HHS Contributor

How, if at all, do we differentiate between the data and the source?

This is part three in a four-part report from the workshop, ‘The Future of the History of the Human Sciences,’ which was held at the University of York, 7-8 April 2016 (see a storify from the workshop here). The workshop was jointly hosted by HHS and Chris Renwick (History, York), and was supported by the Arts and Humanities Research Council, the Wellcome Trust, and the University of York. Here, Maria Damjanovicova (European Institute of Oncology, University of Milan) reports on the third of the workshop’s core problematics: The Problem of The Archive.

What has been the impact of biological data and digital media on the archive and on notions of human nature? In the first talk of this session, ‘Possibilities and Problems with the Growing Archive’, Michael Finn (Museum of the History of Science, Technology, & Medicine, University of Leeds) discussed the changes in how archives are used in research, and the relevance of archival material with the emergence of the digital. He focused on three sets of challenges: in questions of storage for example, digitisation introduces software and copyright issues, as well as a risk of information-loss when physical objects are digitised. In curation-related challenges, the role of the expert on historical subjects and historical expertise in archives is lost – together with a sense of what gets excluded from what is archived and unfiltered in search results. And in interpretation-related challenges, digitisation changes the way we view our archives, as it affects the relationship between what we want to study and what is accessible.

In ‘Molecular Archives of Human History: Moving Beyond Text-Based Sources,’ Jessica Hendy (Department of Archaeology, University of York) drew together a range of material and historical practices showing how, for example, cultural practice towards animals can be gauged through parchment analysis, how the molecular biography of a people (who did not have a chance to write their own history) can be learned from the remains of St. Helena slaves, and how the effects of nineteenth century urbanisation on disease, life, and diet, can be assessed from microbes contained in dental calculus. Hendy argued that the tools we use constrain and shape our research question, and that it is of vital importance to integrate biomolecular data with existing data sets to provide a holistic understanding of the past.

Elizabeth Toon’s (Centre for the History of Science, Technology and Medicine, University of Manchester) ‘Matching the tools to the job, and not the other way round: Digital humanities and the history of the human sciences discussed the question of what digital humanities methods can do for historians of the human sciences. Toon discussed several projects that demonstrated digital humanities approaches to texts and data, and particularly offered insights from her experience of working on one such project – text mining ‘big data’ in the biological and biomedical sciences with the goal of creating a semantic search engine, which allows queries where categories are open. This process highlighted both the promises and perils of such approaches, including questions around revisiting methodologies, collaboration on big projects, and questions of transparency.

Questions raised in the discussion drew out the commonalities among these papers: how are we to move away from the social/biological dyad, and the categories set in the eighteenth century? How, if at all, do we differentiate between the data and the source, in the distinction between what is digitized and not analysed, versus what is simply not digitized? The question of the future of the history of the human sciences, which reverberated across all conference sessions, was posed as: is there another future for disciplinary collaboration beyond providing context? Is there such a thing as a “we” in shaping the future? Who is a part of that ‘we” and who is supporting it’?

Maria Damjanovicova is a PhD candidate in Foundations and Ethics of the Life Sciences (European Institute of Oncology, University of Milan) and she has a background in molecular biology and physiology (Faculty of Biology, University of Belgrade). Her PhD project is focused on epigenetics and policy and it is an outgrowth of the Italian Epigenetics Consortium (EPIGEN) project on Public Engagement and Policy Work on Epigenetics.

(Image Credit: ‘Papyrus text: fragment of Hippocratic oath.’ Wellcome Library, London. Used under the Creative Commons Attribution, Non-commercial, No derivatives licence CC BY-NC-ND 4.0.)

“Heredity, heritage, and inheritance may be increasingly merging today.”

This is part two in a four-part report from the workshop, ‘The Future of the History of the Human Sciences,’ which was held at the University of York, 7-8 April 2016 (see a storify from the workshop here). The workshop was jointly hosted by HHS and Chris Renwick (History, York), and was supported by the Arts and Humanities Research Council, the Wellcome Trust, and the University of York. Here, Maria Damjanovicova (European Institute of Oncology, University of Milan) reports on another of the workshop’s core problematics: The Problem of The Social.

