Looking Back: An emotional but ill-ruled machine

Most of us are probably familiar with the modern usage of 'self-harm' to describe self-inflicted tissue damage. But where did the idea come from? Today, self-harm generally refers to superficial injury to surface tissue, in particular by cutting. However, a historical perspective shows that this is a relatively recent way of defining self-inflicted injury. In other eras, different sets of acts and ways of understanding them have been a focus for concern.

My recent PhD research explores the creation of a category of self-mutilation in late 19th-century asylum psychiatry. While people had certainly intentionally injured themselves before this time, the late 19th century was the first occasion that diverse acts – from amputation to hair-plucking – became regarded as equivalent under a common term: 'self-mutilation'. It was also in this period that psychiatrists began to interpret intentional acts of tissue-damage as psychologically and culturally meaningful.

In the second half of the 19th century, the term 'self-mutilation' began to appear in asylum literature. Beginning in the 1860s with a few articles by alienists (as asylum psychiatrists were known), the literature was expanded by case studies in the 1870s and 1880s. The category was fully endorsed by a five-page definition in  Tuke's Dictionary of Psychological Medicine in 1892 (a multi-authored two-volume textbook that aimed to include all contemporary theories and diagnoses).

For 19th-century alienists, self-mutilation referred to a broad set of practices. As Peter Maury Deas, Medical Superintendent of Exeter's Wonford House, put it in 1896:I have had many cases of self-mutilation not distinctly suicidal, such as exhibit habits of flesh-picking, biting the fingers, or biting other parts of the body, pulling out hair, or eating     rubbish. (Maury Deas, 1896, p.104)

More extreme acts of injury, including castration, amputation and eye-enucleation were also referred to as non-suicidal by most physicians, and published reports frequently concentrated on these dramatic examples.

This practice of viewing acts that could, on the surface, seem very different as one broad category led to a particular way of characterising and understanding self-injury. Alienists were influenced by the popularity of theories of evolution. Just as evolutionary development was thought to progress along a gradual scale (from primitivism to civilisation), psychiatrists identified a similar gradation of self-mutilation. Thus they compared major injuries in those certified insane with the 'nervous, fidgety, restless habits…common among nervous people who are not insane'. Indeed, alienists regarded the extent of these nervous habits (including nail-biting, skin-picking and fidgeting) as a 'valuable criterion' of a patient's mental condition: an indication that the nervous patient might be at risk of developing outright insanity.

An example from my research is 30-year-old Edith Mary Ellen Blyth. On admission to Bethlem Royal Hospital in 1893, doctors noted that she had been 'subject to hysterical symptoms for eleven years but [was] never of unsound mind', and that the patient had never previously been confined. Over the last five years, Blyth had been seen by a variety of doctors for a presumed skin complaint, until 'last June [she] was taken to Mr Treves [elite surgeon Frederick Treves] who said the sores were self-inflicted and they ceased to appear soon after this.' Blyth's admission to Bethlem was, it seems prompted by her resumption of self-injury, now interpreted as a nervous symptom.

Those familiar with asylum history might have expected that writing on self-mutilation emerged from the bureaucratic nature of the expanding late 19th-century asylum system, as well as psychiatric concern with the expansion of diagnostic nosologies. However, this was not the case. In fact, most of the alienists writing on the topic did not embrace 'medical materialism' (a somatic approach to insanity) and hereditary models of illness wholeheartedly. Instead, they drew on a variety of fields – including anthropology, normal psychology, spiritualism, theology and literature – in their efforts to explain self-injurious acts. The diversity of their approaches, as well as the belief that self-mutilation could be compared in sane and insane persons, led alienists to claim that self-injury described more than just a physical wound. Instead, they considered that it could be analysed to uncover underlying mental or emotional meaning.

This is particularly evident in a case reported in an editorial in The Lancet in 1882 as, without doubt, 'one of self-mutilation from insanity'. This was the attempted self-castration of a young farmer from Leek in Staffordshire, Isaac Brooks. In 1879 Brooks had called his doctor to treat a cut-wound to his scrotum. When asked about the injury, the farmer claimed he had been attacked by three men, two of whom were later sentenced to 10 years imprisonment for the crime.

Brooks was treated for a similar injury a year later, giving the same story, but this time refusing to name his attackers. However, the case did not receive public attention until the farmer died, of an unrelated illness, in December 1881. On his death bed, Brooks signed a confession stating that the men were innocent and, according to reports, that the injuries were self-inflicted. There was huge press interest in the case, locally and nationally,  as well as  coverage in medical journals.

Perhaps surprisingly, few reports focused on the miscarriage of justice. Instead, attention centred on the character, personality and life of Isaac Brooks himself, and how these might explain his curious acts. Most writers agreed that Brooks must have injured himself, and many felt this proved he had been insane, although he had never been thought so in life. Other motives were put forward, ranging from financial interests to guilt over past sexual misdemeanours; one newspaper even went so far as to claim (with very little evidence) that the farmer was a 'rustic Don Juan'!

