Pain: Anaesthesia and Self-mutilation in the Nineteenth Century
The first of our series of posts examining the science and experience of pain, is from Sarah Chaney, PhD student at the UCL Centre for the History of Psychological Disciplines. Her research explores nineteenth century attitudes to what medical writers termed “self-mutilation”. Here she reveals how ‘alienists’ strived to understand this behaviour and why the explanation they produced was startlingly different to our contemporary opinion.
Today it is a commonplace, in medical literature and in the media, that some types of deliberate self-harm are carried out in order to substitute severe emotional distress with physical pain. While pain is not necessarily considered essential to all forms of self-inflicted injury, it is certainly generally acknowledged that self-injury such as cutting or burning is a painful experience. Yet this is very different from what many psychiatrists and philosophers assumed in the nineteenth century.
My research focuses on the idea of “self-mutilation”, as it emerged in mid and late nineteenth-century British asylum psychiatry. From the 1860s, the term increasingly appeared in published articles, indexes of textbooks and asylum case records, and received a five-page definition in Daniel Hack Tuke’s Dictionary of Psychological Medicine (1892). Alienists (as asylum psychiatrists were known) referred to a large number of different acts by this term, including amputation, eye enucleation, castration, hair-plucking, skin-picking, burning and head-banging. Self-mutilation was distinguished by these writers from suicidal behaviour; the impulse to self-harm was believed to result from different motives from the desire for death.
But why might people inflict injuries on themselves if they did not wish to kill themselves? One of the simplest answers for physiological psychologists was that the patient simply did not feel any pain. Wilhelm Griesinger (1817 – 68) was a German neurologist and psychiatrist, whose ideas were of much interest to British alienists. He suggested that self-mutilation could be explained by “decreased sensibility, by anaesthesia or analgesia”. By characterising self-inflicted injury as a physical symptom of mental ill-health, scientists like Griesinger hoped to promote the objective classification of mental illness, avoiding the introspective psychology of their predecessors.
Yet pre-existing philosophical principles remained influential. Although discussion of self-mutilation in the late nineteenth century was associated with physiological models of sensation these were still reliant on earlier philosophies of human behaviour. In 1789, Jeremy Bentham had famously suggested that pleasure and pain were the over-riding principles of motivation in man: it is for these two “sovereign masters … alone to point out what we ought to do, as well as to determine what we shall do.”
The pleasure/pain model of behaviour was championed in the nineteenth century by the psychologist Alexander Bain. When Bain spoke of pain and pleasure as the “two great primary manifestations of our nature” he often conflated physical experience and mental function, using the terms pleasure and pain to apply to both physical sensation and the subjective feelings of misery and happiness. Indeed, in much nineteenth century psychology and psychiatry it is impossible to separate emotion and bodily pain.
This model of human motivation, combined with their efforts to find physical evidence for, and explanations of, insanity, reinforced the alienists’ conviction that self-mutilation was associated with anaesthesia. Philosophy told them that humans were driven always to avoid pain. Even in those judged insane, it was inconceivable that they would want to feel pain. So only an insensibility to pain, an absence of pain, could explain self-mutilation.
In later decades self-inflicted injury was often incorporated into the diagnosis of hysteria. Hysteria, by this time, was widely considered to be a “nervous” or “functional” disorder, and encompassed a broad range of symptoms without any obvious physical cause, including cutaneous anaesthesia [numbness of the skin]. These symptoms were often (but not always) associated with emotional or behavioural disturbance, but usually not to the extent that would result in asylum admission.
As alienists came to treat growing numbers of private patients outside the asylum, they became increasingly interested in “hysterical self-mutilation”. One of the main methods of testing for anaesthesia in such patients was by pricking them with pins. So it seems sadly ironic that one form of self-mutilation often associated with hysteria was that of so-called “needle girls”. This term, which appears in the Anomalies and Curiosities of Medicine (1896), referred to a “peculiar type of self-mutilation … sometimes seen in hysteric persons” of “piercing their flesh with numerous needles or pins”.
Once again, an absence of pain was seen as the key to understanding self-inflicted injury, whether or not the patient’s professed motive for carrying out the act was explored. While it might seem obvious to a reader today that physical damage to the body must be considered painful, it is fascinating to consider that the widespread assumption among nineteenth-century clinicians was that self-inflicted injuries could not be – and therefore were not – painful to those who practised them.