How do models of ‘the social’ in the life sciences challenge those in the social sciences and humanities? The first talk of this session was Des Fitzgerald’s ‘The Commotion of the Social’. Fitzgerald (School of Social Sciences, Cardiff University) engaged with a crisis of sociology considered to have been brought about by the challenge that technology poses to sociological research, and confronted the idea of duality in mainstream sociology – that sociology must be dead or alive, digital or analogue, etc. Using urban life, a case with long established interest for both biology and sociology, Fitzgerald introduced the idea of a ‘limit sociology’ – a concept inspired by Stefan Helmreich’s notion of a ‘limit biology’ – as a form of practice, in a time of ecological crisis, and an edge case for connecting sociology and biology in an interesting way. Describing his current project, which embraces a ‘limit sociology approach,’ and looks at stress and the topologies of stress in Shanghai, Fitzgerald proposed an alternative future for the sciences of the social to go on living into the twenty-first century.

In ’The Social as the Non-Biological: Genealogy and Perspectives’, Maurizio Meloni (Department of Sociological Studies, University of Sheffield) examined how we came to think, ‘it is social vs. biological’ via the notion of inheritance and its division into biological heredity and social heritage. Locating the split into soft/hard heredity and genetics/epigenetics in the period after Erasmus Darwin, Meloni identified the postulation of Weismann’s barrier as the moment in which the sphere that we call ‘the social’ became entirely possible as something transcending the biological or the organic. He focused then on epigenetics – as opposed to simple/hard heredity – as an instantiation of the contemporary challenge posed to the biology/society debate, suggesting that heredity, heritage, and inheritance may be increasingly merging today, much like in Erasmus Darwin’s time.

In the final talk, ’Synthesis at What Price?’ Marianne Sommer (Department of Cultural and Science Studies, University of Lucerne) discussed attempts towards a knowledge synthesis by three influential figures, each of whom claimed epistemological superiority for the objects they used in pursuing their political goals. Henry Osborn, for example, argued for epistemic superiority of fossils vis-à-vis other historical approaches, endorsed synthesis of organic and inorganic through integrated anthropology, and advocated progress through notions of racial purity. Julian Huxley, on the other hand, claimed that organisms have epistemic superiority vis-à-vis other historical sources and molecular biology, arguing for the synthesis of research on all the levels on which living phenomena manifest themselves. Huxley advocated evolutionary humanism, social equality, democracy, and peace, while being strongly against racial anthropology and classical eugenics. And Luca Cavalli-Sforza, today, argues for an epistemological pre-eminence of genes vis-à-vis historical sources in linguistics, archaeology (paleo), anthropology, ecological, climatic and human history, and endorses mathematical models of cultural evolution.

What these different approaches to the problem of the social – division in knowledge production; attempts of knowledge synthesis; and crisis of sociology – highlighted, is that the future of the history of the human sciences itself entails the prospect of both a ‘new merger’ of and ‘new boundary work’ between and within the social and the biological sciences.

Book Review: ‘Curing Queers’ and ‘The Straight Line.’

Tommy Dickinson, Curing Queers: Mental Nurses and their Patients, 1935-74, Manchester, Manchester University Press, 2013, 272 pages, £70, ISBN 978-0-7190-9588-7 (hbk).

Tom Waidzunas, The Straight Line: How the Fringe Science of Ex-Gay Therapy Reoriented Sexuality, Minneapolis MN and London, University of Minnesota Press, 2015, 336 pages, £65.47 (hbk), £19.07 (pbk), ISBN 978-0-8166-9614-7 (hbk), ISBN 978-0-8166-9615-4 (pbk).