Castration – attempted and successful – was a major focus in published material on self-mutilation. The Brooks case, The Lancet claimed, was 'no isolated one. There are many well-authenticated cases of youths and men of all ages who have sometimes successfully…performed this painful operation upon themselves.'  Yet my research into asylum records indicated that self-castration was relatively uncommon. At the Bethlem Royal Hospital, just four patients attempted castration in 20 years, such as 19-year-old clerk Alexander Thomson, who was admitted in 1888 after he 'cut his private parts with a razor'. In contrast, far more than four patients each year picked their faces, pulled out their hair or knocked themselves against the wall or floor, and an average of one a year attempted to pluck out their eyes.

The case of Isaac Brooks thus helped to create a focus on self-castration as the major form of self-mutilation within asylum psychiatry. Twenty years later, reflecting back on published reports, two American physicians claimed: 'Self-mutilation in man is almost invariably the result of meditation over the generative function, and the great majority of cases of this nature are avulsions or amputations of some parts of the genitalia' (Gould and Pyle, 1897, p.732). If this emphasis was not, in reality, the case, why was this topic so important to contemporaries?

It is easy to assume that concern around castration arose from what historians have described as a 'crisis' of masculinity in this period. An increase in sedentary occupations among the middle classes and changing attitudes to family life significantly altered the male role in the late 19th century. Reports on self-castration by alienists were certainly connected with ongoing concern around other aspects of male behaviour considered troubling: the ill-effects of masturbation and 'antipathic sexuality' (homosexuality).

In both these instances, however, doctors made an important shift in this period from biological to psychological explanations. They increasingly described masturbation as mentally, rather than physically, damaging to the individual. Early sexologists, such as Richard von Krafft-Ebing in Vienna, also claimed that homosexuality was a psychological state and not, as had previously been suggested, related to under-developed sex organs. Alienists were also increasingly claiming sexual development to be an important psychological period in the life of an individual, particularly men. I shall illustrate this with two examples: first the afore-mentioned Brooks case. In the Journal of Mental Science (the main periodical for asylum psychiatry), a lengthy description of Brooks declared: 'The man was single, and lived a very subjective life; he was just the type of man in whom all the evils of civilization seem to accumulate, great sensibility, with loss of power of control, an emotional but ill-ruled machine. A solitary man, thinking himself misunderstood and neglected, building castles in the air, finding the times out of joint, and from this idea conceiving that he has enemies and persecutors' (Anon., 1882, p.73).

Given that the author of the above had presumably never met Brooks (who was already dead), these words make more sense when compared with my second example: the Russian Skoptzy. This religious sect, who practised ritual castration, came to the attention of British psychiatrists in the same period, through criminal trials such as that over the property of the wealthy Plotitzine in 1882. Although the castration was not literally self-performed, British writers invariably classed it as such: one newspaper even compared the Isaac Brooks case to the practices of the sect.

Members of the Skoptzy were regularly tried and exiled to Siberia by the Russian authorities for their heretical beliefs. In the second half of the 19th century, however, the case against them became increasingly secular. For contemporary writers, sexual behaviour was what defined the normal man: governing his rights and responsibilities, and encouraging rational self-control.

As George Savage, a well-known British alienist and superintendent at Bethlem Royal Hospital, put it in 1883: 'the sexual function is the function which develops altruism, so without children the parents become egotistical, and egotism and insanity are not far apart' (Savage, 1883, p.53). Savage and his colleagues linked the growth of 'sexual feelings' in puberty with the development of 'the highest feelings of mankind'. Conversely, as Russian writer Evgeny Pelikan claimed of the Skoptzy, castration removed the individual's ability to relate to his fellows. 'The young man castrated before puberty ... remains indifferent to his environment, lacking the smallest germ of noble aspiration, sense of duty, or civic obligation' (Engelstein, 1997, p.12).

Late 19th-century doctors thus characterised both Isaac Brooks and the Skoptzy as selfish, with their acts of self-castration viewed as direct evidence of this state of mind. This model of self-mutilation is very different from the modern idea of self-harm. An emphasis on self-castration in this period (well out of proportion to the number of cases) is explained by the increasing psychological emphasis on the sexual instinct in individual development. The growth of sexual desire was heavily associated with the acquisition of self-control and altruistic feeling: conversely, self-castration was read as impulsive and egotistical, whether it was thought to be a symptom of insanity or not.

Sarah Chaney is a Research Associate of the UCL Centre for the History of Psychological Disciplines
[email protected]

References 
Anon. (1882) The case of Isaac Brooks. Journal of Mental Science, 28, 69–74.
Editorial: 'The case of the farmer Brooks'. (1882), The Lancet, 119, 3046, 73.
Engelstein, L. (1997) From heresy to harm: Self-castrators in the civic discourse of late Tsarist Russia. In T. Hara & K. Matsuzato (Eds.) Empire and society: New approaches to Russian history.(pp.1–22). Sapporo: Slavic Research Centre.
Maury Deas, P. (1896) 'The uses and limitations of mechanical restraint as a means of treatment of the insane', Journal of Mental Science, 42: 102–113.
Gould, G.M. & Pyle, W.P. (1897) Anomalies and curiosities of medicine. London/
Philadelphia: Rebman Publishing Co./ W.B. Saunders.
Savage, G.H. (1883) 'Marriage in neurotic subjects', Journal of Mental Science, 29, 49–54.