Chris Millard joined the Department of History in 2016, having studied and taught in York, Birmingham and London. His research focuses on the history of psychiatry and medicine in the twentieth century, particularly around self-harm, suicide, faking illness and child abuse. Chris is also interested more broadly in the welfare state, the ‘helping professions’ of social work and child guidance, and the increasing influence of anthropology and sociology on medicine and psychiatry during the twentieth century. Chris has published on the history of attempted suicide and self-harm, English mental health policy, and the history of the emotions. Chris also worked in the UK Parliament in 2014, researching and writing a briefing on ‘parity of esteem between mental and physical health’.
The inclusion of personal experience in academic work, especially in the medical humanities, has ... more The inclusion of personal experience in academic work, especially in the medical humanities, has increased markedly in the recent past. This article traces the roots of this development, arguing that it is not a simply offshoot of 'experts by experience' in mental health, but has its own specific set of precursors and enabling conditions. Three of these are explored in detail, under the headings of 'psychoanalysis', 'social history' and 'anthropology'. The continuing influence of psychoanalysis privileges the public expression of personal experience as a vital tool and site for self-development. Social history (from the 1960s onwards) takes 'experience' as its privileged object in understanding the past. The tools of twentieth-century anthropology animate much social constructionist and cultural history. This anthropology is based upon the 'lived experience' of the anthropologists, who immerse themselves into the life-world of the 'natives'. The article concludes by cautioning against the unthinking or naïve use of experience as a sure foundation for work in the medical humanities , drawing upon the theoretical insights of Joan Scott, Judith Butler and Sarah Shortall.
Concepts used by historians are as historical as the diagnoses or categories that are studied. Th... more Concepts used by historians are as historical as the diagnoses or categories that are studied. The example of Munchausen syndrome (deceptive presentation of illness in order to adopt the 'sick role') is used to explore this. Like most psychiatric diagnoses, Munchausen syndrome is not thought applicable across time by social historians of medicine. It is historically specific, drawing upon twentieth-century anthropology and sociology to explain motivation through desire for the 'sick role'. Ian Hacking's concepts of 'making up people' and 'looping effects' are regularly utilised outside of the context in which they are formed. However, this context is precisely the same anthro-pological and sociological insight used to explain Munchausen syndrome. It remains correct to resist the projection of Munchausen syndrome into the past. However, it seems inconsistent to use Hacking's concepts to describe identity formation before the twentieth century as they are given meaning by an identical context.
Writing the recent history of mental health services requires a conscious departure from the hist... more Writing the recent history of mental health services requires a conscious departure from the historiographical tropes of the nineteenth and twentieth centuries which have emphasised the experience of those identified (and legally defined) as lunatics and the social, cultural, political, medical and institutional context of their treatment. A historical narrative structured around rights (to health and liberty) is now complicated by the rise of new organising categories such as 'costs', 'risks', 'needs' and 'values'. This paper, drawing on insights from a series of witness seminars attended by historians, clinicians and policymakers, proposes a programme of research to place modern mental health services in England and Wales in a richer historical context. Historians should recognise the fragmentation of the concepts of mental illness and mental health need, acknowledge the relationship between critiques of psychiatry and developments in other intellec...
After 1945 in Britain there emerges an ‘epidemic’ of ‘attempted suicide’ that is read as not aimi... more After 1945 in Britain there emerges an ‘epidemic’ of ‘attempted suicide’ that is read as not aiming at death exclusively, but is instead a form of communication – a ‘cry for help’. This ‘epidemic’ consists predominantly of young people (increasingly gendered female) who present at general hospitals after having taken an amount of medication that is deemed excessive, but insufficient to kill them. This thesis places this ‘epidemic’ into historical context by looking at two interlinked developments in healthcare provision in Britain. First, models of mental healthcare provision change. With mental health included in the NHS, provision slowly and unevenly moves away from the geographically remote asylum, and into general hospitals and ‘the community’. The legislative high point of this process is the 1959 Mental Health Act, removing all legal barriers to mental treatment in general hospitals. This enables consistent psychological scrutiny upon patients presenting at general hospitals. This is cemented by the Suicide Act 1961 which decriminalises suicide and attempted suicide, and is swiftly followed by a government memorandum asking hospitals to ensure that all ‘attempted suicide’ patients presenting at casualty receive psychiatric assessment. The second development is in psychiatric thought, moving towards a socially-focused model of the causation of mental disorder. This is underpinned by broad concepts of ‘mental stress’ which enable pathology to be located in social relationships and social situations. This is achieved through much intellectual and practical labour, with psychiatric social workers carrying out home visits and follow-up, as well as interviewing friends, relatives and even employers, in order to construct a ‘social constellation’ around the ‘overdose’. Thus, the increased scrutiny at general hospitals recasts that presenting ‘physical injury’ as a symptom of a disordered social situation, and a communication with a social circle: ‘a cry for help’, newly possible on a nationwide scale.
