Trauma narratives and self injury in psychiatry and live art

Etymologically, the word trauma refers both to a physical wound, such as a cut and to a psychic wound, an experience that overwhelms the subject, eluding the subjects ability to articulate it and thereby achieve some kind of lasting catharsis. Given this etymological link between the physical and the psychological it is no surprise that narratives of psychological trauma appear frequently within psychiatric literature on self-injury wherein self-injurious practices like cutting, burning, biting, scratching and hitting ones own body, interfering with wound healing, trichotillomania (hair pulling), the ingestion of toxic substances and so on, are explained as attempts to articulate psychical trauma.

These acts are framed within psychiatric, psychological and popular discourses variously as deliberate self-harm, self-inflicted violence, partial suicide, anti-suicide, non-suicidal self-injury, delicate self cutting, wrist cutting syndrome and in older or more sensationalist literature, self-mutilation.1 For the sake of consistency I shall adopt the term self-injury in reference to this literature because it is slightly less overtly pejorative than words like suicide, harm, violence and mutilation. However, the term injury is derived from the Latin, injuria, which means wrongful action, hence injury also has negative moralistic connotations. Whatever term is

A large body of medical, psychological and popular literature exists on self-injury. The first psychiatric text on the subject was Armando Favazzas book, Bodies under Siege: Self-mutilation and Body Modification in Culture and Psychiatry, published in 1987. Since then thousands of books, journal articles, newspaper and magazine articles, websites and pamphlets about self-injury have been published. These range from professional clinical literature designed to understand and devise ways to treat self-injury to self-help books intended to assist people to cease self injury, or to assist non-professionals who care for people who self injure, such as parents and friends, to support loved ones who self-injure. 1

used, the defining feature of self-injury within the literature is the explicit intent to cause tissue damage.2 Again, the term damage implies the destruction of something previously perfect and whole.3 The conflation of morphological perfection or beauty with wholeness, and conversely, imperfection with ugliness and illness can be traced at least as far as Platos doctrine of the Forms.4 This is the (often tacit) aesthetic and moral tradition that informs much of the literature on self-injury.5

Trauma and self-injury in psychiatry

The literature on self-injury is extensive and complex however it has one overall function to refer volitionally injured, bleeding bodies to a discourse of psychopathology. Specifically, the literature usually but not always6 distinguishes between decorative body modifications such as piercings and tattoos and so-called pathological cutting with recourse to the individuals attitude to pain and blood. The assumption is that those who desire decoration dislike the pain and blood but endure it

E. David Klonsky, Non-suicidal self-injury: an introduction. Journal of Clinical Psychology 63, no. 11 (2007): 1039-43. 3 Cite Susan Stryker and Nikki Sullivans argument that bodily integrity is a normative structure of contemporary perception in their work on BIID (Bodily Integrity Identity Disorder) in Kings Member, Queens Body: Transsexual Surgery, Self-Demand Amputation and the Somatechnics of Sovereign Power in Nikki Sullivan and Samantha Murray (eds) Somatechnics: Queering the Technologisation of Bodies (Surrey, Ashgate: 2009): 49-65. 4 Reference? 5 For example, Steve Levenkron describes what he calls self-mutilation as extreme and gruesome and body modification (piercing, tattoos) as repugnant (2006: 223). 6 Sharon Klayman Farber, When the Body is the Target, Self-Harm, Pain and Traumatic Attachments (New Jersey: Jason Aronson, 2002). 2

in order to acquire a product7 whereas [w]hen the self-mutilator cuts herself she is usually in a trance state, seeking out the pain and blood.8 It is the desire for pain and blood itself that is coded as pathological. Further, self-mutilation is distinguished from masochism, where pain alone is an end in itself.9 Hence, the desire to bleed is the problem. The act of injuring oneself is referred to a discourse of psychopathology. For example, psychiatrists Daphne Simeon and Armando R. Favazza write, The phenomenon of people physically hurting themselves is heterogeneous in nature, disturbing in its impact on the self and on others, frightening in its blatant maladaptiveness, and often indicative of serious developmental disturbances, breaks with reality, or deficits in the regulation of affects, aggressive impulses, or self states.10 While psychologist Steve Levenkron asserts, such pathological behavior is as repellant to the psychological community as it is to the general public.11 There are numerous examples of similar statements throughout the literature. Here, to injure oneself is constituted as an index of an underlying emotional and/or psychological disorder, literally an inability to correctly manage ones emotions.12 The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is used in

