A History of Self-Harm in Great Britain
Annotated Bibliography
Millard C. A History of Self-Harm in Britain: A Fenology of Cutting and Overdosing. Basingstoke (UK): Palgrave Macmillan; 2015.
S. Millard’s book analyses of set of multi-layered shift that occurred in the post war period around self harm care, including: the (de)construction of the welfare state, the conceptions and morphology of “self harm,” the social- and chemical-models, and the neoliberal turn. Indeed, he makes a convincing argument that the history of the neoliberal turn, at least in terms of its ideological apparatus, can be understood through shifting standards in self harm. See especially the conclusion’s description of the ideological Triangle of “biomedicine,” “neoliberalism,” and “DSH-as-affective-regulation.”
R. Though a fascinating intervention with respect for the need for a socially enmeshed model of the patient, Millard’s text is a paradigmatic example of the failed Marxist break with atomized liberal subject, second only in my research to Fisher’s. It is also worth noting that, like modes of production and hegemony generally, the neoliberal shift in understanding has come unevenly to different regions and individuals. Indeed, my own experience and that reflected in Hadfield’s study suggests that neoliberal insights of endorphic-regulation and the self-policing patient still feel revolutionary and emancipatory precisely to those who remain enmeshed in a model of self-harm which seems to have barely progressed from the unintelligible, containment-centric notion of madness described in Madness and Civilization chapter 3, “The Insane” Foucualt.
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Millard
theory as such
“the ways in which we make sense of our worlds, the categories and concepts that are available to understand human behavior (such as self cutting) resonate and correspond to larger political constellations 2-3
presentism 24
law and morality: the Hard-Devlin Debates
empty center — “distress” as an agreeably vague term 124 , 129-
good articulation--maybe quote in bulk at the beginning of Millard section
“this move from socially embedded to internally self-regulating self-harm has particular salience given the political fracturing of consensus around welfare and the ascendancy of a neo-liberal rhetoric of self-reliance” 155
history of self harm generally (stages and transitions)
three phases: uncomplicated wish to die, pathological communication, internal regulation 2
shifting sites: (millard emphasizes location) work houses and hospitals; later general hospitals increase in the 50s, critical but undercovered prior to Millard in the asylum to community model in england and, to a lesser extent, the US 21-22
ideas of communication are not banished wholecloth, but “become bound up in negative stereotypes about ‘attention seeking’ behavior, which is seen as unhelpful by many express on self-harm.” 23
religious self harm, victorian cases 24
victorian self mutilation 41
hysterical communication/manipulation in hopkins, women 59
stengel and appeal-theory vs Batchelor’s and Napier’s broken home theory 92
the politics of appeal, spread, malignering 97
physical injury into social disturbance (transubstantiation) 99
legalization of suicide: philosophical, political-personal, and jurisprudencial 105-106
Kessel’s self-poisoning: clearest ideas of intent (and deception)
1. self conscious appeal,
gendered archetype call for attention
amorphous distress 124, ideas of stress 130
distress
(di)stress projected onto the social situation 129-130
fabricating social constelations 132
genuine distress, genuine manipulation, manipulative drama 134
whole situation 135
mutual constitution and begging the question 150-151
helpful summary of Stengle, Batchelor-Napier, and Kessel (125)
back to childhood 142, 146
definite self harm
emerges in north america, young attractive female impatients under high surveillance, feelings of intolerable psychological tension, often carefully considered and ritualistic 157
OD to DSH
general assertions linking tactics to intentions (drugs can mean death, help, or respite from distress
motivational ambiguity (drugs are ambigious, cutting is a coping mechanism)
visibility (drugs are invisible)
clinical management <O> (some safe cutting, zero tolerance for overdosing 160)
not all british lit makes this distinction
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secondary gain: prestige, attention, competition, anger
(D)SH: tension, emptiness, and depression, but still social--learend, and stemming from failure of communication
internalized or “suppressed interpersonal aggression occuing in a personality that has a low threshold of boredom and feelings of frustration’. The social environment is very important here, but in a way that bears much more explicitly upon individual, psychological needs--unlikeMcEvedy’s analysis, where the social setting functions more to explain the transmission and imitation of the behavior. 171
DSH and suicide
suicidal gestures vs attempts 163
anti-suicide
bizzare, possibly means of expressing the impulse 165
grouped with window smashing, screaming, swallowing objects 166,
violent activity becomes essential, broad range of female violence 169
anti-suicide: “Reintegration, repersonalization, and an emphatic return to reality from the state of dead unreality.’