‘Deliberate self-harm’, ‘self-mutilation’ and ‘self-injury’ are just some of the terms used to de... more ‘Deliberate self-harm’, ‘self-mutilation’ and ‘self-injury’ are just some of the terms used to describe one of the most prominent issues in British mental health policy in recent years. This article demonstrates that contemporary literature on ‘self-harm’ produces this phenomenon (to varying extents) around two key characteristics. First, this behaviour is predominantly performed by those identified as female. Second, this behaviour primarily involves cutting the skin. These constitutive characteristics are traced back to a corpus of literature produced in the 1960s and 1970s in North American psychiatric inpatient institutions; analysis shows how pre-1960 works were substantially different. Finally, these gendered and behavioural assertions are shown to be the result of historically specific processes of exclusion and emphasis.
PURPOSE OF REVIEW:
To sketch out how contemporary Anglophone literature on self-damaging behavio... more PURPOSE OF REVIEW:
To sketch out how contemporary Anglophone literature on self-damaging behaviour negotiates serious conceptual difficulties around intention, and to demonstrate (in the British context) how the large-scale emergence of this type of behaviour is made possible by new forms of psychological provision at district general hospitals.
RECENT FINDINGS:
In the past decade, there has been increasing public awareness of 'self-harm'. Despite the view that 'self-harm' has always existed, the British roots of the current 'epidemic' can be traced to changes in the organization of mental healthcare in the postwar period. These changes make possible new understandings of the story behind physical injuries, and allow these readings to be aggregated and projected onto a national, epidemic scale.
SUMMARY:
The increasing provision of psychiatric expertise in general hospitals makes possible new interpretations of self-injury - as psychosocial communication, or affect self-regulation - and creates the phenomenon of 'self-harm' as we understand it today.
During the 1950s and 1960s psychiatrists in Britain began to express concerns about an “epidemic”... more During the 1950s and 1960s psychiatrists in Britain began to express concerns about an “epidemic” of “attempted suicide” by a particular method – “self-poisoning” – that did not aim at death, but was instead a “cry for help”. This was linked to the ready availability of prescription drugs on the National Health Service, and rooted in “marital conflict”, “broken homes” and “intolerable distress”. This was a fundamentally psychiatric concern; toxicologists did report on cases of self-poisoning - discussing various “antidotes” or resuscitative procedures - but hardly ever speculated on the possible causes or motives. Psychiatrists, however, were interested in the causes, motives, and social situations that might have prompted the “attempt” or “cry for help”.
It will be argued that ideas around “body” and “mind” are absolutely foundational to the production and maintenance of this “epidemic”. The central question here is the transformation of a physical injury (an “overdose”) into a psychological disturbance (a “cry for help”). This was achieved by specific and contextual differentiations between “psyche” and “soma”. It was argued that ‘no simple relationship exists between the degree of danger to life and the seriousness of any psychological disorder present… it certainly is not right that mildness of method indicates lack of severity of psychological illness.’ The pivotal issue will be to highlight the intellectual and practical labour involved in turning minor “physical damage” (helping to constitute behaviour as “gestural”) into a potentially acute “psychopathology”.
The entire “epidemic” is at stake here, as “self-poisoned patients”, in most British hospitals, were brought to the casualty department first, to be treated “physically”. Psychiatric attention – and thus the potential for the psychiatric “epidemic” – was limited. In 1961, the year in which suicide was decriminalized in England and Wales, a Ministry of Health Circular claimed that ‘[t]hese cases often come to hospital casualty departments for urgent lifesaving physical treatment… after physical treatment the patient is sometimes discharged without any psychiatric investigation of his condition [which is] of major importance in most cases of attempted suicide’, recommending that all cases received psychiatric attention. This introduces a “spatial element”: psyche/soma is inscribed through the organization of hospital therapeutics, through “physical” & “psychiatric” treatment spaces.