This is a capitalist concept, where one exchanges labour (enduring pain) for a product (tattoo, piercing) whereas pain and blood are somehow positioned outside of the commodity market in this context. 8 Levenkron, 2006: 22-3. 9 ibid pp26 10 Daphne Simeon and Armando R. Favazza, Introduction in Daphne Simeon and Eric Hollander (eds) Self-Injurious Behaviors Assessment and Treatment (Washington: American Psychiatric Publishing, 2005): xi. 11 Steve Levenkron Cutting: Understanding and Overcoming Self-Mutilation (Lions Crown, 2006): 10 12 How are the clinicians affects, disturbing and frightening, functioning? Where do these affects come from? What does this say about culturally shared ideas of normal and abnormal bodies? 3

clinical settings by mental health professionals, especially psychiatrists, to identify, classify and diagnose mental illness. DSM-IV-TR lists self-injury as a symptom of borderline personality disorder (BPD) and notes that self-injury may also be a feature of other diagnoses including depression, anxiety disorders, post-traumatic stress disorder, schizophrenia, several personality disorders other than BPD, substance abuse and eating disorders.13 My task is not to enter into a discussion of the complexities of each diagnosis and the position of self-injury within it. My point is only that the DSM narrows and standardizes the significance of the aforementioned practices by providing a language of pathological subjectivities through which the subject who cuts is interpellated.14 Moreover, these processes of diagnosis are driven, in part, by the strong affective impact that bleeding bodies have on mental health professionals, such as fear and repugnance.15 There is often a voyeuristic (sexual?) element to some clinicians fascination with self-injury. For example, Sharon Klayman Farber perceives body modification as a passive form of self-mutilation.16 Speculating on the reasons why a person may choose to have body piercings, Farber describes in intimate detail how nipple, genital and tongue piercings increase their own [the piercees] sexual excitement [and provide] greater stimulation to the partner during oral sex.17 Farber continues, [o]thers may frequent clubs where they are likely to find vampires, people who
13

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (Washington DC: American Psychiatric Association, c2000). 14 Interpellation is the process by which naming a thing brings it into existence as such. Althusser argued, [a]ll ideology has the function (which defines it) of constructing concrete individuals as subjects, ideology being nothing but its functioning in the material forms of existence of that functioning. For Althussers ideology is not an abstract superstructure opposed to a material substructure; it exists only as multiple immanent, material events of interpellation. 15 Why do bleeding bodies have this effect on witnesses? 16 Sharon Klayman Farber, When the Body is the Target, Self-Harm, Pain and Traumatic Attachments (New Jersey: Jason Aronson, 2002): 20. 17 ibid p21 4

enjoy bloodletting and bloodsucking.18 Faber includes consensual sadomasochism as self-mutilation and describes masochism as a sexual perversion.19 She follows Stoller, who defined perversion as Farber also describes sex-change surgery as an unnecessary and mutilating surgery.20 Klayman Farber does not explain how choosing to undergo a body modification like a tattoo, piercing or scarification is in a passive action. She does not engage with the voices of trans people, for many of whom sex reassignment surgery is vital for their physical, mental, emotional and spiritual well being.21 Klayman Farbers voyeuristic gaze upon, and unproven assumptions about, the sexual practices of pierced people and so-called vampires, and her dismissal of the agency and desires of modified people and trans people, objectifies those whose bodies and desires are other to her own. Moments like this demonstrate that her text, and others like it, functions according to subject/object dialectic whereby the clinician knows and speaks while the modified other is known about and silenced. In response I would diagnose the clinician as an epistemophiliac; one who fetishizes their own knowledge of the other.

[Bleeding bodies as confessional texts (Foucault)] According to Levenkron, the psychopathology of cutting is the fact that the so-called self-mutilator turns inwards, reduces her sense of relating to others, and reduces her sense of relating to others in general.22 Treating her pain symptomatically substituting physical pain and blood for the emotional pain is considered

18 19

ibid p21 ibid pp76-7 20 ibid p21 21 Cite The Transsexual Empire Strikes Back 22 ibid pp42 5

pathological because she is not externalizing her pain; she fails to bring her pain outside herself, where it could be diffused, shared, examined.23

Levenkron explains that his purpose in writing a book about so-called self-mutilation was, first, to invite its [self mutilations] victims to come out from their emotional hiding places and disclose who they really are; second, to encourage more interest (and discourage revulsion) on the part of the mental health community so the more research will be done; and lastly, to help those afflicted.24

[Trauma Narratives and self-injury]

Trauma Narratives and Self-Injury in Live Art

Abjection

23 24

ibid pp42 ibid pp19 6