In late 2015, the international campaigning organisation ‘All Out’ launched a new website: Gay Cure Watch. The aim of this was to monitor and ultimately shut down individuals and groups offering so-called reorientation therapies, in which attempts to convert LGBT people to heterosexuality and gender conformity are offered under the guise of medical science. ‘We know you can’t catch “gay” and you can’t cure it either’, the site proclaims. The process through which homosexuality, and particularly male homosexuality in north America and Europe, came to be seen as a matter for medical science over and above legal, religious, or moral considerations has been well-documented; the standpoints of both Gay Cure Watch and the organisations against which it campaigns are legacies of this. They are not the whole story, though, and the story is not a simple one. We urgently need to understand the myriad ways in which theories, practices, and activism surrounding reorientation therapies have been used, by whom, and with what intended and unintended outcomes. Tommy Dickinson’s Curing Queers and Tom Waidzunas’s The Straight Line are both valuable contributions towards answering these complex questions.

Curing Queers delves into the history of aversion therapy in Britain. It is rooted in original oral history interviews, conducted not only with eight individuals who received such treatment to cure them of homosexuality, but also with 17 nurses who were involved in providing it. The goal is to examine their experiences, their impressions and their motivations as they attempted to cure or be cured, and the memories shared in these interviews are deployed effectively throughout. The first two chapters situate aversion therapies and the nurses who delivered them within their medical and cultural context. The first chapter provides an overview of clinical theories and treatments surrounding homosexuality, the impact of the Second World War on sexual attitudes and behaviour, post-war anxieties surrounding gender roles and loss of empire, and the impact of newspaper reporting of the homosexual ‘problem’ and key events such as the publication of the Wolfenden Report. The value of examining the experiences and views of both patients and nurses is brought out here: the mixed messages and confusion about what ‘caused’ homosexuality and what should be done about it affected patient and nurse alike. Men who were troubled by their same-sex attraction were encouraged to seek medical help, albeit often only as a desperate alternative to imprisonment, and nurses were encouraged to see homosexuality as a potentially damaging but curable condition. Widespread condemnation of homosexuality enabled nurses to participate in aversion therapy on the grounds that it could be beneficial for the individual patient who had sought out a cure, even though some nurses were homosexual themselves.

This is perhaps one of Dickinson’s most striking findings. The mental hospital itself could be a particularly welcoming environment for gay men on its staff: it was an enclosed community, slightly separated from the social mores of the wider world, and some nurses recalled a lively gay subculture. And yet, delivering aversion therapies to gay men rarely created the personal or professional tensions that we might expect. Patients were understood to be fully consenting and to be so very distressed and desperate to change that they were prepared to undergo almost anything. In this, they were perceived by nurses who were content with their homosexuality as entirely different from themselves, and perhaps able to benefit from treatment. This and other features of the professional context in which aversion therapy was practised are described in the second chapter. The nature of nursing education, hospital hierarchies, the rise of somatic explanations and treatments for all forms of mental illness, and the move towards treatment in the community in the post-war era, are all carefully outlined. Each contributed to creating an environment in which aversion therapy for homosexuality was widely and often unquestioningly accepted by nursing staff.

Chapters 3 and 4 then turn to the responses and reactions of nurses in more detail. They are divided into the submissive and subversive, with the former drawing on comparisons with nursing staff working for the Nazis and taking part in the infamous Tuskegee experiments, in which African American men participating in a decades-long medical study of syphilis were denied treatment and information that could have saved many lives. Nurses, Dickinson argues, have used a variety of methods to justify and cope with their participation in unethical and dangerous treatments. These have included a focus on their own specific role rather than the larger programme, faith in the overall benefits of their activities and the ready consent of their patients, failure to empathise with their patients, and an acknowledged need to fit in to the wider hospital community and to protect their job. However, not all nurses simply obeyed orders. Two of Dickinson’s interview subjects described acts of subversion, from simply chatting to patients to offer reassurances about their homosexuality, to throwing away medication and lying to superior staff about witnessing behaviour that suggested a successful ‘cure’. These nurses are quoted at length, bringing their personalities and experiences vividly to life. It is only a shame that more first-hand accounts could not be found to flesh out the analysis.