Thus, arrangements for treating attempted suicide were, first and foremost physical. In order for consistent psychiatric attention to be trained upon these patients, psyche and soma had to be split, so that the psychopathology could be placed above the somatic consequences of the “attempt”, enabling sustained psychiatric concern. The spatial organisation of therapeutics around “psyche/soma” divides, and the intellectual and administrative work performed across these spaces, are of fundamental importance to the very existence of this “attempted suicide” in 1960s and 70s Britain.
Beginning in the late 1960s and throughout the 1970s psychiatrists in Britain made increasing use... more Beginning in the late 1960s and throughout the 1970s psychiatrists in Britain made increasing use of what they called “computing machines”. Feeding the results of their psychological questionnaires into these machines by way of edge-clipped computer punch cards, they were able to apply statistical and mathematical functions to psychological data that were more complex than ever before. Through the now-unfamiliar practices of renting computing time, specialist programmers and computer programs from universities, they were able to employ statistical sense-making tools in ever more sophisticated ways. This had significant consequences for the ways in which psychological and emotional states were conceptualised.
Data gained from personality tests were often processed in these ways, and this paper will examine ways in which a group of Edinburgh clinicians made sense out of an “epidemic of attempted suicide”, conceived by them not as aimed at death in any simple way, but instead as a “cry for help”. They attempted this by performing a string of translation practices: from questionnaire and “personality inventory” answers, to computer punch cards, through various computer program machinations, to supposed emotional states, all in a quest for the “attempted suicide personality”. Beginning in the early 1960s with rather folkish, catch-all notions of “emotional distress”, the clinicians became more technical as the decade wore on, with concepts of “introversion” and “extraversion” laid over ideas of hostility which made possible the idea that “extrapunitiveness” (punishing the self) and “intropunitiveness” (punishing others) were both central to this “attempted suicide as cry for help”.
Thus the idea of “mastery” investigated here is one of technological and professional control, configuring emotional states through translation practices in order to make sense out of, and to better predict and treat – i.e. to master – “attempted suicide”.
The inclusion of personal experience in academic work, especially in the medical humanities, has ... more The inclusion of personal experience in academic work, especially in the medical humanities, has increased markedly in the recent past. This article traces the roots of this development, arguing that it is not a simply offshoot of 'experts by experience' in mental health, but has its own specific set of precursors and enabling conditions. Three of these are explored in detail, under the headings of 'psychoanalysis', 'social history' and 'anthropology'. The continuing influence of psychoanalysis privileges the public expression of personal experience as a vital tool and site for self-development. Social history (from the 1960s onwards) takes 'experience' as its privileged object in understanding the past. The tools of twentieth-century anthropology animate much social constructionist and cultural history. This anthropology is based upon the 'lived experience' of the anthropologists, who immerse themselves into the life-world of the 'natives'. The article concludes by cautioning against the unthinking or naïve use of experience as a sure foundation for work in the medical humanities , drawing upon the theoretical insights of Joan Scott, Judith Butler and Sarah Shortall.
Concepts used by historians are as historical as the diagnoses or categories that are studied. Th... more Concepts used by historians are as historical as the diagnoses or categories that are studied. The example of Munchausen syndrome (deceptive presentation of illness in order to adopt the 'sick role') is used to explore this. Like most psychiatric diagnoses, Munchausen syndrome is not thought applicable across time by social historians of medicine. It is historically specific, drawing upon twentieth-century anthropology and sociology to explain motivation through desire for the 'sick role'. Ian Hacking's concepts of 'making up people' and 'looping effects' are regularly utilised outside of the context in which they are formed. However, this context is precisely the same anthro-pological and sociological insight used to explain Munchausen syndrome. It remains correct to resist the projection of Munchausen syndrome into the past. However, it seems inconsistent to use Hacking's concepts to describe identity formation before the twentieth century as they are given meaning by an identical context.
