Making Sense of Self-harm

The Cultural Meaning and Social Context of Nonsuicidal Self-injury

Peter Steggals

• Publisher: Palgrave Macmillan
• Year: 2015
• ISBN:
  9781137470591
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Making Sense of Self-Harm provides an alternative approach to understanding nonsuicidal self-injury; using Cultural Sociology to analyse it more as a practice than an illness and exploring it as a powerful cultural idiom of personal distress and social estrangement that is peculiarly resonant with the symbolic life of late-modern society.

1

What is Self-harm?

And they came over the strait of the sea, into the country of the Gerasenes. And as he went out of the ship, immediately there met him out of the monuments a man with an unclean spirit, who had his dwelling in the tombs, and no man now could bind him, not even with chains. For having been often bound with fetters and chains, he had burst the chains, and broken the fetters in pieces, and no one could tame him. And he was always day and night in the monuments and in the mountains, crying and cutting himself with stones.

Gospel of Mark (5: 1–5)

Introduction: A Question of Meaning

The disturbing effect of an ‘unclean spirit’ described in Mark’s gospel raises an interesting question of meaning and categorisation, namely the degree to which we can recognise here exactly the same pattern of meaning and action that we now call ‘self-harm’ or ‘nonsuicidal self-injury’. As a recognised pattern and category of disorder self-harm is relatively new, traceable at best to the 1938 book Man Against Himself by the great psychiatrist Karl Menninger. However, the prevalence and cultural pervasiveness that self-harm has gained since the 1990s has, unsurprisingly, provoked an obvious question: has it always been with us and we simply failed to notice? Or is self-harm more a product and expression of its particular time and place?

The significance of this kind of question typically lies in its perceived capacity to settle a fairly standard debate over the nature of ‘minor psychiatric illnesses’ or what the psychiatrist and anthropologist Roland Littlewood nicely describes as ‘dissociations of our customary consciousness’ (2002: xi). Are such categories of illness and disorder best understood as something like a natural kind (Zachar, 2000); a definite and particular thing in its own right with an intrinsic unity and a timeless essence (Young, 1997), which has presumably always existed even if it has only recently been recognised by medical science (De Vries et al., 1983; Conrad and Schneider, 1992)? Or are they better understood as salient articulations of the tensions and dilemmas that are peculiar to a particular society; less a timeless thing then than a situated cultural practice, a sort of ritual or idiomatic symbol of distress and estrangement (Gaines, 1992)?

It’s a well-rehearsed debate, of course, familiar from the study of hysteria, anorexia nervosa, and any number of retrospective diagnoses made by historically minded psychiatrists and medically minded historians (Showalter, 1991; Shorter, 1992; Bordo, 2003). But, as interesting as it may be, its answer is nonetheless more often assumed than argued, and Mark’s gospel account typically stands as one of the evidential exhibits in the historical and ethnographic record invoked by writers like Linda Plante when she states that

Whether carried out in the socially sanctioned context of tribal initiation rites … the modern piercings common to Western adolescents, or the self-cutter’s visual proclamation of internal struggle, the damaging of one’s skin has spoken a common language across time and culture (2007: 7).

Indeed, for many self-harm simply is a transcultural and transhistorical ‘thing’ that has everywhere and always been present and, as such, has always ‘spoken a common language’. And, of course, there is a kind of intuitive logic to this, reflecting a deeply embedded prejudice of late-modern culture. When faced with the complex bustle and commotion of everyday life we have a tendency to reach down under this shifting empirical matter and grasp at some-thing we imagine to be hidden below the level of personal consciousness, cultural meaning and social context,¹ some-thing we hope will prove to be more simple and solid, more stable and less transient (Elias, 1978; Derrida, 1991; Ricoeur, 2004). It’s a well-entrenched perspective, strongly associated with the authority of natural science, medicine and the more biologically oriented approach to psychiatry and psychology; an objectivist perspective succinctly described by the anthropologist Clifford Geertz as the idea that ‘culture is icing, biology, cake … difference is shallow, likeness, deep’ (2000: 53), and one that is clearly evident in the current professional and public appetite for grounding explanations of seemingly every facet and nuance of human life and behaviour in biology and genetics (Rose et al., 1990; Nelkin and Lindee, 1995; Martin, 2004; Tallis, 2011).