The final section of Curing Queers considers changes from the 1950s in the worlds of nursing and gay liberation campaigns alike. New nurse therapists brought a greater theoretical awareness of psychiatric diagnoses and treatments, Dickinson argues, while critiques of psychiatry in general and aversion therapy in particular challenged the status of homosexuality as an illness with a recognised cure. This final chapter perhaps does not connect these changes to the experiences of patients and nurses as much as it might. However, the most striking omission in Curing Queers is the lack of recognition of the very different scientific and ethical standards that were in place during the period under examination. It was not only this group of patients whose consent to treatment was neither adequately informed nor freely given, by today’s standards; coercion and questionable consent having a long history within mental health medicine. Nor was it unusual to find that evidence of efficacy in mental health medicine relied upon a handful of individual case studies, patient self-report, and no long-term follow up. It is around these matters of changing ethics and scientific practice that The Straight Line provides an ideal companion piece.

The Straight Line takes up the story on the other side of the Atlantic, examining reorientation therapies (as aversion therapies and their companion treatments within psychoanalysis and psychotherapy came to be known) from the late 1940s through to 2010. Its approach and objectives are rather different from those of Curing Queers. With a background in the sociology of scientific knowledge, Waidzunas seeks to trace the shifting meaning of sexual orientation and homosexuality, and the changing nature of credible scientific evidence. Through careful and intellectually rich analysis of the battles during these decades between psychiatrists, religious leaders, gay activists, and ex-gay campaigners, he plots transformations in what it meant to be homosexual or heterosexual, to be cured, and to prove such states with science. Beginning with the psychoanalytic understanding of orientation that dominated in post-war America, he emphasises that the case study, relying upon the patient’s own report of their sexuality, was initially accepted as persuasive evidence thanks to the pervasive influence of Freud’s case studies. This was challenged in the 1960s with the rise of experimental psychology. Behavioural treatments were imported from Britain to the USA, and this research sought to produce a different kind of evidence. It relied upon experimentation involving a greater number of participants, control groups, and physical measurements of arousal. Sexual orientation itself shifted from the mind to the body.

At the same time, however, all attempts at reorientation were coming under fire. Homosexuality was removed from the influential American reference work of the American Psychiatric Association (APA), the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973. The next section of The Straight Line is centred around the work of Robert Spitzer, the psychiatrist who is credited with this removal and who then provoked enormous controversy three decades later by researching and reporting on the occasional efficacy of the same reorientation treatments he had helped to condemn. Spitzer is used to illustrate the extent to which the meaning and measures of orientation shifted over this period: Waidzunas argues that Spitzer’s own opinions and methods remained unchanged, while the meaning and measurement of orientation did not. In the 1970s, his view of homosexuality as ‘suboptimal’ but not an illness was both radical and essential to the rewriting of the DSM, as was his willingness to engage with the views of gay activists on the margins of the psychiatric profession. By 2010, those on the margins were the advocates of reorientation, and his readiness to rely upon self-reports from the ex-gay community was roundly criticised on evidentiary and ethical grounds. Although his findings were used as proof that orientation could be changed, pro-reorientation campaigners no longer spoke of illness but grounded their arguments instead in the language of human rights and religious freedoms. The question of how to define and measure orientation remained contested, though, as debate surrounding the measurement and alteration of sexuality continued.

Subsequent chapters provide an account of a new ‘middle way’ in the 2000s, including the APA’s influential position statement on conversion therapy for homosexuality. The APA came down firmly on the side of sexual orientation as immutable and located in the body, physiologically measurable, and unsuitable for treatment. Reflecting the compromises and adjustments made by the ex-gay movement and their opponents in search of their ‘middle way’, the APA also acknowledged that sexual identity, rather than orientation, could be changed by psychological treatment. This was only appropriate for individuals for whom a homosexual identity could not be reconciled with other aspects of their life, such as a religious identity, the APA report emphasised. This distinction between orientation and identity had emerged from debates between ‘ex-gay’ groups, grappling with the nature and meaning of a lifelong change in sexuality, and ‘ex-ex-gay’ activists, who were sympathetic towards deeply held religious beliefs and promoted respect for the decisions of those who sought treatment. Separating orientation and identity allowed for the possibility of same-sex attraction to remain while a heterosexual lifestyle was pursued, and made space for physiological testing to measure arousal, or orientation, alongside self-reporting to assess the individual’s sexual identity. Here, Waidzunas brings out the rich and complex interactions between different groups, as meanings and evidence were carefully negotiated.

