This book is the first account of self-harming behaviour in its proper historical and political context. The rise of self-cutting and overdosing in the 20th century is linked to the sweeping changes in mental and physical health, and wider political context. The welfare state, social work, Second World War, closure of the asylums, even the legalization of suicide, are all implicated in the prominence of self harm in Britain. The rise of 'overdosing as a cry for help' is linked to the integration of mental and physical healthcare, the NHS, and the change in the law on suicide and attempted suicide. The shift from overdosing to self-cutting as the most prominent 'self-damaging' behaviour is also explained, linked to changes in hospital organization and the wider rise of neoliberal politics. Appreciation of history and politics is vital to understanding the psychological concerns over these self-harming behaviours.

Contents

• Acknowledgements
• Introduction: Self-Harm from Social Setting to Neurobiology
  • A note on the present tense
  • Textbook emergence
  • Retrospective diagnosis and source-based confusion
  • Projections into the past: history and epidemic overdosing
  • How did self-harm become an object of study, and what kind of object is it?
  • Attempted suicide in the nineteenth century: asylums, and others
  • Twentieth century: observation wards and general hospitals
  • Separated therapeutic approaches
  • Stress, social psychiatry and psychiatric epidemiology
  • Concluding thoughts
• 1. Early Twentieth-Century Self-Harm: Cut Throats, General and Mental Medicine
  • Renewal, responsibility and economics
  • Differences and similarities – rupture and continuity?
  • From workhouse infirmary to mental observation ward (1929–30)
  • Observation wards: diagnostics and the contested nature of treatment
  • Frederick Hopkins and attempted suicide (1937, 1943)
  • Concluding thoughts
• 2. Communicative Self-Harm: War, NHS and Social Work
  • War, therapeutic communities and psychosocial practice
  • The NHS and psychological scrutiny during the 1940s and 1950s
  • A&E Under the NHS
  • Ward 3 of the Royal Infirmary of Edinburgh
  • An idiosyncratic, contested observation ward
  • Politics, PSWs, and child guidance
  • Observation wards, PSWs and the production of the ‘social setting’
  • Batchelor and Napier: therapeutic crossover, intensive scrutiny and John Bowlby
  • Social constellations, broken homes and Bowlby
  • ‘Broken homes’: aetiology and intent in the past
  • Stengel and Cook: PSWs and a present-centred appeal
  • Referral, therapeutic mixing and rising psychiatric scrutiny in 1950s observation wards
  • Psychiatric resources, intensities of scrutiny and PSWs
  • Concluding thoughts
• 3. Self-Harm Becomes Epidemic: Mental Health (1959) and Suicide (1961) Acts
  • The Mental Health Act (1959): psychiatry into the ‘mainstream of medicine’
  • Two narratives: the dominance of ‘asylum-community’ and economic concerns
  • Ad hoc referrals and eclectic clinicians
  • Suicide Act 1961: complex intent, legal reform and government intervention
  • Stengel, legal reform and complex intent
  • Hospital Memorandum HM(61)94 – Prescribing referral between therapeutic regimes
  • Wider integration and legal opportunity: common ground between 1959 and 1961
  • Psychiatric resources and ministry follow-up
  • Concluding thoughts
• 4. Self-Harm as a Result of Domestic Distress
  • Institutional and national background
  • Kessel’s ‘self-poisoning’: similarities and modifications
  • Poisoning, overdosing and drugs: local and national concerns
  • Distress and the social constellation
  • Social settings and social workers – PSWs at Edinburgh and beyond
  • The present, marriage guidance and managing the boundary of pathology
  • Distress, domesticity and gendered self-poisoning
  • Observation ward to DGH unit: practical integration and new crossover
  • Separated therapeutics, beds and referral
  • Concluding thoughts
• 5. Self-Harm as Self-Cutting: Inpatients and Internal Tension
  • Self-injury as self-cutting: the exclusion of overdoses in the present
  • British clinicians and self-injury: inpatients and American influence
  • From imitation and epidemics to internal psychopathology and internal tension
  • Presuming the social and confounding expectations
  • North American influence and the triumph of internal tension
  • Stability and comparison with self-poisoning
  • The difference between inpatient and outpatient objects of self-harm
  • Concluding thoughts
• Conclusion: The Politics of Self-Harm: Social Setting and Self-Regulation
  • Summary of argument
  • Methodological reflection
  • The rise of neurology
  • Neo-liberalism, individualism and biomedicine
• Bibliography

Mental Health in Historical Perspective

Series editors:

Matthew Smith, Senior Lecturer, Director of Research (History) and Deputy Head of School of Humanities, University of Strathclyde, UK

Catharine Coleborne, Professor of History, School of Social Sciences, Faculty of Arts and Social Sciences, University of Waikato, New Zealand

Editorial Board:

Dr Allan Beveridge (Consultant Psychiatrist, NHS and University of Edinburgh, book reviews editor History of Psychiatry)

Dr Gayle Davis (University of Edinburgh, former book reviews editor of History of Psychiatry)

Dr Erika Dyck (University of Saskatchewan)

Dr Alison Haggett (University of Exeter)

Dr David Herzberg (University of Buffalo)

Professor Peregrin Horden (Royal Holloway)

Professor Mark Jackson (University of Exeter and Wellcome Trust)

Dr Vicky Long (Glasgow Caledonian University)

Professor Andreas-Holger Maehle (Durham University)

Professor Joanna Moncrieff (University College London)

Associate Professor Hans Pols (University of Sydney)

Professor John Stewart (Glasgow Caledonian University)

Professor Akihito Suzuki (Keio University)

Professor David Wright (McGill University)

Covering all historical periods and geographical contexts, this series explores how mental illness has been understood, experienced, diagnosed, treated and contested. It publishes works that engage actively with contemporary debates related to mental health and, as such, are of interest not only to historians, but also mental health professionals, service users, and policy makers. With its focus on mental health, rather than just psychiatry, the series endeavours to provide more patient-centred histories. Although this has long been an aim of health historians, it has not been realised, and this series aims to change that.

This series emphasises interdisciplinary approaches to the field of study, and encourages titles which stretch the boundaries of academic publishing in new ways.