Writing the recent history of mental health services requires a conscious departure from the hist... more Writing the recent history of mental health services requires a conscious departure from the historiographical tropes of the nineteenth and twentieth centuries which have emphasised the experience of those identified (and legally defined) as lunatics and the social, cultural, political, medical and institutional context of their treatment. A historical narrative structured around rights (to health and liberty) is now complicated by the rise of new organising categories such as 'costs', 'risks', 'needs' and 'values'. This paper, drawing on insights from a series of witness seminars attended by historians, clinicians and policymakers, proposes a programme of research to place modern mental health services in England and Wales in a richer historical context. Historians should recognise the fragmentation of the concepts of mental illness and mental health need, acknowledge the relationship between critiques of psychiatry and developments in other intellec...
After 1945 in Britain there emerges an ‘epidemic’ of ‘attempted suicide’ that is read as not aimi... more After 1945 in Britain there emerges an ‘epidemic’ of ‘attempted suicide’ that is read as not aiming at death exclusively, but is instead a form of communication – a ‘cry for help’. This ‘epidemic’ consists predominantly of young people (increasingly gendered female) who present at general hospitals after having taken an amount of medication that is deemed excessive, but insufficient to kill them. This thesis places this ‘epidemic’ into historical context by looking at two interlinked developments in healthcare provision in Britain. First, models of mental healthcare provision change. With mental health included in the NHS, provision slowly and unevenly moves away from the geographically remote asylum, and into general hospitals and ‘the community’. The legislative high point of this process is the 1959 Mental Health Act, removing all legal barriers to mental treatment in general hospitals. This enables consistent psychological scrutiny upon patients presenting at general hospitals. This is cemented by the Suicide Act 1961 which decriminalises suicide and attempted suicide, and is swiftly followed by a government memorandum asking hospitals to ensure that all ‘attempted suicide’ patients presenting at casualty receive psychiatric assessment. The second development is in psychiatric thought, moving towards a socially-focused model of the causation of mental disorder. This is underpinned by broad concepts of ‘mental stress’ which enable pathology to be located in social relationships and social situations. This is achieved through much intellectual and practical labour, with psychiatric social workers carrying out home visits and follow-up, as well as interviewing friends, relatives and even employers, in order to construct a ‘social constellation’ around the ‘overdose’. Thus, the increased scrutiny at general hospitals recasts that presenting ‘physical injury’ as a symptom of a disordered social situation, and a communication with a social circle: ‘a cry for help’, newly possible on a nationwide scale.
‘Deliberate self-harm’, ‘self-mutilation’ and ‘self-injury’ are just some of the terms used to de... more ‘Deliberate self-harm’, ‘self-mutilation’ and ‘self-injury’ are just some of the terms used to describe one of the most prominent issues in British mental health policy in recent years. This article demonstrates that contemporary literature on ‘self-harm’ produces this phenomenon (to varying extents) around two key characteristics. First, this behaviour is predominantly performed by those identified as female. Second, this behaviour primarily involves cutting the skin. These constitutive characteristics are traced back to a corpus of literature produced in the 1960s and 1970s in North American psychiatric inpatient institutions; analysis shows how pre-1960 works were substantially different. Finally, these gendered and behavioural assertions are shown to be the result of historically specific processes of exclusion and emphasis.
PURPOSE OF REVIEW:
To sketch out how contemporary Anglophone literature on self-damaging behavio... more PURPOSE OF REVIEW:
To sketch out how contemporary Anglophone literature on self-damaging behaviour negotiates serious conceptual difficulties around intention, and to demonstrate (in the British context) how the large-scale emergence of this type of behaviour is made possible by new forms of psychological provision at district general hospitals.
RECENT FINDINGS:
In the past decade, there has been increasing public awareness of 'self-harm'. Despite the view that 'self-harm' has always existed, the British roots of the current 'epidemic' can be traced to changes in the organization of mental healthcare in the postwar period. These changes make possible new understandings of the story behind physical injuries, and allow these readings to be aggregated and projected onto a national, epidemic scale.
SUMMARY:
The increasing provision of psychiatric expertise in general hospitals makes possible new interpretations of self-injury - as psychosocial communication, or affect self-regulation - and creates the phenomenon of 'self-harm' as we understand it today.
