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‘Delicate’ Cutters: Gendered

Self-mutilation and Attractive Flesh in
Medical Discourse

BARBARA JANE BRICKMAN

In the mid- to late-1990s a mass of articles, books, and popular fiction (both in
print and on film) warned against a growing ‘epidemic’ of self-harm, particularly
among a young female population.1 Several medically-oriented texts (Conterio
and Lader, 1998; Favazza, 1996; Strong, 1998) led the charge to better understand
and treat what has been likened to an addiction: self-mutilation or ‘direct, delib-
erate destruction or alteration of one’s own body tissue without conscious
suicidal intent’ (Favazza, 1996: 225). In the late 1960s and 1970s, a cutter profile
was created by the first confluence of psychiatric interest in a ‘delicate’ form of
self-mutilation: the delicate cutter is typically a white, adolescent girl. However,
despite warnings from recent researchers like Favazza and Conterio and Lader
that cutting ‘is not simply a problem of suburban teenage girls’ (Strong, 1998: 19,
my emphasis), that picture of the typical ‘cutter’ appears again and again in
popular articles and fiction.2 In short, the white, suburban, attractive teenage girl
persists as the face of self-mutilation. Whether in the admissions of Princess
Diana on the BBC or in episodes of Beverly Hills 90210 (‘Skin Deep’, 1998) or
7th Heaven (‘Cutters’, 1998) or in popular media (from Sassy or Seventeen

Body & Society © 2004 SAGE Publications (London, Thousand Oaks and New Delhi),
Vol. 10(4): 87–111
DOI: 10.1177/1357034X04047857

www.sagepublications.com
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[Pederson, 1996; Tood, 1996] to The New York Times Magazine [Egan, 1997]),
the tragic culprit is always the same.3 For example, The New York Times
Magazine article contends that women ‘seeking treatment for self-injury’ far
outnumber men, while also recognizing that ‘among adolescent injurers, the ratio
of boys to girls is near equal’ (Egan, 1997: 23); however, it still features Jill
McCardle in a full-page portrait facing the title page.4 McCardle solemnly stares
down the camera, dressed in her cheerleading uniform with her arms pinned
behind her back (hiding her scars or holding a pair of pom-poms in typical cheer-
leader stance?). Egan describes her as ‘5 feet, 10 inches with long blond hair, green
eyes and an underbite that often makes her look as if she’s half-smiling . . . Jill
cuts an imposing figure for 16’ (1997: 21). The story of this ‘popular’ winner of
her cheerleading squad’s ‘coveted Spirit Award’ recalls a collection of case
histories and psychiatric statistics and diagnoses from the 1960s and 1970s that
fret over this curiously ‘feminine’ disorder. But, before addressing the popular
re-emergence of this typical cutter myth which includes its feature film debut in
James Mangold’s 1999 adaptation of Susanna Kaysen’s Girl, Interrupted, we first
need to examine the scientific (or medical) discourse that produced the myth in
the first place.
Beginning in 1960 with Offer and Barglow’s paper in Archives of General
Psychiatry, psychiatrists began documenting with growing frequency a relatively
new ‘syndrome’. Eventually termed ‘delicate self-cutting’, a new model for
‘typical’ self-mutilative behavior, usurping Menninger’s (1938) suicidal gesture
model, was developed in conjunction with a description of the typical cutter.
Psychiatric professionals devoted a steadily increasing amount of research time
to this new breed of mutilators, and, by the mid-1970s, they were able to propose
the profile of the typical cutter: young (adolescent to just-post-adolescent),
female, and almost always attractive. Although at least one pair of later
researchers seeks to dispel ‘the myth’ of the typical self-mutilator within the
scientific discourse (Ross and McKay, 1979: 11), their same study contributes to
it by focusing only on 71 adolescent females in a Canadian training school, after
having just insisted that self-mutilation ‘is not a phenomenon which is to be
found only in girls, or only in institutions, or only among disturbed delinquents’
(1979: 9). Similarly, the persistence of the early diagnoses and characterizations
might be perceived in the amount of work Favazza (1996) must do to diffuse the
myth, while still being intrigued by the numbers of adolescent (probably female)
skin-cutters currently documented. Therefore, despite recent efforts to change
the nature of research on self-mutilation, the model developed by psychiatric
studies decades ago and created from a particular social bias that pathologizes the
female body continues to work in both scientific and popular discourses today.
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Feminists (as far back as Wollstonecraft in the 18th century) have opposed
exactly this sort of defining and pathologizing of the female body and female
behavior in relation to the body; they have sought to expose the mechanisms of
social control, surveillance, and medicalization that attempt to constrict, redefine,
and manage those bodies. ‘Second wave’ feminism in particular examined both
representations of the female body and the material body itself as a ‘site of
political struggle’:
feminism imagined the human body as itself a politically inscribed entity, its physiology and
morphology shaped by histories and practices of containment and control – from foot-binding
and corseting to rape and battery to compulsory heterosexuality, forced sterilization, unwanted
pregnancy, and (in the case of the African American slave woman) explicit commodification.
(Bordo, 1993: 21–2)5