The final chapter moves our attention to Uganda at the time of an Anti-Homosexuality Act, passed there in 2014. This offers an interesting contrast to the USA: social workers rather than psychiatrists and psychologists were key figures in the debate around homosexuality, and although reorientation therapies were accepted in theory, criminalisation and the extent of hostility towards gay people meant that it had not been put into practice. Importantly, homosexuality was frequently defined not simply as same-sex attraction, but as behaviour invariably involving child abuse and the spread of HIV. As a result, campaigners did not debate how sexual orientation might be measured or caused, but rather, focused on increasing and enforcing criminal penalties on the one hand, and offering covert grassroots support and education for and about LGBT issues and people on the other. Would it help campaigners against the Anti-Homosexuality Act to adopt an essentialist argument, to present sexual orientation as innate and immutable, Waidzunas asks? This closing chapter brings to the foreground one of the underlying issues that The Straight Line addresses: on what basis should LGBT rights arguments be founded? The opportunity to present any case about sexual orientation – acquired disorder, inborn state, natural variation – depends upon legal, political, professional and intellectual structures, and each one creates its own opportunities and limitations alike.

These books illustrate the potential for harm within any rigid model of acceptable gendered and sexual behaviour. They also highlight that scientific authority is far from neutral, that it can be used in unexpected ways, that such uses will themselves have unintended outcomes. Alternatives to criminal penalties aiming to cure rather than punish are not necessarily preferable; arguments in favour of greater tolerance on the basis of biology leave tolerance on other grounds out in the cold. As Waidzunas remarks in his closing pages, recognising the limits of science is not to condemn its achievements. Rather, such recognition might allow us to step away from rigid binaries and universals of all types, and towards reflection, dialogue, and thoughtful enquiry. Science, after all, is not the only way of knowing.

Janet Weston is a Research Fellow at the Centre for History in Public Health at the London School of Hygiene and Tropical Medicine, where her research explores how the prison medical services in England and Ireland responded to HIV/AIDS from the 1980s onwards. This is part of a Wellcome Trust-funded project on the history of prisoner health: https://histprisonhealth.com/. Her PhD looked at medical approaches to sexual offenders in the early/mid-twentieth century.

“The human is not dead; it is going to be resurrected.”

This is the first in a four-part report from the workshop, ‘The Future of the History of the Human Sciences,’ which was held at the University of York, 7-8 April 2016 (see a storify form the workshop here). The workshop was jointly hosted by HHS and Chris Renwick (History, York), and was supported by the Arts and Humanities Research Council, the Wellcome Trust, and the University of York. Here, David Saunders (postgraduate student at the Centre for the History of Science, Technology and Medicine, Manchester) reports on one of the workshop’s core problematics: The Problem of The Human.

“We very much hope that this is an event where we can all be provocative and disagree with each other,” notes Felicity Callard (editor-in-chief of History of the Human Sciences) in her opening address to the attendees of the ‘Future of the History of the Human Sciences’ conference. The event’s first session, ‘The Problem of the Human’, sought to address the human sciences’ most central, and yet most frustratingly illusive, subject of inquiry – the human itself. The death of the human as a philosophical and scientific category has been endlessly prophesised and postponed over the years, from Michel Foucault’s oft-repeated prediction of man ‘erased, like a face drawn in the sand at the edge of the sea’ (Foucault, 1966) to more recent concerns regarding the supposed overthrow of ‘selfhood’ by ‘brainhood’ facilitated by the emergent neurosciences (Vidal, 2009). Discussions among historians and human scientists about the uncertain ontological status of the human clearly continue to foster the kind of passionate and provocative disagreement that the event’s organisers had hoped for.

