. Morgan, C.J. Burns-Cox, H. Pocok and Susan Pottle, ‘Deliberate Self-Harm: Clinical and Socio-Economic Characteristics of 368 Patients’ British Journal of Psychiatry 127 (1975): 572
N. Kreitman (ed.), Parasuicide London, John Wiley & Sons (1977): 8
R. Turner and H. Morgan, ‘Patterns of Health Care in Non-fatal Deliberate Self-harm’ Psychological Medicine 9(3) (1979): 488, referring to Morgan et al., ‘Deliberate self-harm’ (1975)
For a recent example, see I. Ciorba, O. Farcus, R. Giger and L. Nisa, ‘Facial Self-mutilation: An Analysis of Published Cases’ Postgraduate Medical Journal 90, 1062 (2014): 191–200
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Millard, C. (2015). Self-Harm as Self-Cutting: Inpatients and Internal Tension. In: A History of Self-Harm in Britain. Mental Health in Historical Perspective. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-137-52962-6_6
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