During the 1950s and 1960s psychiatrists in Britain began to express concerns about an “epidemic”... more During the 1950s and 1960s psychiatrists in Britain began to express concerns about an “epidemic” of “attempted suicide” by a particular method – “self-poisoning” – that did not aim at death, but was instead a “cry for help”. This was linked to the ready availability of prescription drugs on the National Health Service, and rooted in “marital conflict”, “broken homes” and “intolerable distress”. This was a fundamentally psychiatric concern; toxicologists did report on cases of self-poisoning - discussing various “antidotes” or resuscitative procedures - but hardly ever speculated on the possible causes or motives. Psychiatrists, however, were interested in the causes, motives, and social situations that might have prompted the “attempt” or “cry for help”.
It will be argued that ideas around “body” and “mind” are absolutely foundational to the production and maintenance of this “epidemic”. The central question here is the transformation of a physical injury (an “overdose”) into a psychological disturbance (a “cry for help”). This was achieved by specific and contextual differentiations between “psyche” and “soma”. It was argued that ‘no simple relationship exists between the degree of danger to life and the seriousness of any psychological disorder present… it certainly is not right that mildness of method indicates lack of severity of psychological illness.’ The pivotal issue will be to highlight the intellectual and practical labour involved in turning minor “physical damage” (helping to constitute behaviour as “gestural”) into a potentially acute “psychopathology”.
The entire “epidemic” is at stake here, as “self-poisoned patients”, in most British hospitals, were brought to the casualty department first, to be treated “physically”. Psychiatric attention – and thus the potential for the psychiatric “epidemic” – was limited. In 1961, the year in which suicide was decriminalized in England and Wales, a Ministry of Health Circular claimed that ‘[t]hese cases often come to hospital casualty departments for urgent lifesaving physical treatment… after physical treatment the patient is sometimes discharged without any psychiatric investigation of his condition [which is] of major importance in most cases of attempted suicide’, recommending that all cases received psychiatric attention. This introduces a “spatial element”: psyche/soma is inscribed through the organization of hospital therapeutics, through “physical” & “psychiatric” treatment spaces.
Thus, arrangements for treating attempted suicide were, first and foremost physical. In order for consistent psychiatric attention to be trained upon these patients, psyche and soma had to be split, so that the psychopathology could be placed above the somatic consequences of the “attempt”, enabling sustained psychiatric concern. The spatial organisation of therapeutics around “psyche/soma” divides, and the intellectual and administrative work performed across these spaces, are of fundamental importance to the very existence of this “attempted suicide” in 1960s and 70s Britain.
Beginning in the late 1960s and throughout the 1970s psychiatrists in Britain made increasing use... more Beginning in the late 1960s and throughout the 1970s psychiatrists in Britain made increasing use of what they called “computing machines”. Feeding the results of their psychological questionnaires into these machines by way of edge-clipped computer punch cards, they were able to apply statistical and mathematical functions to psychological data that were more complex than ever before. Through the now-unfamiliar practices of renting computing time, specialist programmers and computer programs from universities, they were able to employ statistical sense-making tools in ever more sophisticated ways. This had significant consequences for the ways in which psychological and emotional states were conceptualised.
Data gained from personality tests were often processed in these ways, and this paper will examine ways in which a group of Edinburgh clinicians made sense out of an “epidemic of attempted suicide”, conceived by them not as aimed at death in any simple way, but instead as a “cry for help”. They attempted this by performing a string of translation practices: from questionnaire and “personality inventory” answers, to computer punch cards, through various computer program machinations, to supposed emotional states, all in a quest for the “attempted suicide personality”. Beginning in the early 1960s with rather folkish, catch-all notions of “emotional distress”, the clinicians became more technical as the decade wore on, with concepts of “introversion” and “extraversion” laid over ideas of hostility which made possible the idea that “extrapunitiveness” (punishing the self) and “intropunitiveness” (punishing others) were both central to this “attempted suicide as cry for help”.
Thus the idea of “mastery” investigated here is one of technological and professional control, configuring emotional states through translation practices in order to make sense out of, and to better predict and treat – i.e. to master – “attempted suicide”.
