Self-Harm as Self-Cutting: Inpatients and Internal Tension

  • Chris Millard
Open Access
Part of the Mental Health in Historical Perspective book series (MHHP)


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.


Social Setting Psychiatric Inpatient Borderline Personality Disorder Deliberate Self Harm Suicidal Intent 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    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): 153CrossRefGoogle Scholar
  2. 2.
    A.J. Smith, ‘Self-Poisoning with Drugs: a Worsening Situation’ British Medical Journal 4, 5833 (1972): 157–9CrossRefGoogle Scholar
  3. 3.
    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;CrossRefGoogle Scholar
  4. 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): 118–23CrossRefGoogle Scholar
  5. 4.
    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)Google Scholar
  6. 6.
    N. Kessel, ‘Attempted Suicide’ Medical World 97 (1962): 312Google Scholar
  7. 7.
    H.G. Morgan, Helen Pocock and Susan Pottle, ‘The Urban Distribution of Non-Fatal Deliberate Self-Harm’ British Journal of Psychiatry 126 (1975): 320CrossRefGoogle Scholar
  8. 8.
    N. Kreitman (ed.), Parasuicide London, John Wiley & Sons (1977): 8Google Scholar
  9. 9.
    See C. Millard, ‘Self-Mutilation: Emergence, Exclusions and Contexts 1967–1976’ MA Thesis, University of York (2007);Google Scholar
  10. C. Millard, ‘Making the Cut: The Production of “Self-harm” in Anglo-Saxon Psychiatry’ History of the Human Sciences 26(2) (2013): 126–50;CrossRefGoogle Scholar
  11. B.J. Brickman, ‘“Delicate” Cutters: Gendered Self-mutilation and Attractive Flesh in Medical Discourse’ Body and Society 10(4) (2004): 87–111CrossRefGoogle Scholar
  12. 10.
    M.A. Simpson, ‘Self Mutilation and Suicide’ in Suicidology: Contemporary Developments E.S. Shneidman (ed.) New York, Grune and Stratton (1976): 310Google Scholar
  13. 11.
    The most cited articles are: H. Graff and R. Mallin, ‘The Syndrome of the Wrist Cutter’ American Journal of Psychiatry 124 (1967): 36–42;CrossRefGoogle Scholar
  14. L. Crabtree Jr., ‘A Psychotherapeutic Encounter with a Self-mutilating Patient’ Psychiatry 30 (1967): 91–100;Google Scholar
  15. H. Grunebaum and G. Klerman, ‘Wrist Slashing’ American Journal of Psychiatry 124 (1967): 527–34;CrossRefGoogle Scholar
  16. P. Pao, ‘The Syndrome of Delicate Self-cutting’ British Journal of Medical Psychology 42 (1969): 195–205;CrossRefGoogle Scholar
  17. 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;CrossRefGoogle Scholar
  18. S. Asch, ‘Wrist Scratching as a Symptom of Anhedonia: A Predepressive State’ Psychoanalytic Quarterly 40 (1971): 603–13;Google Scholar
  19. R. Rosenthal, C. Rinzler, R. Wallsch, and E. Klausner, ‘Wrist-cutting syndrome: the meaning of a gesture’ American Journal of Psychiatry 128 (1972): 1363–8CrossRefGoogle Scholar
  20. 12.
    American Psychiatric Association, ‘Non-Suicidal Self-Injury’ Diagnostic and Statistical Manual of Mental Disorders (5th ed.) Washington, D.C., American Psychiatric Association (2013): 803Google Scholar
  21. 13.
    D. Tantam and N. Huband, Understanding Repeated Self-Injury: A Multidisciplinary Approach Basingstoke, Palgrave Macmillan (2009): 1Google Scholar
  22. 14.
    L. Fagin, ‘Repeated Self-Injury: Perspective from General Psychiatry’ Advances in Psychiatric Treatment 12 (2006): 193CrossRefGoogle Scholar
  23. 15.
    B. Walsh and P. Rosen, Self-mutilation: Theory, Research and Treatment Guildford, Guildford Press (1988): 32, quoted inGoogle Scholar
