Self-Mutilation and Psychiatry: Impulse, Identity and the Unconscious in British Explanations of Self-Inflicted Injury, c. 1864 – 1914 Sarah Chaney PhD History of Medicine University College London 2013 2 DECLARATION I, Sarah Chaney, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. 3 Abstract Modern accounts of “self-harm” commonly attribute self-inflicted wounds with emotional or other psychological “meaning”, while assuming that these acts are a product of twentieth- century concerns. While self-harm is certainly a modern concept, the attribution of meaning to self-inflicted injury – above and beyond the physical existence of the wounds themselves – is not new. This thesis explores the way in which medical writers in the later nineteenth century understood and explained what they called “self-mutilation”, situating this debate within the history of asylum psychiatry (where most discussion occurred). Self-mutilation as a concept, it is argued, could only exist within the context of a prior understanding of “the self” as a specific physical and psychological entity, and physiological, anthropological and psychological approaches to selfhood are closely associated with medical attention to self- injury. While it might have been expected that writing on self-mutilation emerged from the bureaucratic nature of the contemporary asylum system, and psychiatric concern with the expansion of diagnostic nosologies, this was not necessarily the case. In fact, most of the alienists writing on this topic did not embrace “medical materialism” and hereditary models of illness wholeheartedly, but drew on a wide variety of fields – including anthropology, normal psychology, spiritualism and religious and literary allegory – in their efforts to understand self-injurious acts. This approach encouraged the idea that self-mutilation described more than just a physical wound, but was an act which could be analysed to uncover underlying mental or emotional meaning. In the writings and practices of these psychiatrists and, indeed, in cases of so-called “insane self-mutilation” reported more widely, I show that ideas and attitudes towards self-mutilation in this period can also inform the historian about ideas of the human condition, normal versus abnormal behaviour, and the very idea of selfhood. 4 Acknowledgements Many people have aided me in my research and writing up. I would like to thank the Wellcome Trust for funding my studentship, and thus giving me the opportunity to pursue this research. I would also like to thank my supervisor, Sonu Shamdasani, for his unfailing support and interest in my project, in addition to his important criticisms. Thanks are also due to my secondary supervisor, Roger Cooter, in particular for his advice during the difficult period of my first year, as well as his helpful comments on later drafts. I would also like to offer my gratitude to Andrew Wear, for kindly taking the time to read a thesis outside his own field of research, and providing many important comments on my final draft, as well as much-appreciated encouragement. During my research, I have used a number of archives and libraries, and I am grateful to the staff at these various institutions for their assistance: in particular, Colin Gale, Archivist at the Bethlem Royal Hospital, and Jonathan Edwards, Archivist at the Royal London Hospital. I would also like to thank staff at the Oxford University Press, the Kent County Archives and the National Hospital for Neurology, Queen Square. Wellcome Library archivists have been invariably helpful and supportive: I am particularly grateful to Lesley Hall for casting a critical eye over my fourth chapter and recommending additional sources. Other colleagues have also provided numerous suggestions and criticisms of my work. In particular, I wish to acknowledge Joanne Ella Parsons, my colleague in organising the ‘Damaging the Body’ seminar series, for her invaluable help. I would also like to thank my colleagues in the UCL Centre for the History of Psychological Disciplines and the Centre for the History of Medicine, in particular Sally Frampton and Emma Sutton. Carole Reeves has also been especially generous in reading a full draft of the thesis and offering suggestions for comparison from her own work on Colney Hatch Asylum. I would also like to thank everyone in the London History of Psychiatry Reading Group, in particular Åsa Jansson, Chris Millard and Jennifer Wallis, who have offered helpful advice and served as a soundboard for many of my ideas. I have also benefited from criticism from Ivan Crozier, at the University of Edinburgh, and Thomas Dixon at the Queen Mary Centre for the History of Emotions, whose comments and suggestions have aided me enormously. Finally, I would like to thank my friends and family for their support and advice throughout, in particular Stewart Caine, with whom countless discussions in the past three years, often late into the night, have been invaluable in stimulating and organising my ideas. 