While the particular thing in question may be variously modelled as microscopic agents of genetic destiny, or as the somewhat capricious chemical and mechanical processes of biology, or as so many programmes hardwired into our neural architecture, or even as the structural dynamics of our psyches, however we imagine or hypothesise it, it always carries the same strangely attractive yet counterintuitive implication: that an unseen, hidden and sometimes entirely hypothetical entity can somehow be more ‘real’, more concrete and more significantly causal than the immanent collage of content, movements and surfaces that makes up our actual experience of life from one moment to the next, now relegated to a mere façade (Rose et al., 1990). This objectivist prejudice then typically leads us to look past meaning in search of mechanism and past culture in search of nature. It represents an asymmetric binary that organises the natural and the mechanical on the one hand as being opposed to the cultural and the meaningful on the other, positioning them as the primary is positioned to the secondary, the necessary to the complementary, and as the facts of the matter are positioned to personal prejudice and local colour (Littlewood, 2002; Timimi, 2002).

Perhaps it is little wonder then that in discovering a pattern of practice and experience like self-harm, seemingly present in both contemporary and Biblical psychiatry, that we would automatically assume the presence of something more natural than cultural and something that, while subject to historical variation at the margins, nonetheless always remains the same in essence and as such always speaks a common language. In this way the basic question of what self-harm is has typically been posed in objectivist terms and subsequent research and discussion has automatically framed it as a pathological behaviour and a clinical problem, a symptom more than a symbol and something to be diagnosed and treated more than something to be understood and made sense of. This is not to suggest that the realm of meaning has been completely dismissed or ignored, rather it has been side-lined or looked past as something that is of interest but not of much consequence, and the objectivist logic, although not the only one at work in representations and talk about self-harm, as we will see in Chapter 2, has commonly been used to define the nature of self-harm, to set the terms of the debate and answer the question of what kind of a thing it is, and in so doing has set out and regulated the boundaries of what can be said and thought about self-harm with any sense or authority.

However, as culturally typical and socially authoritative as this standard objectivist logic may be it has nonetheless struggled to make sense of self-harm (Tantam and Huband, 2009; Chandler et al., 2011). In fact, far from submitting to this approach the phenomenon of self-harm has seemed to actively resist it; appearing less as a ready and transparent object of knowledge characterised by an intrinsic unity and a timeless essence than as a troubling supplement always carrying more meaning than can be accounted for (Derrida, 1991), spilling through accepted categories to place treasured assumptions under a deconstructive strain (Derrida, 1976), and producing the all-too-familiar troubling and uncanny air of otherness that shrouds self-harm and which I noted in the Introduction. Perhaps then we need to heed Kafka when he noted that ‘[a]ll human errors are impatience, a premature breaking off of methodical procedure, an apparent fencing-in of what is apparently at issue’ (1994: 3), and if our objectivist assumptions have failed to contain self-harm then perhaps we need to question them and return to the question at the heart of that standard and familiar debate—is self-harm really something like a natural kind that has always been around even if we didn’t realise it, the product of an individual psychopathology arising from some kind of biogenetic dysfunction or perhaps some deep mechanism buried in our basic psychological architecture? Or is it something less amenable to the objectivist logic, something more deeply tied into our particular time and place in the world, the characteristic expression of our culture and the ‘crystallization of its discourses and contradictions’, as the philosopher Susan Bordo put it in discussing anorexia nervosa (2003: 141); a package of meanings and actions that is practised and put to use in people’s lives because of the ideas and values that are coded into it? Or, to put it another way: exactly what is it we are talking about when we talk about ‘self-harm’?

A World of Self-mutilation

Of course, it stands to reason that if self-harm can be found across radically different cultures then whatever causes it must be equally pervasive. The transient realms of the cultural and the social would perhaps prove too contingent and too changeable to provide this kind of solid base and invariant anchor and so, instead, if this was the case, we would have to locate that vocal ‘thing’ that speaks its common language from self-inflicted wounds the world over within the only common denominator universally present: the human body. Or rather that basic package of innate tendencies in thought, feeling and behaviour that we popularly call ‘human nature’ and that we imagine to be the basis and default condition of all human beings, regardless of the context and conditions of their lives (Rose et al., 1990). In this way the contention of a universal self-harm leads inexorably to a search for explanations that can only be found by digging deeply into the objective and substantive cake of biology and medicine. However, it is also precisely here that we find Kafka’s premature breaking off of methodical procedure.