In the first paper, ‘Resisting Neurosciences and Sustaining History’, Roger Smith (Emiritus Reader in the History of Science, Lancaster) expresses his scepticism regarding the supposed novelty and radical impact of the neurosciences on conventional ideas of the human. Rather, Smith argues, materialist explanations for sentience have been present since the nineteenth-century and have had a very limited impact on the daily lives of ordinary people. Instead of neuroscientific colonisation, Smith sees the persistence of non-neuro understandings of the human, drawn from diverse sources such as folk knowledge, religious belief, and the social sciences. For Smith, any claim that these bodies of knowledge will all become subservient to the neurosciences is extremely questionable. Thus, rather than the replacement of one body of knowledge by another, Smith wishes to focus on the relationships between ways of knowing and being.

Such an approach structures Smith’s current research on the history of kinaesthesia. For Smith, movement provides a privileged entry point into engagements between the neurosciences, literary and cultural studies, and historical research, brought into contact via a shared interest in embodied knowledge and experience (e.g. Berthoz and Petit, 2008). This interest in touch and movement is not a recent development, Smith argues, but instead has formed a central preoccupation for philosophical inquiries since the time of Aristotle. Ultimately, Smith proposes, this recognition of the complex historical ontology underpinning modern concepts of the senses reminds us that all psychological categories of human experience are ‘up for grabs’ in future historical studies.

Steve Fuller’s (Sociology, Warwick University) following paper, ‘Kuhn’s Curse and the Crisis of the Human’, directly critiques Smith’s conceptualisation of the human. Fuller begins his paper with two pervasive influences in the history of the human sciences: Thomas Kuhn and Michel Foucault. Fuller argues that the one of the key tenets of Kuhn’s approach to history is frequently overlooked: his belief that historical studies can only be conducted on issues that have long since been resolved. Thus, writing histories of the human necessarily requires a Foucauldian perspective in which the human has ‘come and gone’ as a distinct category of being. However, Fuller argues that this perspective has been lost through the work of Ian Hacking, which he proposes has distorted Foucauldian thinking in a way that protects the special ontological status of the human and phenomena such as free will and autonomy (Hacking, 2002). The ensuing philosophical confusion, Fuller contends, has fuelled transhumanist debates.

Transhumanism, Fuller argues, is ‘not ashamed’ to talk about human issues of free will and autonomy, but rather questions whether the biological body, as bequeathed by evolutionary processes, is the only platform from which one can hold such discussions. Instead, Fuller suggests that a greater embrace of technology and cyborg forms of living is required. What emerges from this, he argues, is an ‘anti-Foucauldian’ view of the human in which ‘the human is not dead; it is going to be resurrected’. The role of history in this process, Fuller posits, is to recover alternative and long-forgotten paths in medicine and science that will legitimate and provide past precedents for the technological breakthroughs of future generations. Thus, historians’ attempts to reveal the contingent nature of current scientific orthodoxy, and to look again at paths not taken, has more than academic value; it provides a glimpse of the histories that future generations will use to make sense of their own understandings of human nature.

Jonna Brenninkmeijer’s (Behavioural and Social Sciences, University of Groningen) paper, ‘The Case of Neuromarketing’, provides an empirical perspective on these conceptual visions of the human. Utilising observations from fieldwork in a neuromarketing company, Brenninkmeijer outlines how neuro-practitioners in marketing have constructed a vision of the human as overly-complex, self-deceiving, and ultimately unreliable. These practitioners have thus turned to the brain to provide more straightforward, and thus commercially profitable, answers. For Brenninkmeijer, neuromarketing research ‘dehumanises’ consumers, removing the uncertainty and contradiction of human experience in order to gain reliable, quantitative results. Thus, the use of neuroscientific technologies such as functional magnetic resonance imaging (fMRI) provides opportunities to map out emotional and subjective responses and standardise and predict consumer reactions.

Ultimately, Brenninkmeijer contends that neuromarketing research fuels a conceptual dichotomy in which humans and brains are equated with deception and truth respectively. This also creates tension between experimenters and participants, with the former frequently frustrated by the difficulty and complexity of managing human subjects in a research environment. Brenninkmeijer concludes that this tension between human and brain cannot be resolved by these neuro-practitioners; even when brains give uniform and commercially useful ‘answers’, the free will, autonomy, and resistance of human subjects will continue to frustrate their agendas.

