Needle girls and motiveless malingerers

In 1906, 35-year-old Daniel P. was admitted to the Royal London Hospital after having, as he explained it, 'got some needles into himself'… Invalided home from the Boer War in 1901 and with a history of fits, Daniel P. struggled to make ends meet. His prescriptions were stamped 'no means' on every visit to the Hospital and by 1909, he was recorded to be homeless. A radiograph revealed two needles in the patient's thigh, although an operation failed to locate and remove them. Having initially claimed the needles had only entered his hand and leg, when he returned to the Hospital in 1909, Daniel said that he had 'got some into back, got some into legs, got some into left arm'. Since his first visit to the Royal London, the patient had had needles removed at Birmingham, Guy's, Fleetwood and Pipton Hospitals.

Had Daniel been a woman, his doctors might have given a name to his medical history. In 1897, two American physicians – George Gould and Walter Pyle – coined the phrase 'needle girls' to refer to a 'peculiar type of self-mutilation... sometimes seen in hysteric persons' of 'piercing their flesh with numerous needles or pins' (Gould & Pyle, 1897, p.735). In their book, Anomalies and Curiosities of Medicine, Gould and Pyle retrospectively applied this phrase to a collection of cases published over the previous 50 years. Both medical and popular versions of the book were produced, and the phrase 'needle girls' was presumably intended to play on popular interest in 'fasting girls' (on whom they also included a section). The phrase also, of course, suggests that all cases were female.

Hysteria and hypochondriasis

It is possible that Daniel was an exception. After all, women in the Victorian and Edwardian period came into contact with needles and pins more often than men, and men may have injured themselves in different ways. But it is also possible that Gould and Pyle's selection of cases was biased… they didn't publish all of the needle cases, and the authors they cited wrote only about a small selection of their patients. Of seven 'needle girls' articles in the book, the one referring to a man, 77-year-old Charles Nutter, did not specify his sex (Suicide with a darning needle, 1887), leaving the reader to wrongly assume that the patient was a woman.

Selection and emphasis of this kind has suggested that women are more prone to self-injury than men on more than one occasion. In the late 1960s, small studies of inpatients in psychoanalytic hospitals in the north-eastern United States claimed that the typical 'wrist-slasher' (as some psychiatrists called them) was a young, college-educated, white woman. This was just the type of person over-represented in these private hospitals, where up to two-thirds of patients were female, usually from white, middle-class families (Brickman, 2004; Millard, 2013).

Gould and Pyle referred to 'girls' rather than 'ladies' or 'women': a medical shorthand for hysteria at the time, implying young, unmarried women. Some men were also diagnosed with hysteria around the turn of the 20th century (or hypochondriasis, which for many years was considered the 'male' version of hysteria) (Micale, 2008). Yet between 1893 and 1910 at the Royal London Hospital, men were far more likely than women to receive a diagnosis of 'mental disease' or 'nil/malingering', while women were more likely to be deemed suffering from 'nervous diseases' (hysteria and hypochondriasis). Where self-injury was concerned, men and women might be treated quite differently, depending on their presumed motive.

For men, concern over malingering (feigned or exaggerated illness) increased rapidly over the last few decades of the 19th century. In three key medical journals (Journal of Mental Science, British Medical Journal and The Lancet), the number of articles containing the term soared from less than 30 in 1851 to nearly 300 in the first decade of the 20th century. Similar increases occurred in textbooks and newspapers. Several historians linked the concern of malingering to the rise of health insurance systems across Europe: the introduction of accident insurance in Germany in 1871 and the Employer's Liability Act of 1880 and subsequent Workmen's Compensation Acts in England (Eghigian, 2000, 2001; Schaffner, 2001) raised the possibility of insurance fraud.

Class issues

In 1908, Georges Dieulafoy, professor of pathology at the Hôtel-Dieu de Paris, presented a lengthy report of an unusual case. Dieulafoy's patient was a 'boy' of 30, who had suffered from a gangrenous affection of the skin for two and a half years. The young man had consulted numerous doctors and surgeons before ending up at the Hôtel-Dieu. On one occasion, the patient agreed to have most of his arm amputated, and had contemplated further operations. Despite this drastic treatment, Dieulafoy came to the conclusion that the man's injuries were self-inflicted. In order to prove this diagnosis, he had portions of the skin tested for corrosive substances and, when these tests proved positive, arranged a confrontation with the patient in the presence of his employer. The patient's confession was secured when Dieulafoy assured him that he would not be held responsible for his previous actions, which were the result of a morbid mental state. However, if he persisted in the deception now that it had been uncovered he would become a dishonest man – a malingerer. Work and duty were held up as significant factors in self-injury in men, hence the necessary presence of the patient's employer for this 'cure'.

Self-inflicted injuries in working-class women were sometimes interpreted in the same way. In 1889, George Thorpe, a general practitioner in Walthamstow, wrote indignantly on the case of a 17-year-old servant he had treated. This 'healthy-looking country girl' visited Thorpe on several occasions with an inflamed hand. Thorpe seems to have been suspicious from the outset, for 'her mistress informed me that the girl was not at all fond of work, and that she had a deal of trouble to get her to do it'. When Thorpe examined the young woman's hand he discovered a needle, which he removed, a procedure that recurred several times over the next week. Eventually Thorpe 'felt so disgusted with her that I advised her mistress to get rid of her at once, which was done, and the girl returned to the country'. Despite concluding that 'it seems hardly credible that a person of her age could be so cunning, and would inflict so much pain upon herself to avoid work', this nonetheless appeared to Thorpe to be the only possible explanation, given the girl's station in life.