“more psychic then social”
survival/hopelessness dichotomy 185
psychic-social interactions 186
emptiness numbness contra tension 181, 187
observation sites
the cry for help must be heard before it can be voiced (31)
importance of observation wards 59,
asylum records and coroner statistics 27-28
the war triumvirate and social work help to produce the social object (chapter 2)
Napier and Batchelor’s: mixed observation, frustration theory (with a few temperamentally disposed appeal patients 81-82
asylum-community-hospital shuffle 99 (see also 101 on decarceration, or lack thereof)
suspect objects 109, 117
standardizing the abnormal 113-117. see also 144
the Greer appeal: internal conflict, environmental stress, childhood and current situation, 147
restraint/confinement
mind (violence, restraint) vs somatic needs 42
gender
hysteria and women 59
casualty department and the self-harm stereotype 69
distress is gendered female 125-126
genuine distress, genuine manipulation, manipulative drama 134
commentary
the dead stillness, the awful skin of anger (shedding skin, shattering, sirens, dissociation) 2
does intent to appeal require a recipient? 92
cannary in a coal mine theory of mental illness, weakness, etc. 98 vs my politicization of self harm as a transformative subject
Quotes
Introduction
Self harm is a significant problem in the twenty-first century...The behavior is usually said to be motivated by a desire to regulate feelings of intolerable tension, sadness, or emotional numbness, and is almost always reported to be 'on the increase’; it is also often reported as a problem primarily affecting young women. 1
This book...argues that cast self harm as an innate, eternal or transcendental practice (as much of the current literature does) is not helpful, historically speaking. In fact it is decidedly ahistorical, as the core motivations underlying the practice of self-harm are seen as outside of history.
This book shows how clinical ideas and medical diagnoses (such as ‘self-harm’) are intimately related to the specific, practical contexts in which they emerge and function. It also shows how shifts in concepts of self-harm correspond to much broader political trends. The central political shifts in this book are the ones that bring the welfare state into being after 1945, with nationalized industry and commitment to collective provision in housing and healthcare. This corresponds to an understanding of self-harm (overdosing) that is collective, communicative and socially embedded. The rollback of the selfarestate in the 1980s, coupled with the ascendancy of a more individualized understanding of human beings as competitive and market driven, corresponds to an understanding of self harm (self-cutting) that is read as largely non-communicative and designed to regulate internal emotional states. 1-2
Ideas about self-harm have gone through three broad phases in the twentieth century. From being seen in the early part of the century as a largely uncomplicated attempt to die, to a pathological communication wtiha social setting in the middle of the century, to a method of regulating internal psychic tention that exists today. More recently, self-harm as tension reduction has begun to be understood in nerochemical terms, especially the notion of neurological triggering, as setting off an episode of self-cutting. 2
The shift from understanding based upon social settings to one based upon internal tension is of considerable political importance, given how it coincides with the collapse of consensus politics, the ascent of neoliberal economics, and the rollback of the welfare state in the 1980s. It is the central contntion of this book that the ways in which we make sense of our wolrds, the categories and concepts thatare availiable to understand human behavior (such as self-cutting), resonate with and correspond to larger political constellations. 2
[fortress masculinity, gridwork] 6
I am not making this up. And yet in another way, that is precisely what I am doing. 9
The past is to a great extent always a projection of present concerns, but this does not necessitate collapsing the past into present meanings. 21
Psychiatric epidemiology and social psychiatry begin to make sense in the twentieth century thanks to a broad eclectic set of explanations under the terms ‘stress’ and ‘distress’, which are neither normal nor pathological. In the twentieth century, ‘the social’ is rearticulated through ‘stress’, ‘distress’ and coping’ in a new and pervasive ways as a source and broad canvas for psychological problems, so that by the early 1950s ‘the psychiatrist ...is incessantly forced to consider the social relations of his patient.’ 34-35
The history of cutting and overdosing in Britain can show how such ohercences can come into use and how possibilities for identity are historically formed, linking the shifting analytical frameworks around self-harm to broader changes in cultural and political spheres. 38
This is important because…’by exposing illusions of the permanence or enduring truth of any particular knowledge…[one] opens the way for change’. 38
Finally, there are significant ethical implications for this kind of history. In showing how the meanings for the past and present are bound up with broader historical shifts, from social to internal, this book makes a point about the possibilities for change.