The commonly accepted idea that self-harm is everywhere evident and always speaks the same language is typically made, by Plante and virtually every other writer who makes the same claim, not by reference to original research but rather by reference to a single, and singularly important, text: the American psychiatrist Armando Favazza’s 1987 book Bodies Under Siege: Self-mutilation and Body Modification in Culture and Psychiatry (2nd edition 1996). Perhaps the most important and influential book in the history of self-harm literature, Bodies Under Siege has without question exerted a massive influence on the very fundamentals of how we frame and think about self-harm. After its publication it quickly established itself as, and remains to this day, the indispensable reference for anyone writing on the subject and, as such, it is not just a book about self-harm but an important moment in its cultural history and a part of its ongoing story.

It is a large rambling mansion of a book, an ambitious global and historical survey of self-mutilation the pages of which are packed with vivid and colourful examples drawn from across the full spectrum of human life, from ancient myths of dismemberment to gruelling shamanic rituals, from religious asceticism and self-flagellation to factitious surgical addictions, from traditional initiation rites and the culturally sanctioned scarification, branding and body-marking practices of beauty, status and identity, to extreme forms of psychotic self-amputation and, of course, the kind of ‘deviant’ self-harm or repeated nonsuicidal self-injury that is our subject here. Indeed, the book’s great strength is that, in describing self-mutilation as ‘an integral part of the human experience’ (Favazza in Strong, 1998: x), we are reminded of the symbolic power and psychosocial significance of our bodies. That we live not just in but through our bodies, and these bodies are not just the natural, biological objects that we typically take them to be but are rather the objective extension of our subjectivity, the raw corporeal matter upon which we inscribe, and through which we experience, our culture, our social position, our identity and our sense of self (Butler, 1993; Turner, 2008).

What is clear from the global tour that Bodies Under Siege provides is that forms of self-mutilation and body modification, far from being deviant, are, in fact, part of normal, ordinary human life. From cutting hair, clipping nails and various other common practices of grooming and ordering, to tattooing, piercing, wearing high heels and tight clothing, to the systematic destruction of muscle tissue in the gym as we seek to remove fat and sculpt our bodies into culturally defined and socially sanctioned ideals, Favazza reminds us that our bodies are not naturally civilised but rather that we make them so on a daily basis with discipline, effort and sharp implements. It is, of course, an important point to make, and a kind of mental palette cleanser to be taken before getting too lost in the fascination of strange foreign rituals and the transgressive thrill of talking about pathological self-mutilations. But as important as it may be to begin by recognising this fact, and as useful as it may be to help us forge links of understanding across the uncanny divide of estrangement and deviance that otherwise keeps self-harm and the people who practise it at an enigmatic distance, it is also important to understand that this is not the same as establishing that all such practices of self-mutilation represent the same basic pattern of meaning and action, experience and expression; that in some essential sense they are all examples of the same kind of thing and ultimately all stand in need of one basic explanation.

Take the Sun Dance ritual, for example, which appears in Favazza’s book and which describes an eight-day ritual of the North American plain Indians. A basically shamanic ritual that climaxes with its participants being suspended from wooden skewers that are dug deeply into their muscles. The expectation of such a public, religious ritual is a vision experience and while, as Favazza explains, the ‘participants volunteer out of personal initiative, the entire tribe cooperates in its performance, for it is the entire tribe that benefits from the suffering and self-mutilation of the dancers’ (1996: 12). While it is certainly a practice of self-mutilation it is demonstrably not the same pattern of meaning and action that describes, for example, a British schoolgirl sat lonely and depressed behind the locked door of her bedroom and reaching for her razor blades because she can no longer manage or express her personal thoughts and feelings in any other way.² Indeed, if Favazza’s crowded miscellany of rituals, practices, rites and behavioural outbursts is a testament to anything it is human diversity.

But if this is the case then why do Plante and so many others take Favazza’s diverse anthology as evidence of a single phenomenon? The problem at root seems to be with the way a set of observations is transformed under the influence of common, and so rarely questioned, objectivist assumptions. The book itself is explicitly about ‘self-mutilation’, which Favazza defines as ‘the direct, deliberate destruction or alteration of one’s own body tissue without conscious suicidal intent’ (ibid: 225) and as far as this goes there can be little argument with the assertion that self-mutilation, so defined, really does appear across remarkably different cultures separated by both geography and history. However, we must be careful to keep in mind what this statement actually amounts to.