During the 1960s, psychiatric interest in “attempted suicide” as a “cry for help” could flourish,... more During the 1960s, psychiatric interest in “attempted suicide” as a “cry for help” could flourish, after the decriminalization of suicide in 1961. A particular government-funded research unit, based in Edinburgh under Morris Carstairs, took the lead in the investigation of this phenomenon – though to be prevalent amongst young, working-class women. In this paper I shall examine the processes through which people arriving at the Royal Edinburgh Hospital’s Regional Poisoning Treatment Centre were diagnosed and treated. The psychopathology of this phenomenon was made meaningful by producing it as ritualistic and locating it within a social network – as a “cry for help”. But a number of practices such as interviewing the spouse of the “self-poisoner”, and the employment of psychiatric social workers enabled this phenomenon to be rooted in marital or romantic troubles, conceptualised as psychopathogenic domestic space. These projections of and into “the home” were further enabled by splitting the “physical” damage caused by “the overdose” from the “underlying psychopathology”, and focussing upon the latter. Thus the damage to the body (often dismissed in “gestural overdoses”) was subordinated to the psychic damage rooted in domestic space, helping to consolidate a psychiatric foothold in physical resuscitation wards.
This book is open access under a CC BY license and charts the rise and fall of various self-harmi... more This book is open access under a CC BY license and charts the rise and fall of various self-harming behaviours in twentieth-century Britain. It puts self-cutting and overdosing into historical perspective, linking them to the huge changes that occur in mental and physical healthcare, social work and wider politics.
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To sketch out how contemporary Anglophone literature on self-damaging behaviour negotiates serious conceptual difficulties around intention, and to demonstrate (in the British context) how the large-scale emergence of this type of behaviour is made possible by new forms of psychological provision at district general hospitals.
RECENT FINDINGS:
In the past decade, there has been increasing public awareness of 'self-harm'. Despite the view that 'self-harm' has always existed, the British roots of the current 'epidemic' can be traced to changes in the organization of mental healthcare in the postwar period. These changes make possible new understandings of the story behind physical injuries, and allow these readings to be aggregated and projected onto a national, epidemic scale.
SUMMARY:
The increasing provision of psychiatric expertise in general hospitals makes possible new interpretations of self-injury - as psychosocial communication, or affect self-regulation - and creates the phenomenon of 'self-harm' as we understand it today.
It will be argued that ideas around “body” and “mind” are absolutely foundational to the production and maintenance of this “epidemic”. The central question here is the transformation of a physical injury (an “overdose”) into a psychological disturbance (a “cry for help”). This was achieved by specific and contextual differentiations between “psyche” and “soma”. It was argued that ‘no simple relationship exists between the degree of danger to life and the seriousness of any psychological disorder present… it certainly is not right that mildness of method indicates lack of severity of psychological illness.’ The pivotal issue will be to highlight the intellectual and practical labour involved in turning minor “physical damage” (helping to constitute behaviour as “gestural”) into a potentially acute “psychopathology”.
The entire “epidemic” is at stake here, as “self-poisoned patients”, in most British hospitals, were brought to the casualty department first, to be treated “physically”. Psychiatric attention – and thus the potential for the psychiatric “epidemic” – was limited. In 1961, the year in which suicide was decriminalized in England and Wales, a Ministry of Health Circular claimed that ‘[t]hese cases often come to hospital casualty departments for urgent lifesaving physical treatment… after physical treatment the patient is sometimes discharged without any psychiatric investigation of his condition [which is] of major importance in most cases of attempted suicide’, recommending that all cases received psychiatric attention. This introduces a “spatial element”: psyche/soma is inscribed through the organization of hospital therapeutics, through “physical” & “psychiatric” treatment spaces.
Thus, arrangements for treating attempted suicide were, first and foremost physical. In order for consistent psychiatric attention to be trained upon these patients, psyche and soma had to be split, so that the psychopathology could be placed above the somatic consequences of the “attempt”, enabling sustained psychiatric concern. The spatial organisation of therapeutics around “psyche/soma” divides, and the intellectual and administrative work performed across these spaces, are of fundamental importance to the very existence of this “attempted suicide” in 1960s and 70s Britain.