5 Contents Page Introduction 8 PART I Definitions of Self and Self-Injury in Psychiatry 26 1) 1. 2) From Self-Injury to Self-Mutilation: Medicine and the Somatic Self3) 26 (1864 – 1894) 4) 2. 5) Anthropology and the Evolutionary Body: Mutilated Development6) 68 (1870 – 1900) 7) 3. 8) The Normal Self: Psychology and ‘Motive Power’ in Self and 9) 107 Society (1880 – 1914) PART II Models of Self-Mutilation in Late Victorian Psychiatry 147 4. Sexual Self-Mutilation: Masturbation, Masculinity and Self- 147 Control (c. 1880 – 1900) 5. The Hysterical Malingerer: Attention-Seeking and the 187 Unconscious at the Turn of the Twentieth Century (c. 1890 – 1914) Conclusion: Reflections on The Modern Meaning of Self-Harm 230 Bibliography 238 6 List of Graphs and Images Figure Title Page 1 Graph showing references to “Self-Mutilation” in newspapers, 31 1830 – 1900 2 Graph showing references to “Self-Mutilation” in medical 32 journals, 1840 – 1900 3 Chart showing diagnoses of "self-mutilating" patients at Bethlem, 51 1880 – 1900 4 Chart showing total diagnoses at Bethlem, 1880 – 1900 51 5 Graph showing the percentage of self-mutilating patients at 57 Bethlem considered to be suicidal or dangerous, 1880 - 1900 6 Graph showing types of self-mutilation in medical journals, 1840 58 – 1900 7 Graph showing types of self-mutilation in Bethlem patients, 1880 58 – 1900 8 Image showing perforation of the ears and lips practised by the 73 Botocudos 9 Photograph of Mary Stoate at Bethlem, 1895 76 10 Photograph of a group of Nyam-nyam showing their sharpened 78 teeth 11 Chart showing skin-picking at Bethlem by diagnosis, 1880 - 1900 81 12 Chart showing hair-plucking at Bethlem by diagnosis, 1880 – 1900 81 13 Photograph of Robert Haussmann at Bethlem, wearing padded 90 gloves (1884) 14 Graph showing restraint by psychiatric diagnosis in skin-picking 91 and hair-plucking patients at Bethlem 15 Graph showing restraint by gender in skin-picking and hair- 92 plucking patients at Bethlem 16 Graph showing the increase in discussion of malingering, 1850 – 133 1910 17 Photograph of the Watts Memorial to Heroic Self-Sacrifice, 141 Postman’s Park, London 18 Photograph of three male Skoptsy in the early 1900s 182 7 19 Image from Nicoll's 'A Remarkable Case of Persistent Ingestion of 200 Needles' 20 Graph showing diagnoses of male medical patients at the Royal 205 London Hospital, 1893 - 1910 21 Graph showing diagnoses of female medical patients at the Royal 205 London Hospital, 1893 - 1910 22 Photograph of hairpin, removed from a patient’s bladder in 1882, 207 in the St Bartholomew’s Hospital Pathology Collection 23 Graph showing the relative occurrence of different types of self- 211 mutilation in the Parkes Weber Collection, c. 1894 - 1956 24 Diagram showing the pattern of a self-inflicted chemical burn 213 8 Introduction The “Truth Hurts,” began a 2006 National Inquiry, going on to state that one in fifteen young people (aged 11 – 25) in the UK has practised self-harm.1 The study, as is common in modern accounts, used the term self-harm to describe “a wide range of things that people do to themselves in a deliberate and usually hidden way”: in particular cutting, but also burning, scalding, hair pulling, bone-breaking and ingesting toxic substances. Around the same time this report was published, British newspapers also commented on a proposal to “allow ‘safe’ self-harming” in psychiatric hospitals, a topic of discussion at the Royal College of Nursing (RCN)’s annual congress.2 This discussion (seemingly the only one of over twenty debates at the congress to be picked up by the mainstream press) considered the role of the nurse in facilitating such systems, reporting on a pilot scheme at St George’s psychiatric hospital in South Staffordshire, in which staff advised patients “to use ice cubes to freeze their skin or elastic bands to flick themselves with.”3 Such widespread interest indicates the high level of concern over the topic of self-harm in the modern media, as well as the breadth and variety of opinions on the subject. Nurses involved in the RCN debate claimed that psychiatric patients required support, rather than censure, while newspapers cited a clinical report from 2004, which had suggested that health service attitudes toward people who self-harm were “characterised by ignorance, negative attitudes and, sometimes, punitive behaviour by professionals.”4 Conversely, all newspaper reports agreed that “the controversial plans [for “safe” self-harm] will be resisted by those who argue that the duty of health-care professionals is to prevent harm, not to help cause it.”5 None of these reports, however, questioned the idea that self-harm can be considered a discrete and constant category. The physical reality of self-inflicted injuries appears to suggest to many writers today that the term is simply the description of a 1 Camelot Foundation, Truth Hurts: Report of the National Inquiry into Self-harm Among Young People, (London: Mental Health Foundation, 2006).