Self-harm, whether for religious, ritual or medical reasons, has been performed “since the earliest times” (Menninger, 1938). Yet, it is wrongly thought to be a recent behaviour and only started to be extensively researched in the late 19th century. As explained by Sarah Chaney, “Although self-injurious acts had been carried out and described previously in medical and religious contexts, the late 19th century was the first time that diverse acts were combined into one overall model. From this, the conclusion was drawn that self-injury might have one overarching meaning that could be uncovered.” Despite not being named as such at the time, the idea of non-suicidal self-injury (NSSI) started to be conceptualized and some motives were correctly understood by psychoanalysts. We define NSSI as “a self-aggressive, intentional and repetitive activity, performed without deliberate suicidal, aesthetic or sexual wish, and that is in no way socially accepted” (Trybou, Brossard, & Kédia, 2018). The late 19th and early 20th centuries played a fundamental role in today’s perception of self-harm, both in our understanding of this behaviour and in the spreading of stubborn prejudices.
Before the late 1870s, self-harm behaviors were already described by anthropologists and doctors. Methods were diverse, according to Channing (1878), “[b]urning, scalding, depillation, emasculation are found to be the favorite methods”. Motives were diverse as well, such as religious, ritual, social or psychotic. One early depiction of self-harm can be read in the Bible as a man, said to be possessed but now supposed by some to be psychotic, hurts himself on purpose: “Night and day among the tombs and on the mountains he was always crying out and cutting himself with stones.” (Mark 5:5). Self-harm was often associated to madness (Chaney, 2017c) and a great number of cases described in the late 19th century were extreme forms of self-mutilation such as self-castration, despite Chaney finding no evidence of self-castration being an actual relatively spread phenomenon (Chaney, 2017a).
In the 1870s, malingering and manipulation were added to the possible interpretations of self-harm. The purpose of malingering could be financial gain or avoiding work – which were mainly seen as the motives of men or working-class women – or attention-seeking and a need for sympathy which was mainly considered female, especially young unmarried middle-class women. (Chaney, 2017b). Therefore, gender stereotypes influenced the perception of self-harm. Women were seen as manipulative and hysterical. For example the term “needle-girls” was defined as “the habit sometimes seen in hysteric persons of piercing their flesh with numerous needles” (Gould & Pyle, 1896). Therefore, despite the existence of a few similar cases committed by men, this behavior has been characterized as a female one caused by hysteria. Such an assumption could be explained by the fact that malingering by men and working-class women seemed more easily understandable by doctors. “Distinguished from patients where the reason for self-inflicted injury was considered obvious – evasion of duty or financial gain – these women ‘assume their maladies without any ostensible object in sight, and often to the destruction, apparently, of their social happiness’” (Chaney, 2019). The case of Helen Miller (Channing, 1878) is another example of the way female self-harm was considered. Channing tells about Helen Miller, a woman who was hospitalized after simulating hematemesis. She then repeatedly hurt herself on purpose by cutting her arms and inserting articles such as pieces of glass and splinters in the wounds. Helen Miller was described as being “very hysterical” and Channing writes that “Mrs. Miller sometimes attempted simulation”.
During World War I, some soldiers injured themselves in order not to have to fight. As Europe was more affected by the war than the United States, the association of self-harm with malingering became more persistent there and European studies focused on medico-legal topics such as distinction between simulators and actual ill self-harmers (Trybou, Brossard, & Kédia, 2018). This could explain why NSSI is still relatively unknown by the public in Europe. Meanwhile research about self-harm greatly developed in the United States. Psychoanalysis criticized the malingering interpretation of some self-harm behaviors. “For a long time there was not a very clear distinction in the minds of physicians between malingerers and neurotics, and perhaps there are still those who think of neurotics as deliberate fakers.” (Menninger, 1938). Basing his interpretation on the psychoanalysis concept of the unconscious, Menninger acknowledges the existence of malingering but interprets it as both a tool to obtain a gain (whether sympathy, attention, money, embarrassment or annoyance of the physicians…) but also a self-punishment for such a behavior. Although prejudice about NSSI persists today and it is still often seen as attention-seeking, psychoanalysis played a fundamental role in the better understanding of NSSI.
Indeed, despite being flawed, the psychoanalyst interpretation of self-harm greatly influenced our understanding of the behaviour and was a first step to conceptualizing NSSI as we define it today. Until then, cases of self-harm discussed in medical texts were often extreme forms of self-mutilation such as self-castration or self-enucleation. “[U]ntil recently considered highly pathological [self-harming behavior] is becoming a norm” (Burešová, 2016). Although it has already been done before to some extent, Menninger, in Man against Himself (1938), clearly classifies different forms of self-harm behaviors under one specific category named “focal suicide” and explains that “it is the nature of the act rather than its degree of seriousness which determines its classification”. Menninger includes in this category self-mutilation, malingering, compulsive polysurgery (the addiction to surgical operations), some unconsciously purposive accidents and sexual impotence. The degree of unconsciousness varies between these categories but Menninger’s interpretation of each form of focal-suicide is overall the same. In order not to stray from our main topic, that is NSSI, I shall focus on self-mutilation only.
Menninger defines focal-suicide as “localized self-destruction”, explaining that it is a form of suicide committed on a part of the body in order not to commit total suicide.