Data gained from personality tests were often processed in these ways, and this paper will examine ways in which a group of Edinburgh clinicians made sense out of an “epidemic of attempted suicide”, conceived by them not as aimed at death in any simple way, but instead as a “cry for help”. They attempted this by performing a string of translation practices: from questionnaire and “personality inventory” answers, to computer punch cards, through various computer program machinations, to supposed emotional states, all in a quest for the “attempted suicide personality”. Beginning in the early 1960s with rather folkish, catch-all notions of “emotional distress”, the clinicians became more technical as the decade wore on, with concepts of “introversion” and “extraversion” laid over ideas of hostility which made possible the idea that “extrapunitiveness” (punishing the self) and “intropunitiveness” (punishing others) were both central to this “attempted suicide as cry for help”.
Thus the idea of “mastery” investigated here is one of technological and professional control, configuring emotional states through translation practices in order to make sense out of, and to better predict and treat – i.e. to master – “attempted suicide”.
To sketch out how contemporary Anglophone literature on self-damaging behaviour negotiates serious conceptual difficulties around intention, and to demonstrate (in the British context) how the large-scale emergence of this type of behaviour is made possible by new forms of psychological provision at district general hospitals.
RECENT FINDINGS:
In the past decade, there has been increasing public awareness of 'self-harm'. Despite the view that 'self-harm' has always existed, the British roots of the current 'epidemic' can be traced to changes in the organization of mental healthcare in the postwar period. These changes make possible new understandings of the story behind physical injuries, and allow these readings to be aggregated and projected onto a national, epidemic scale.
SUMMARY:
The increasing provision of psychiatric expertise in general hospitals makes possible new interpretations of self-injury - as psychosocial communication, or affect self-regulation - and creates the phenomenon of 'self-harm' as we understand it today.
It will be argued that ideas around “body” and “mind” are absolutely foundational to the production and maintenance of this “epidemic”. The central question here is the transformation of a physical injury (an “overdose”) into a psychological disturbance (a “cry for help”). This was achieved by specific and contextual differentiations between “psyche” and “soma”. It was argued that ‘no simple relationship exists between the degree of danger to life and the seriousness of any psychological disorder present… it certainly is not right that mildness of method indicates lack of severity of psychological illness.’ The pivotal issue will be to highlight the intellectual and practical labour involved in turning minor “physical damage” (helping to constitute behaviour as “gestural”) into a potentially acute “psychopathology”.
The entire “epidemic” is at stake here, as “self-poisoned patients”, in most British hospitals, were brought to the casualty department first, to be treated “physically”. Psychiatric attention – and thus the potential for the psychiatric “epidemic” – was limited. In 1961, the year in which suicide was decriminalized in England and Wales, a Ministry of Health Circular claimed that ‘[t]hese cases often come to hospital casualty departments for urgent lifesaving physical treatment… after physical treatment the patient is sometimes discharged without any psychiatric investigation of his condition [which is] of major importance in most cases of attempted suicide’, recommending that all cases received psychiatric attention. This introduces a “spatial element”: psyche/soma is inscribed through the organization of hospital therapeutics, through “physical” & “psychiatric” treatment spaces.
Thus, arrangements for treating attempted suicide were, first and foremost physical. In order for consistent psychiatric attention to be trained upon these patients, psyche and soma had to be split, so that the psychopathology could be placed above the somatic consequences of the “attempt”, enabling sustained psychiatric concern. The spatial organisation of therapeutics around “psyche/soma” divides, and the intellectual and administrative work performed across these spaces, are of fundamental importance to the very existence of this “attempted suicide” in 1960s and 70s Britain.
Data gained from personality tests were often processed in these ways, and this paper will examine ways in which a group of Edinburgh clinicians made sense out of an “epidemic of attempted suicide”, conceived by them not as aimed at death in any simple way, but instead as a “cry for help”. They attempted this by performing a string of translation practices: from questionnaire and “personality inventory” answers, to computer punch cards, through various computer program machinations, to supposed emotional states, all in a quest for the “attempted suicide personality”. Beginning in the early 1960s with rather folkish, catch-all notions of “emotional distress”, the clinicians became more technical as the decade wore on, with concepts of “introversion” and “extraversion” laid over ideas of hostility which made possible the idea that “extrapunitiveness” (punishing the self) and “intropunitiveness” (punishing others) were both central to this “attempted suicide as cry for help”.
Thus the idea of “mastery” investigated here is one of technological and professional control, configuring emotional states through translation practices in order to make sense out of, and to better predict and treat – i.e. to master – “attempted suicide”.