In many ways, it seems to me that the human that emerges from both Smith and Brenninkmeijer’s papers demonstrates notable similarities. In both accounts, the human is irreducible to a single conceptual category or body of knowledge, retaining its ability to confuse, surprise, and frustrate historian and human scientist alike. However, Fuller departs from this vision of the body, downplaying the current biological form of the human as merely one phase through which humanity will eventually pass. Divisions between these competing visions of the human continued to surface throughout the conference without any clear resolution. Yet to return to Callard’s initial call for disagreement, and indeed the new editors’ introduction for the History of the Human Sciences at this new juncture, these ongoing debates need not be a source of disciplinary anxiety, but might instead provide ground upon which innovative engagements with the problem of the human can grow and flourish in the years to come.

David Saunders is a postgraduate student at the Centre for the History of Science, Technology and Medicine (University of Manchester). His forthcoming doctoral research at the Centre for the History of the Emotions (Queen Mary University of London) focuses on the rise of the neurosciences in British post-war epilepsy research as part of the Wellcome Trust Collaborative Research Project ‘Living with Feeling‘

“Self-harm has become internal and non-communicative. It has become self-regulatory and not interpersonal. It is difficult not to see this change as relating to the much larger economic and political shifts of the late 1970s and early 1980s.”

What is self-harm, and where does it come from? These are the two questions that I am trying to answer in my new, open access book A History of Self-Harm in Britain: A Genealogy of Cutting and Overdosing (2015).

The question really depends upon when and where you ask. In Britain during the 1950s and 1960s, the terms ‘self-harm’ and ‘self-damage’ largely signify taking an overdose of medication. It is also called ‘attempted suicide’, ‘self-poisoning’, ‘pseudocide’ and ‘propetia’ (from the Greek for ‘rashness’). The studies from which such terminology emerged were rooted in hospital Accident and Emergency departments (A&E). At this point, the overdose is generally understood as a disordered communication – a ‘cry for help’ – and is assessed by psychiatrists attached to hospitals, alongside another particular group of professionals: psychiatric social workers (PSWs).

But the idea that ‘self harm’ essentially indicates ‘overdosing as a cry for help’ changes during the 1980s. In particular, the practice of self-cutting as a form of tension release or emotional regulation gains more prominence. Initially studies of self-cutting emerge from inpatient units in North America and Britain. Despite being called things like ‘delicate cutting’ or ‘wrist-slashing’, these studies actually document a wide range of behaviours including self-burning, skin-picking, smashing windows, and swallowing objects such as pins or dominoes. However, self-cutting is repeatedly emphasized as being archetypal in some way (this is a topic I discuss in much more detail in another paper).

Despite this emphasis on self-cutting, the behaviour presenting at hospitals doesn’t really change: between 80 and 95 per cent of the cases under the label ‘self-harm’ in hospital statistics remain self-poisoning. However, there are now huge numbers of studies from psychotherapists, counselors and psychiatrists documenting ‘self-cutters’.

The behavioural stereotypes inaugurated during the 1980s remain substantially intact today. ‘Self-cutting as emotional self-regulation’ is still largely presumed to be the behaviour and motivation indicated by the term ‘self-harm’. The key questions are, why have things changed, and why at that point? The answers are still murky, even after 250+ pages of the book. I am pretty clear on why self-poisoning emerges as a national concern in the 1960s: changes in mental health law in 1959 mean that more psychiatric assessment and therapy can take place at general hospitals (rather than the remote Victorian-era asylums). This increase means that increasing numbers of people are assessed psychologically after arriving at A&E having harmed themselves. Thus, what is normally quite a small amount of damage physiologically speaking can be assessed in terms of a person’s mental state, home life and romantic attachments. Thus we have more possibility for a ‘cry for help’.