The labels, and the kinds of labels, that we use have consequences that cannot merely be shrugged off by citing some external, intractable undercurrent that validates (or is validated by) the imposition of current terms on the past. Not only must we take responsibility for the descriptions we use, it is incumbant upon us to be aware of how they fit into--and naturalise--broader transformations in thought and practice. The displacement of ‘the social’ (and with it much of the post-war welfare settlement) is a matter of great concern that this book, in its own small way, attempts to address. I am also concerned at the increasing reduction of human potential to biology and neurology in contemporary neuroscience, and the ways in which scientists and neo-liberal practices are being used to discipline and neuter the critical functions of higher education…. 38-39
Chapters 1-4
The idea of ‘self-harm’ as we presently understand it does not exist in 1914. The late-Victorian concern labelled ‘self-mutillation’ is significantly different, as it includes practices such as swallowing or inserting needles into oneself, self-casteration, enucleation...and eating rubbish alongside the more familiar cutting, flesh-picking, and self-biting. As Sarah Chaney clearly states: self-cutting ‘is not emphasiszed in nineteenth-century writings.’ 41
[economics--expensive to watch would-be-suicides] 44, 47
[secure wards] 61
The second world war nurtures and catalyses a large number of reforms and innovations in the thought and practice of British psychiatry. Attending the psychological casualties of the Second World War generates a huge number of interpersonally focused psychotherapeutic practices. The psychological significance of personal relationships, of adjustment to situations, of communication and social interaction become centrally linked aims of maintaining military and civilian morale on the one hand, and returning psychological casualties to service as soon as possible on the other. The link between the social setting and psychological well-being is not generated by the war. However, the war does give an enormous boot to conceptions o fwhat becomes known as the ‘psychosocial.’ 62
Of no less import is the post-war settlement, particularly the National Health Service (NHS). Its enormous significance impacts psychiatry in diverse ways. Most important here is inclusion of mental health within the comprehensive service, which enablses closer-co-operation and refereal between the fields...NHS funding removes the financial burden of attempted suicide from voluntary hospitals…
[the funding of the NHS and general service, public facing nature of the ER provided two of the three necessary ingredients for creating a complex conception of self-harm motivation, the last being sustained psychological observation 62-63
...the mental-hygiene movement during the interwar period. Jonathan Toms notes that an important strand of this movement was based on the insight that the mind ‘was not atomistic and it couldn’t be understood separately from its environment’. 63
Looking at these practices and intellectual frameworks in a more abstract and analytical way, we can see how the presenting problem is subordinated to a social constellation--the problem is recast as a symptom of disordered interpersonal relationships. In 1949 John Bowlby argues that ‘more and more clearly...the overt problem which is brought into the clinic in the person of the child is not the real problem; the problem which as a rule we need to solve is the tension between all the different members of the family.’ 80
Batchelor and Napier explain the attempted suicide as a frustration reaction largely rooted in a pathogenic broken home in childhood. The intent or purpose of the attempt is particularly complicated because this principal aetiological factor (the broken home) is in the distanct past...81
Chapter 5
“Another form of self-harm emerges in the 1960s and 1970s in British psychiatry. Self injury, self-mutilation, or self-laceration are blables identifying people who damage themselves principally by cutting the skin on their forearms and/or wrists. This kind of behavior is today the archetype broadly presumed to be indicated by the terms ‘self--damage’ The rise in the prominence of this behavior coincides with a decline in self-evidence for self-poisoning as communication, a cry for help. Overdosing comes to be seen (especially by those who focus predominantly on self-cutting) as an earnest attempt to end life, rather than a cry for help. This chapter brings into focus a clinical concern that, in a certain sense, displaces overdosing. This is not to comment upon the relative prevalence of these behaviors...but to mark a transformation in what it meant by ‘self-harm’ 154-155
Like self-poisoning, self-cutting or self-mutilation does not have a common-sense, self-evident existence. It is a concept made and refined over a period of time, one which gradually becomes coherent and even obvious. What starts as a range of disruptive behaviors i(including window-smashing, shouting obscenities, or swallowing ‘bizzare’ objects such as dominoes) is refined through increasing focus on self-cutting and the exclusion or relegation of other behvairos to secondary significance. Similarly, the reasoning put forth by psychbiatrists in the earlier studies to explain the motivations for self-cutting osscilate between awareness of communicative intent and a focus on internal emotional states that are regulated by cutting.