  24. 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): 198–9Google Scholar
  25. 16.
    J. Sutton, Healing the Hurt Within: Understand Self-Injury and Self-Harm, and Heal the Emotional Wounds 3rd ed. Oxford, How To Books (2007): 14Google Scholar
  26. 17.
    N. Pengelly, B. Ford, P. Blenkiron and S. Reilly, ‘Harm Minimisation after Repeated Self-harm: Development of a Trust Handbook’ Psychiatric Bulletin 32 (2008): 63CrossRefGoogle Scholar
  27. 19.
    Royal College of Psychiatrists, ‘Self-harm, Suicide and Risk: Helping People Who Self-harm’ College Report CR158 (2010) online at: accessed 30 January 2015: 6Google Scholar
  28. 20.
    K. Hawton, K.E.A. Saunders and R.C. O’Connor, ‘Self-harm and Suicide in Adolescents’ Lancet 379, 9834 (2012): 2373–4CrossRefGoogle Scholar
  29. 22.
    P.A. Adler and P. Adler, The Tender Cut: Inside the Hidden World of Self-Injury New York, New York University Press (2011);Google Scholar
  30. T. McShane Blades, Blood and Bandages Basingstoke, Palgrave Macmillan (2012);Google Scholar
  31. P. McCormick, Cut London, Collins Flamingo (2009);Google Scholar
  32. C. Rainfield, Scars Lodi, New Jersey, Westside Books (2011)Google Scholar
  33. 23.
    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)Google Scholar
  34. 24.
    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.CrossRefGoogle Scholar
  35. 25.
    A. Strauss, L. Schatzman, R. Bucher, D. Ehrlich and M. Sabshin, Psychiatric Ideologies and Institutions London, Collier-Macmillan Limited (1964): 12Google Scholar
  36. 26.
    D. Offer and P. Barglow, ‘Adolescent and Young Adult Self-Mutilation Incidents in a General Psychiatric Hospital’ Archives of General Psychiatry 3 (1960): 194CrossRefGoogle Scholar
  37. 28.
    See A.H. Stanton and M.S. Schwartz, The Mental Hospital London, Tavistock Publications (1954)Google Scholar
  38. 30.
    M.E. Staub, Madness Is Civilization: When the Diagnosis Was Social, 1948–1980 London, University of Chicago Press (2011)CrossRefGoogle Scholar
  39. 31.
    T.F. Main, ‘The Ailment’ Medical Psychology 30(3) (1957): 129–45CrossRefGoogle Scholar
  40. 33.
    P.D. Moss and C.P. McEvedy, ‘An Epidemic of Overbreathing Among Schoolgirls’ British Medical Journal 2 (1966): 1295–1300;CrossRefGoogle Scholar
  41. C.P. McEvedy, A. Griffith and T. Hall, ‘Two School Epidemics’ British Medical Journal 2 (1966): 1300–2CrossRefGoogle Scholar
  42. 45.
    C.P. McEvedy and A.W. Beard, ‘Royal Free Epidemic of 1955: A Reconsideration’ British Medical Journal 1, 5687 (1970): 7–11CrossRefGoogle Scholar
  43. 46.
    For example, K. Skegg, ‘Self-harm’ Lancet 366, 9495 (2005): 1471–83CrossRefGoogle Scholar
  44. 47.
    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): 140Google Scholar
  45. 48.
    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;CrossRefGoogle Scholar
  46. D.W. McKerracher, T. Loughnane and R.A. Watson ‘Self-Mutilation in Female Psychopaths’ British Journal of Psychiatry 114 (1968): 829–32CrossRefGoogle Scholar
  47. 49.
    F. Graham ‘Probability of Detection and Institutional Vandalism’ British Journal of Criminology 21(4) (1981): 361Google Scholar
  48. 52.
    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:CrossRefGoogle Scholar
  49. M. Pickersgill, ‘Between Soma and Society: Neuroscience and the Ontology of Psychopathy’ BioSocieties 4 (2009): 45–60CrossRefGoogle Scholar
  50. 57.
    P.C. Matthews ‘Epidemic Self-Injury in an Adolescent Unit’ International Journal of Social Psychiatry 14 (1968): 131Google Scholar
  51. 58.
    G.A. Kelly, The Psychology of Personal Constructs 2 Vols, New York, Norton (1955)Google Scholar