PSWs take the lead here, following up patients by visiting them at home and bringing to bear assessments of various life stresses (such as an alcoholic spouse, sexual infidelity or a difficult adjustment to married life). Suicide law also changes in 1961, meaning that people who take overdoses are no longer breaking the law. This allows the government to recommend that all ‘attempted suicides’ are psychologically assessed. Previously it would have been difficult to do this given the technical illegality of such actions (even if it is rarely prosecuted post-1945).

The reason why self-poisoning, rather than self-cutting, predominates at hospital A&E departments is rather mundane. If somebody is discovered having taking an overdose, even only ten tablets, how many laypeople would be comfortable leaving it to chance and advising the person to ‘sleep it off’? These cases, even if thought by doctors to be ‘trivial’, are much more likely to end up at A&E. However, self-cutting of the forearms (the archetypal site) seems much less physically lethal, and more people are comfortable dealing with this physical damage with their own first-aid skills. Thus it is more likely to emerge through counseling, rather than at A&E.

Reasons for the shift in the 1980s from cutting to overdosing in popular usage of the term ‘self-harm’ are much more unclear. Partially it has to do with the delegation of self-poisoning assessment away from hospital psychiatrists in the 1980s. Fewer research psychiatrists coming into contact with the behaviour on such a regular basis leads to a drop-off in studies. But there is another order of explanation that interests me.

In broad terms British society in the 1950s and 1960s is that of consensus politics, of active welfarism and social support, the post-War settlement, the NHS, social work, and commitment to social housing. By the 1980s, exemplified by the ascent of Ronald Reagan in the USA and Margaret Thatcher in Britain, there is a sense of something new: rolling back the state, championing the logic of the market and the virtues of competition and self-regulation. As far as the social setting and social intervention are obvious and necessary in post-1945 Britain, we are told post 1980 that there is ‘no such thing as society’.

It seems to me that we have a form of self-harm in the 1960s that is socially-embedded, accessed by social workers, and fundamentally understood as interpersonal behaviour. It is a very ‘social’ form of self-harm. In the 1980s, the kind of self-harm that resonates is one that focuses upon individual emotional states, and the practice of self-regulation. The very idea of ‘crying for help’ is recast as negative and manipulative; it is never totally free of those implications in the 1960s, but there is a much more prominent understanding of humans as social, communicative beings. This sense of communication is entirely recast in a negative light in the 1980s. Clinicians who want this behaviour taken seriously as a clinical problem (rather than something to be ignored as manipulative) therefore stress the internal emotions, the overwhelming tension, and dismiss or downplay any communicative aspect.

Self-harm has become internal and non-communicative. It has become self-regulatory and not interpersonal. It is difficult not to see this change as relating to the much larger economic and political shifts of the late 1970s and early 1980s. The history of psychiatry can help us to understand that the categories that we use to understand human behaviour are unavoidably tied up with broader political and social circumstances. When we cast mental health or mental distress as internal or external, as social or biological, we are lining up (like it or not) with much broader political questions about the nature of humans. I should end on one of my favourite quotations from Michel Foucualt, words uttered in the course of the debate with Noam Chomsky in their famous debate on human nature:

“The real political task in a society such as ours is to criticize the workings of institutions that appear to be both neutral and independent, to criticize and attack them in such a manner that the political violence that has always exercised itself obscurely through them will be unmasked, so that one can fight against them.”

Even as we attend to self-harm, the ways in which we understand the behaviour, and the ways in which the behaviour is experienced at a deep level, resonate with dominant constellations of power.

In the huge clutter of concepts and shorthands and commonsense with which we make sense of the world, visions of human nature lurk. Before we can contest them, before we can agree with them, we must see that they are there at all.

Chris Millard is Wellcome Trust Medical Humanities Research Fellow in the School of History, at Queen Mary University of London. ‘A History of Self-Harm in Britain: A Genealogy of Cutting and Overdosing’ is published now by Palgrave Macmillan. It is available, open access (thanks to the Wellcome Trust), from the following link: A History of Self-Harm in Britain: A Genealogy of Cutting and Overdosing.