In these two ways, through practices of exclusion and emphasis, ‘self-cutting as emotional regulation’ becomes a coherent clinical concern, and it largely displaces the concern qround self poisoning.
This move from socially embedded to internally self-regulating self-harm has particular salience given the political fracturing of consensus around welfare and the ascendancy of a neoliberal rhetoric of self-reliance. 155
...it would be misleading to say that cutting is entierly new in the context of self-poisoning or attempted-suicide studies...Sometimes [it] is implied by mention of surgical treatment; at other times it is stated explicitly, as by Kessel in 1962, who notes that whilst gassing, thorat- and wrist-cutting used to be common, but ‘nowadays these come a poor second to drug taking’. 156
The new DSM-5 category of non-suicidal self-injury (NSSI) excludes self-poisoning, which is described as ‘intentional self-inflicted damage to the surface of his or her body’. With the specificaiton of surface, self-poisoning is ruled out. However, general hospitals still include both cutting and poisoning under ‘self-harm’ in their statistics. 158
[critical site] 189-190
Conclusion
Millard’s project involves a “very tight focus on the subject matter of [psychiatric journal] articles [which] does not leave very much space for the ‘patient experiences’ of self-cutting or overdosing. 198
[This is an area where i feel i am able to make a significant contribution]
I am far more concerned with how ideas and research practices interact and produce the concepts and shorthand that humans use to understand themselves and others. Basing this book on the experience of the patient would make it a very different project.
[true, but these ideas and practices produce concepts that in turn shape the understanding of the patient as well, in turn linking back up to the same ideas and projects through the clinical interactions]
In addition, Joan Scott writes persuasively: ‘When experience is taken as the origin of knowledge, the vision of the individual subject (the person who had the experience or the historian who recounts it) becomes the bedrock of evidence on which explanation is built. Questions about the constructed nature of experience, about how subjects are constituted as different in the first place, about how one’s vision is constructed--about language (or discourse) and history--are left aside. 199
[but they need not be—indeed, they demand their full realization in just such self-reflective experiences. after all, why should we suggest that there is a single origin point of knowledge?]
This is not to demean patients or their stories, but to say that this history attempts something different. The patients and their experiences recede in this telling...What is left are practices, arrangements, ideas, concepts...it might make the various individuals involved in the story less visible (in terms of their experiences) or flatten them out to their research contributions, but it also allows new links: between categories of identity and the rise of professional groups; between broad political contexts and clinical categories; between an intellectual climate in psychology and psychiatry and the ways in which we understand self-damaging behavior; between politics and the ways in which people understand themselves and their identities 199
[Millard offers us tremendous insights and painstaking archival research, one which itself can likewise be contextualized in individual patient history]
‘The anti-Marxist philosophy-cum-ideology founded on a view of human nature as entirely self-interested and incapable of thinking beyond “the market” which it constructs and sells as an autonomous force.’ 203
[..]
[in addition to citing the famous ‘no such thing as society’ speech, McSmith] cites handwritten notes from a 1979 speech proclaiming ‘no such thing as collective conscience, collective kindness, collective gentleness, collective freedom.’ 204
[that’s interesting. there’s this ontological-impossibility position being struck, one which mystifies, refusing any foundation for the dreaded collective (what does she imagine the collective is? telepathy? we’ve got telepathy, it is conducted through vibrations in the air emerging from our mouths, we call it language.]
Here we have the core of neo-liberalism: individual rights, antipathy towards the welfare state and organised labour, and a stress upon self-reliance rather than collective provision. 205
[the mad are therefore not the enemies of liberalism so much as the point of it’s impossibility, the vanishing point where the neoliberal prescription gives way to a hopeless prognosis, for the individual madman is the collapse of the individual under the power of its own rights, the atom which cannot function in the system and so must be managed, by means of clinical force, to comply and/or die.]