  52. 59.
    J. P. Watson, ‘Relationship between a Self-mutilating Patient and her Doctor’ Psychotherapy and Psychosomatics 18 (1970): 67–8CrossRefGoogle Scholar
  53. 65.
    B.R. Ballinger, ‘Minor Self-Injury’ British Journal of Psychiatry 118 (1971): 535CrossRefGoogle Scholar
  54. 67.
    For example, A.R. Gardner and A.J. Gardner, ‘Self-mutilation, Obsessionality and Narcissism’ British Journal of Psychiatry 127 (1975): 127–32;CrossRefGoogle Scholar
  55. Alec Roy, ‘Self-Mutilation’ British Journal of Medical Psychology 51 (1978): 201–3CrossRefGoogle Scholar
  56. 68.
    D. Bhugra, Culture and Self Harm: Attempted Suicide in South Asians in London London, Psychology Press (1994)Google Scholar
  57. 69.
    S.S.A. Waldenberg, ‘Wrist-Cutting: A Psychiatric Enquiry’ MPhil Thesis, University of London, Institute of Psychiatry (1972): 12.Google Scholar
  58. 84.
    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;CrossRefGoogle Scholar
  59. 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): 147–52Google Scholar
  60. 88.
    M.A. Simpson, ‘Phenomenology of Self-Mutilation in a General Hospital Setting’ Canadian Psychiatric Association Journal 20(6) (1975): 429–34;Google Scholar
  61. M.A. Simpson, ‘Self-Mutilation and Suicide’ in Suicidology Contemporary Developments E.S. Schneidman (ed.) (1976): 286–315;Google Scholar
  62. M.A. Simpson, Medical Education: A Critical Approach London, Butterworths (1972);Google Scholar
  63. M.A. Simpson, ‘Self-Mutilation and Borderline Syndrome’ Dynamische Psychiatrie 1 (1977): 42–8Google Scholar
  64. 94.
    Alec Roy, ‘Self-mutilation’ British Journal of Medical Psychology 51 (1978): 201, 203.Google Scholar
  65. 95.
    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;CrossRefGoogle Scholar
  66. 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): 166–70CrossRefGoogle Scholar
  67. 96.
    D. Pallis, A. Langley and D. Birtchnell, ‘Excessive Use of Psychiatric Services by Suicidal Patients’ British Medical Journal 3, 5977 (1975): 216CrossRefGoogle Scholar
  68. 97.
    K. Hawton, ‘Excessive Use of Psychiatric Services’ British Medical Journal 3, 5983 (1975): 595CrossRefGoogle Scholar
  69. 98.
    K. Hawton, ‘Deliberate Self-poisoning and Self-injury in the Psychiatric Hospital’ British Journal of Medical Psychology 51(3) (1978): 257–8CrossRefGoogle Scholar
  70. 101.
    M.D. Enoch and W.H. Trethowan, Uncommon Psychiatric Syndromes 2nd ed. Bristol, John Wright and Sons (1979): 87–8Google Scholar
  71. 102.
    H.G. Morgan, Death Wishes? The Understanding and Management of Deliberate Self-Harm Chichester, John Wiley and Sons (1979): 115–16Google Scholar
  72. 105.
    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): 117Google Scholar
  73. 108.
    Hawton and Catalán Attempted Suicide 2nd ed. Oxford, Oxford University Press (1987): 16Google Scholar
  74. 109.
    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): 572CrossRefGoogle Scholar
  75. 110.
    N. Kreitman (ed.), Parasuicide London, John Wiley & Sons (1977): 8Google Scholar
  76. 111.
    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)CrossRefGoogle Scholar
  77. 118.
    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): 191–200CrossRefGoogle Scholar

Copyright information

© Chris Millard 2015

Open Access This Chapter is distributed under the terms of the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Authors and Affiliations

  • Chris Millard
    • 1
  1. 1.Queen MaryUniversity of LondonUK

Personalised recommendations