Thus, psychoanalysts understood that self-harm can be a coping mechanism, a “bargain” as Menninger calls it, to uneasiness. “Physical pain distracted her attention and was a means of escaping such distress” as Emerson explains about a specific case (Emerson, 1913). “[T]he understanding of self-harm as evidence of inner psychological turmoil is still widely held in the Western world today” explains Sarah Chaney (2018). Self-harm is finally understood as not only an attempt to hurt oneself but also an attempt at self-healing.
Therefore, the psychoanalyst interpretation of self-harm is relatively close to today’s one of NSSI. However, it is also flawed. While it can be one motive of NSSI, psychoanalysts saw self-harm as both a form of self-punishment and self-healing. Their interpretation of self-harm was centered around the idea that self-harmers felt guilty – usually for sexual but also sometimes for aggressive cravings – and had to punish themselves for these and in the same time be allowed to further indulge themselves by the very punishment. Menninger also notes that the choice of the body part to harm is never random and represents – either directly or symbolically – the guilty behavior. For example, he mentions the case of a depressed man who murdered his baby and who then cut the arm with which he killed the daughter. In other cases as mentioned in Anomalies and Curiosities of Medicine (Gould & Pyle, 1896) and by Menninger, the genitals, or a symbolic substitute, are mutilated as a punishment for sexuality, following the Biblical command “If thy right eye offends thee, cut it off”. Moreover, self-harm was often seen as a substitution to masturbation and, according to Menninger, “the prototype of all self-mutilation is self-castration”. “The sacrifice of the genital or its substitute appears to satisfy certain erotic and aggressive cravings and at the same time to gratify the need for self-punishment by a self-inflicted penalty”. Therefore, psychoanalysts thought self-harm often had an erotic or aggressive function in addition to being a form of self-punishment and of self-healing. Emerson’s depiction and analysis of the self-mutilative behavior of Miss A is very well representative of the psychoanalyst interpretation of self-harm. He writes that “in inflicting pain she satisfied her aggressive masculine impulses” and that she had “strong sadistic impulses” but also that self-harm brought her mental relief with pain distracting her from her distress and “sexual relief through symbolical masturbation” (Emerson, 1913). This supposed sexual function of self-harm can also be found in the case of Helen Miller, as Channing writes that “[s]trange as it seems, she apparently experience actual erotic pleasure from the probings she was subjected to” (Channing, 1878). Therefore even if its interpretation of self-harm as a behavior related to sexual cravings and self-castration has now been contradicted, psychoanalysis deeply impacted our understanding of NSSI by interpreting it as a coping mechanism to avoid suicide.
To conclude, as Sarah Chaney points out, the representation of self-harm in the 19th century testifies to the standards and fears of this time. For example, the unjustified obsession with self-castration in the late nineteenth century “says much more about wider cultural fears. The same period saw rapidly increasing concern over male sexual desire, bound up with contemporary debate over the perceived perils of masturbation, increased attention to homosexuality and changes to the male role within the home and family.” (Chaney, 2017c). The difference of interpretation between female and male self-harm also testifies to the stereotypes and gender roles of this era. Finally, although it has not been discussed in this article, some studies about self-harm reveals the western sense of superiority and lack of understanding of other cultures at the time. For instance, in Anomalies and Curiosities of Medicine (Gould & Pyle, 1896), the authors explain in a section about religious and ceremonial self-mutilations that “outside of a few minor customs still prevalent among our own people we must to-day look to the savage tribes for the perpetuation of such practices”. Menninger goes one step further by writing that “[i]n a sense, what we call insanity is simply a regression to the savage state in which one does not have to consider these restrictions”. Yet, we should not be overly judgmental, for such thoughts were the norm at the time and should not make us forget the great achievements made by some researchers and psychoanalysts, and instead, as Chaney suggests, regard these false assumptions as the opportunity to look with hindsight at our own interpretation of self-harm.
Burešová, I. (2016, April). Self-Harm Classification System Development – Theoretical Study. Review of Social Sciences, pp. 13-20.
Chaney, S. (2017a, May 5). The history of self-harm: An interview with Sarah Chaney. Retrieved from The Historian: https://projects.history.qmul.ac.uk/thehistorian/2017/05/05/the-history-of-self-harm-an-interview-with-sarah-chaney/
Chaney, S. (2017b, March 6). The Victorians are to blame for assumptions that self-harm is just attention-seeking. Retrieved from The Conversation: https://theconversation.com/the-victorians-are-to-blame-for-assumptions-that-self-harm-is-just-attention-seeking-72680
Chaney, S. (2017c, august 15). Why Should We Care What the Victorians Thought of Self-Harm? Retrieved from Psychology Today: https://www.psychologytoday.com/us/blog/the-history-self-harm/201708/why-should-we-care-what-the-victorians-thought-self-harm
Chaney, S. (2018, January 16). How 1930s Psychoanalysts Thought Self-Harm Explained War. Retrieved from Psychology Today: https://www.psychologytoday.com/us/blog/the-history-self-harm/201801/how-1930s-psychoanalysts-thought-self-harm-explained-war
Chaney, S. (2019, November). Needle girls and motiveless malingerers. The Psychologist, pp. 66-69.
Channing, W. (1878, January). Case of Helen Miller. American Journal of Insanity.
Emerson, L. (1913). The Case of Miss A. Psychoanalytic Review, pp. 41-54.
Gould, G. M., & Pyle, W. L. (1896). Anomalies and Curiosities of Medicine.
Menninger, K. A. (1938). Man Against Himself. Harvest Book.
Trybou, V., Brossard, B., & Kédia, M. (2018). Automutilations: Comprendre et soigner. Odile Jacob.