This political shift broadly coincides and intimately corresponds to the much more individualistic reading of self-damage, based upon emotional self-regulation. Indeed, neo-liberalism’s stress on individual actors’ radical freedom to make choices for their own benefit fits well with a model of self-harm that emphasies the individualistic, private feelings of tension, and the self-regulation of these through cutting. The coincidence of neo-liberal political ascendency from the early 1980s in the United States and United Kingdom, and the displacement of the social setting from understandings of self-damage are not chance occurrences. 205
[indeed, it is cleanly contained in the dichotomy of radical freedom and natural self interest, can thus be reconciled not only with each other but with the general social model, in which through the radical freedom of self harm one’s natural interest in functioning is, far from being usurped, is facilitated, self harm being a coping mechanism to bring about mental states conducive to rapid bouts of unproductivity.]
[structuralist/material dialectical approach to history 206]
In the same way, the rise of self-cutting as based upon autonomous, self-regulating individuals pushes out a reading of socially embedded, collective responsibility for psychological distress. No longer is pathology redistributed onto spouses or social relations (in Thatchers terms ‘casting their problems on society’) it is internal, individual, and self-regulated.
The relationship between the two outlooks and their different scales (macro and micro) is complicated and rather opaque. It is approaching the banal to say simply that they feed off each other and correspond to each other. This sentiment might be developed by arguing that from the infinite possibilities of human behavior, only a small number ever congeal into perceptible objects and are labled as taits, syndromes or patterns. We see with self-cutting that a large number of other behaviors (such as swallowing objects, smashing windows, paroxysms of rage or social imitation) are consistently downplayed in order to produce a comprehensible object. In the same way, self-poisoning as communication neglects internal psychological states in favour of charting the psychological significance of the environment. In a general sense, these objects rely upon the intellectual and institutional conditions, where they are studied and from where they are publicised (secure inpatient facilities, A&E, counselling services, psychoanalytic interviews, and so on). The objects that appear from these settings can then be regulated, studied or managed (by government memoranda, informal referral arrangements, or specially designed questionnaires). If that management is removed or undercut (by a rethinking of the responsibilities of the state), then the objects fall from view, leaving space for others. These new objects are more likely to attain prominence if they resonate with other changes going on in the political sphere. 206
[there may be something promising, potentially even revolutionary about this observation, the resonant theory of ideology, if we entertain the hypothesis that what ideological constructs we operate by not only conform to but also help to constitute trends in the political-discursive sphere. understanding my own proclivities to cut, my practice at self-harming according to a psychocollective framework can impact the way i understand socioeconomics phenomena, such as the process of alienating myself from my labor in public, signaling to those with eyes to see and ears to listen the ways in which i punish my body into complying as well as the ways i gird myself to resist.]
[socially embedded science 208]
The thing that baffles and unnerves me in equal measure is the refusal of some to countenance that this embrace of neurology is itself a culturally, socially situated phenomenon. The ways in which we search for a handle on human nature change over time, and are parts of humanity’s socially influenced, culturally saturated existence. The claims of science to be beyond culture, to be a method by which unarguable truth is revealed, begins to sound more and more theological the more entrenched it gets. It also fails to see how the ways in which science considers itself beyond cultural contexts and biases—the complex notion of objectivity—have themselves changed over centuries. The idea that laboratory science lives up to its self-billing as a controlled, bias- and culture-free environment ha been convincingly demolished or some time. 208
[]
[Motives 208]
It is written after the 2008 economic crash and bailout, and during the election in Britain of a coalition government of Conservative and Liberal Democrat MPs who are ever more committed to slashing public budgets along with collective responsibility for social problems. In this particular context, it becomes clearer why the text might painstakingly reconstruct a time where the social setting and social interventionism is taken for granted. It establishes a contrast with what is considered so natural in the present (of 2015). 210
[the ideological intervention of the text]
Finally, it is important that reconstructing and analysing the underpinnings of a category based in a social setting is not the same as glorifying or even agreeing with high levels of social intervention...this book is not calling for a ‘return to the social’--even if that were possible. 211
[no call for return]
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[triangle passage]
Xecuative Notes
!Find triangle passage
!Summary of the relevant points
!Itinerary of points of interest, objection, extrapolation, application, etc.
!10 Theses
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