Given Favazza’s definition, the term ‘self-mutilation’ works as a loose and highly generalisable category, built from what the philosopher Gilbert Ryle calls ‘thin description’ (1971), which is to say the kind of bare bones description of events and phenomena that could be made by a detached observer or perhaps even by a recording device; a log of no more than what was actually physically said or done devoid of empathy, interpretation, meaning or explanation (Geertz, 2000; Ponterotto, 2006).³ So if a person mutilates or causes harm to their own body tissue without the intention of killing themselves then their actions qualify as ‘self-mutilation’ by Favazza’s definition, regardless of what other motivations, meanings, ideas, values, concerns, contexts or intentions may have been woven into the experience, or how deeply these dimensions may differentiate one such practice from another. Indeed, such differences simply don’t matter to a category like ‘self-mutilation’ because it is what we could call a thin or observational category; a category that does not collect examples of a single ‘thing’ with a single common nature and explanation but rather one that casts its nets widely and collects examples of various phenomena that fit a relatively superficial set of criteria without having to establish a substantial or natural connection between them.

The statement that self-mutilation can be widely found across different cultures then, while true, amounts to little more than similar statements using similar thin categories; that body adornments can be found across different cultures for example or ‘running behaviour’. Imagine a Favazza-like book that catalogued various different examples of people running, from the morning jog to running in the Olympics to running from an axe murderer. If someone is observed running then it qualifies as ‘running behaviour’, regardless of why they are running, and, as such, it can be included in the book. As interesting as such an anthology might be it is hard to imagine that we would mistake the thin, observational category used here to collect these examples with a thicker, more meaningful and explanatory category. We would not think that just because running behaviour can be observed universally that it must be caused by some mechanism, some structure or some-thing that is also universal, something that not only compels running, but that can also explain it. To make this argument would be to overlook the significant qualitative difference between running for fitness, running to compete and running for your life. Those genuine physical mechanisms that do underpin running do not compel it or explain it but rather simply facilitate its possibility so that in varying circumstances different people in different times and places may find themselves running for considerably different reasons and it would be those reasons that constituted the explanation of their running and not the physical mechanics of their knee and ankle joints or their quadriceps muscles.

As unlikely as it is that we would commit this objectivist fallacy for a thin category like running behaviour it is nonetheless this exact fallacy, this conflation of the observational for the explanatory and the thin for the thick, that leads Plante and similar writers to assume that just because self-mutilation is everywhere present that all self-mutilation must be the product of a single causal structure or mechanism, one that crosses cultures and centuries more or less unchanged and that can therefore speak a common language because it is basically the same thing wherever you find it.

‘Self-mutilation’, then, is not a thing, but a criteria of observation, and Favazza’s book does not zero in on a universal human trait but rather on the myriad and deeply divergent ways that people have, in different times and places, turned to their bodies as a material, existential and psychosomatic resource to mark and enact issues of great meaning and significance. Indeed, the close relationship between our body and our sense of self, along with the malleability of the flesh and the physical capacity we possess to effect, modify and mutilate our bodies renders them a unique canvas on which we can experience and express significant ideas, thoughts and feelings, and through which we make selves and claim identities and status (Mascia-Lees and Sharpe, 1992; Turner, 2008). Given this, it is hardly surprising that we can find as many different kinds of self-mutilation as there have been different peoples but this does not mean that all self-mutilation is the same thing, is caused by the same thing and can be explained by reference to the same thing.

That such diversity is all too easily overlooked is as blatant an example of the implicit asymmetric binary I mentioned earlier (that while life may be both cultural and biological, culture only expresses or presents things, while biology causes and therefore also explains them) as you will find. The thing is that in Plante’s work and that of several others there is an acknowledgement of and even a fascination with culture, with meaning and with social context; these factors are not denied at all. But in practice this fascination somewhat distracts from and covers over, even I suspect for the authors themselves, the persuasive effect of the asymmetric binary that is all the more powerful for being implicit. This bin...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Acknowledgements
• Introduction: The Signifying Wound
• 1. What is Self-harm?
• 2. The Problem of Good Understanding
• 3. The Ontological Axis
• 4. The Aetiological Axis
• 5. The Pathological Axis
• 6. The Belaboured Economy of Desire
• Conclusion: Making Sense of Self-harm
• Notes
• Reference
• Index