The puzzling cases that became the so-called 'needle girl' syndrome, however, tended to be of middle-class women. The British Medical Journal referred to these as 'motiveless malingerers'. 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'. They were 'almost invariably of the class of those known as "hysterical". In other words, they are of the female sex, arrived at the age of puberty and unmarried' (Motiveless Malingerers, 1870, p.15). In the absence of any other symptoms, hysteria became the obvious explanation given the patients' sex, age, marital status and class.

Hysterical temperament

Towards the close of the 19th century, doctors had begun to talk of the 'hysterical temperament', characterised by negative traits including a desire for attention. The assumption that hysterics desired attention was used to explain self-inflicted injury: as psychiatrist Maurice Craig put it in 1905, 'hysterical individuals not uncommonly inflict injuries upon themselves, probably from a desire to obtain the sympathy of others'. Some doctors thought that any case of self-injury in a young woman was an example of 'hysterical deception' in these 'highly neurotic, sly, and deceitful' hysterical women (Callender & Baker, 1872; Jessett, 1896).

Early 20th century physicians continued to focus on the gendered nature of self-inflicted injury in relation to hysterical temperament. Dermatologist Frederick Parkes Weber wrote that hysteria was a disorder of the 'tertiary sex characters'; those psychological characteristics thought to be common to men or women. Going full circle, he used an evolutionary understanding of sexual characteristics to explain the existence of self-mutilation in women.

'In past ages... simulation or deception of various kinds must often have been serviceable to the weaker female in protecting herself from the stronger (and sometimes cruel) male, as well as in enabling her sometimes to get her own way... therefore, at the present time the facility (instinct) for deception is probably greater in the average female than in the average male' (Weber, 1911, p.1542).

Weber viewed self-inflicted injury as a female behaviour, rooted in the morally dubious context of deception, even when he thought that social and environmental factors enhanced this manipulative tendency. Preconceptions about women therefore contributed to concepts of hysterical deception and motiveless malingering.

Roots of modern assumptions

The connections between self-injury, class and gender around the turn of the 20th century are not straightforward. Publications on needle insertion and skin-picking tended to focus on self-injury in young, middle-class women, simply because these cases were often considered harder to explain than self-harm in other individuals. It seemed obvious to doctors and surgeons that men or working-class women who harmed themselves were attempting insurance fraud or avoiding work or duty. Where those explanations were unavailable, self-inflicted injury became medicalised as part of a hysteria diagnosis.

Hysterics were also thought to be deceitful and troublesome, craving the attention of others, and these traits began to be associated with self-injurious behaviour. Young women who injured themselves were assumed to prove the duplicitous nature of women in general. Both of these assumptions – that self-harm is predominantly a female behaviour and that it is a negative form of attention-seeking – remained widespread long after the associated views on class and gender shifted.

- Dr Sarah Chaney is a Research Fellow at Queen Mary Centre for the History of the Emotions. Her monograph, Psyche on the Skin: A History of Self-Harm is published in paperback by Reaktion.

[email protected]

Illustration: Karla Novak

References

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Craig, M. (1905). Psychological medicine: A manual on mental diseases for practitioners and students. London: J. & A. Churchill.

Dieulafoy, G. (1908). Escarres multiples et rècidivantes depuis deux ans deux bras et au pied. - Amputation du bras gauche. Discussion sur la nature de ces escarres. - Pathomimie. La Presse Médicale, 369–373.

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Eghigian, G. A. (2001). German welfare state as a discourse of trauma. In M. S. Micale, & P. F. Lerner (Eds.) Traumatic pasts: History, psychiatry and trauma in the modern age, 1870 - 1930 (pp. 92–114). Cambridge, UK: Cambridge University Press.

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Jessett, F. B. (1896). A case of faecal fistula due to self-mutilation occurring twice in the same patient. The Lancet, 148(3818), 1213–1215.

Micale, M. S. (2008). Hysterical men: The hidden history of male nervous illness. Cambridge, MA: Harvard University Press.

Millard, C. (2013). Making the cut: The production of "self-harm" in post-1945 Anglo-Saxon psychiatry. History of the Human Sciences, 26(2), 126–150.

Motiveless Malingerers. (1870). British Medical Journal, 1(470), 15–16.

Schaffner, W. (2001). Event, series, trauma: The probabilistic revolution of the mind in the late nineteenth and early twentieth centuries. In M. S. Micale, & P. F. Lerner (Eds.) Traumatic pasts: History, psychiatry and trauma in the modern age, 1870 - 1930 (pp. 81–91). Cambridge, UK: Cambridge University Press.

Suicide With a Darning Needle. (1887). The Lancet, 129(3309), 230–231.

Thorpe, G. (1889). A strange case of malingering. The Lancet, 134(3455), 1001.

Weber, F. P. (1911). The association of hysteria with malingering. The Lancet, 178(4605), 1542–1543.