As I know from bitter experience, self-harm is often linked to a desire to seek attention. “What’s the point in referring you?” a GP once said to me, with obvious irritation, when I asked him for referral to a free, charity service that helped camouflage self-harm scars. “You’ll only go and do it again.”
Today, the term self-harm usually refers to superficial injuries to the surface of the skin, especially those made by cutting. In 2013, it was listed as a category for the first time in the fifth edition of the influential Diagnostic and Statistical Manual of the American Psychiatric Association.
Meanwhile, the notion that self-harm is a demanding or attention-seeking behaviour has become so ingrained in modern, Western life that today it’s seen as an obvious way of viewing self-inflicted injury – even among some doctors.
Yet the attitude that self-harm is attention-seeking has only been common since the late 19th century, as my new research has tracked.
Malingerers, with and without a motive
Victorian psychiatrists were the first to consider a desire to manipulate others as a widespread motivation for self-mutilation. Before this time, each individual case was usually considered on its own terms. Yet attention-seeking was by no means the most significant of the reasons that doctors in the 19th century suggested for self-harm. These included religious conviction, demonstrations of endurance, attempted suicide, response to hallucinations and delusions and, most prominently at this time, sexual perversion.
Manipulation of others, however, was a new explanation that began to appear in the 1870s. Most of the cases these psychiatrists described had very practical benefits. Men were often accused of self-mutilation to gain financially through bogus insurance claims or the avoidance of work or duty. This made these working men malingerers in the classic sense, defined by the outcome of their act.
Women, unlike men, were categorised as “motiveless malingerers” for there seemed to be no obvious reason for their attempts to harm themselves. Their acts, doctors explained, were symptoms of hysteria, for “hysterical patients are extremely fond of attracting attention and sympathy”.
It is impossible to detach the diagnosis and treatment of hysteria from prevailing attitudes to gender, and this can be seen clearly in the case of self-harm. An act of self-injury might be the only symptom observed by a Victorian doctor, but nonetheless led to a diagnosis of hysteria. As an anonymous writer in the British Medical Journal put it in 1870, motiveless malingerers:
Are 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. Hysterical in any more definite sense they seldom are.
For a single woman to self-harm, then, was all the evidence that was needed to make a diagnosis of hysteria. After all, “we know that hysterical women cheat in all manner of ways”. Blunt statements like this implying a desire to manipulate, made by surgeon Benjamin Collins Brodie in 1843, were later used to explain self-injury in women.
By the early 20th century, this view was often reversed. Rather than diagnosing women as hysterical as a result of self-inflicted injuries, self-harm was instead used as proof that all women (whether or not they self-harmed) were attention-seeking. Applying an evolutionary perspective to psychology seemed, to some doctors, to support this. As the doctor Frederick Parkes Weber put it in 1911, women were physically weaker than men. Therefore, they had evolved mentally to use “simulation or deception of various kinds” in order to protect themselves from men. Self-harm was, to Weber, a piece of evidence that the female brain had evolved in such a way.
This led him to the damning conclusion that: “At the present time the facility (instinct) for deception is probably greater in the average female than in the average male.”
Attention-seeking and gender stereotypes
This view of the manipulative, deceitful female self-harmer has lingered in the popular imagination, often attached to subsequent concerns about the changing role of women. In Elizabeth Ferrars’s 1942 detective novel, Don’t Monkey With Murder, female self-harm became sexualised, with the plot hinging around the self-mutilation of the beautiful, promiscuous and murderously manipulative Katharine Peach. By the 1980s, the female professional became the new trope, as in the film Fatal Attraction, in which Glenn Close plays a successful businesswoman who cuts her wrists and leg in a manipulative act of obsessive jealousy.
There is actually little reliable scientific evidence on whether more women or men self-harm today: statistics, after all, rely on who happens to come into contact with health services or otherwise and then reports injuring themselves. Describing self-harm as attention-seeking or assuming that only women self-harm tells us very little about an act of self-injury and what has caused it. It tells us much more about cultural assumptions: what is considered normal or appropriate male and female behaviour, and what stereotypes remain prevalent about the supposed emotional needs of women.
Kama ninavyojua kutokana na uzoefu mgumu, kujidhuru mara nyingi huhusianishwa na tamaa ya kutafuta uangalifu. "Ni nini uhakika katika kutaja wewe?" GP mara moja aliniambia, na hasira dhahiri, wakati mimi aliuliza yake kwa ajili ya rejea kwa bure, huduma ya misaada ambayo alisaidia camouflage kujeruhi makovu. "Utaenda tu na kufanya hivyo tena". Leo, neno "kujidhuru" kwa kawaida hurejezea majeraha ya juu ya uso wa ngozi, hasa yale yanayotokana na kukata. Katika mwaka wa 2013, ugonjwa huo ulitajwa kwa mara ya kwanza katika toleo la tano la Daftari la Uchunguzi na Takwimu la Chama cha Psychiatry cha Marekani. Wakati huo huo, wazo kwamba kujidhuru ni tabia ya kudai au kutafuta umakini imekuwa imezama sana katika maisha ya kisasa ya Magharibi kwamba leo inaonekana kama njia ya wazi ya kuona kujidhuru - hata kati ya baadhi ya madaktari. Hata hivyo, mtazamo kwamba kujidhuru ni kutafuta tahadhari imekuwa tu ya kawaida tangu mwishoni mwa karne ya 19, kama utafiti wangu mpya imebainisha. "Wanafalsafa wa zamani wa Victoria walikuwa wa kwanza kuzingatia hamu ya ""kuathiri wengine"" kama kichocheo cha kujidhuru." Kabla ya wakati huo, kila kisa kilikuwa kikizingatiwa kwa njia yake mwenyewe. Hata hivyo, kutafuta uangalifu haikuwa mojawapo ya sababu kuu ambazo madaktari wa karne ya 19 walitoa kwa ajili ya kujidhuru. Hizi zilitia ndani imani ya kidini, maonyesho ya uvumilivu, jaribio la kujiua, majibu ya hallucinations na delusions na, zaidi ya yote wakati huu, upotovu wa kingono. Hata hivyo, kuathiri wengine ni jambo jipya ambalo lilianza kuonekana katika miaka ya 1870. Matukio mengi yaliyoelezwa na madaktari hao wa magonjwa ya akili yalikuwa na manufaa ya vitendo. Mara nyingi wanaume walishtakiwa kwa kujiua ili kupata faida ya kifedha kupitia madai bandia ya bima au kuepuka kazi au wajibu. Hilo liliwafanya wafanyakazi hao wawe waigizaji katika maana ya kawaida, waliojulikana kwa matokeo ya tendo lao. Wanawake, tofauti na wanaume, waliorodheshwa kama "waigizaji wasio na nia" kwa sababu hakukuwa na sababu dhahiri ya majaribio yao ya kujidhuru. Madaktari walieleza kwamba matendo yao yalikuwa dalili za kichefuchefu, kwa kuwa "wagonjwa wenye kichefuchefu hupenda sana kuvutia uangalifu na huruma". Ni vigumu kutenganisha utambuzi na matibabu ya hysteria na mitazamo ya kawaida ya jinsia, na hii inaweza kuonekana wazi katika kesi ya kujidhuru. "Hatua ya kujidhuru inaweza kuwa dalili pekee iliyoonekana na daktari wa Victoria, lakini hata hivyo ilisababisha utambuzi wa ""hysteria.""" "Mwandishi mmoja wa gazeti la British Medical Journal aliandika hivi: ""Watu wanaojigamba bila sababu ni watu wanaojulikana kuwa wenye kichefuchefu." Kwa maneno mengine, wao ni wa jinsia ya kike, wamefikia umri wa kubalehe na hawajaolewa. Hysterical katika maana yoyote zaidi dhahiri wao ni mara chache. Kwa hiyo, mwanamke mmoja aliyeolewa kujiumiza ndiye aliyehitajiwa ili kugundua kwamba alikuwa na ugonjwa wa kihisia-moyo. Baada ya yote, <unk>tunajua kwamba wanawake hysterical kudanganya katika njia zote<unk>. "Mfano wa maneno haya ya ""kujiumiza"" na ""kujiua"" ni yale ya daktari wa upasuaji Benjamin Collins Brodie, ambaye aliandika juu ya jinsi wanawake wanavyojiumiza." Kufikia mwanzoni mwa karne ya 20, maoni hayo yalibadilishwa mara nyingi. Badala ya kugundua wanawake kama hysterical kama matokeo ya kujidhuru, kujidhuru badala yake ilitumiwa kama uthibitisho kwamba wanawake wote (iwe au la) walikuwa kuangalia tahadhari. Kwa madaktari fulani, kutumia maoni ya mageuzi katika saikolojia kulionekana kuunga mkono jambo hilo. "Mwanamke mmoja wa Marekani, Frederick Parkes Weber, aliandika hivi: ""Kama ilivyoelezwa na wengi, wanawake ni dhaifu zaidi kuliko wanaume." Kwa hiyo, walikuwa wamebadilika kiakili ili kutumia "udanganyifu au udanganyifu wa aina mbalimbali" ili kujilinda dhidi ya wanadamu. Weber aliona kujidhuru kuwa uthibitisho kwamba ubongo wa mwanamke umebadilika kwa njia hiyo. "Hii imemwongoza kwenye hitimisho la kushangaza kwamba: ""Kwa sasa, uwezekano wa kuwadanganya wanawake ni mkubwa kuliko wanaume wa kawaida."" ""Kutafuta umakini na mitazamo ya kijinsia"" ""Mtazamo huu wa mwanamke wa kujidhuru wa udanganyifu na udanganyifu umedumu katika mawazo ya watu wengi, mara nyingi kuhusishwa na wasiwasi wa baadaye kuhusu mabadiliko ya jukumu la wanawake." Katika riwaya ya upelelezi ya Elizabeth Ferrars ya 1942, Don't Monkey With Murder, kujeruhi kwa wanawake kulibadilishwa kuwa ngono, na njama ilizunguka kujidhuru kwa Katharine Peach, mrembo, mchafu na mwuaji. "Mwanamke wa kwanza wa filamu ya ""Fatal Attraction"" Glenn Close, ambaye ni mwanamke wa biashara, amejikata mikono na miguu yake katika tendo la wivu." Kuna ushahidi mdogo wa kisayansi wa kuaminika juu ya ikiwa wanawake au wanaume zaidi hujidhuru leo: takwimu, baada ya yote, hutegemea nani anayekutana na huduma za afya au vinginevyo na kisha ripoti kujeruhi. Kujiumiza kama kutafuta tahadhari au kudhani kwamba wanawake tu wanajiumiza hutupa habari chache sana kuhusu tendo la kujidhuru na nini kililosababisha. "Hii inatuambia mengi zaidi juu ya dhana za kitamaduni: ni nini kinachohesabiwa kuwa tabia ya kawaida au sahihi ya kiume na ya kike, na ni nini stereotypes bado ni ya kawaida kuhusu mahitaji ya hisia ya wanawake. """