Furthermore, one of the major forces that aided in the containment and control
of female bodies was the authority of science and/or medicine. Feminists argue
that, beginning in the 19th century, science, and particularly the medical
profession, took women as an object of study as a way to give authority to social
and economic distinctions between men (public/work) and women
(private/home), distinctions which in turn ‘meshed ideally with the needs of the
maturing economy, which would increasingly depend on the economic pattern
of individual domestic consumption to fuel its growth’ (Ehrenreich and English,
1978: 25). This medicalization of the female body works by first, making scien-
tific or medical assessments of certain behaviors or conditions as healthy or ill,
which then are excised or controlled as deviant behaviors that threaten the social
norm (Riessman, 1992: 124; see also Bordo, 1993; Martin, 1990, 1997; Shilling,
1993). Additionally, much feminist writing of the 1980s and 1990s expanded
upon Michel Foucault’s study of medicalization and his insistence that medical
discourses as ‘pathways of modern power’ help structure social relations and
even construct bodies, most insidiously by influencing subjects to police them-
selves (Bordo, 1993: 26; see also Shilling, 1993; Terry and Urla, 1995).6
Mindful of the feminist tradition cited above, I would first like to propose that
the medical discourse on ‘delicate’ cutting pathologizes the female body, relying
on the notion of ‘femininity as a disease’ (Ehrenreich and English, 1978: 99).
Paula Treichler suggests that by the late 1990s, when her chronicle of the AIDS
epidemic was published, ‘it is a commonplace of feminist scholarship to claim
that medical discourse represents women’s bodies as pathological and contami-
nated’ (1999: 42), but she reminds us that scholarship remains committed to
examining how certain discourses, such as the medical, come ‘to enact, and by
default, to reinforce deeply entrenched, pervasive, and stubbornly conservative
cultural narratives about gender’ (1999: 45–6). If, therefore, because of work by
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feminists like Treichler (1999), Martin (1990), or Bordo (1993), I can assume an
antagonistic relationship between medical discourse and women’s bodies, as well
as the ‘constructed’ nature of that medical discourse, which is as likely to be
produced by as to produce ‘conservative cultural narratives about gender’, then
the project of this article is to illustrate again how these narratives about gender
work in medical discourse, particularly psychiatric studies.7 Further, I contend
with Treichler that popular and biomedical discourses are part of the same
continuum, not a dichotomous pair – unmediated truth and heavily-mediated
fiction. Culture works through both, most obviously in the form of language,
and both have a specific social context in which they function. The semi-
epidemic of self-cutting emerged onto the medical scene most strongly in the late
1960s and early 1970s and was found in a particular group of females.8 Gender
lines were drawn again, and the female body was viewed as pathological at a time
when, specifically in the USA, the emergent Women’s Movement was beginning
to contest gender roles. The antagonism between the pathological female body
and medical discourse, in this case, seems obvious enough, but how the medical
discourse and material bodies interrelate and interact with each other and with
the cultural narratives around them remains an important question for a feminist
scholar. Interestingly, while, for instance, eating disorders have been studied
extensively, little feminist attention has been given to cutting or self-mutilation,
with the exception of a few works that unquestioningly reproduce the early
studies (Kaplan, 1991; Pitts, 1998, 1999; Strong, 1998). This article hopes to show
that such attention is not only warranted but necessary.
Few of the psychiatric studies I read ask what society’s role may be in encour-
aging, supporting, or even causing the self-mutilative behavior and, further, what
sort of cultural assumptions, particularly about femininity or the body, direct
their own work. Therefore, this article will investigate how the diagnosis and
profile of a ‘typical’ cutter was made within the psychiatric discourse – a
discourse influenced by ‘culturally lodged research goals’ (Terry and Urla, 1995:
3). I have chosen the major, most respected, and most influential studies about
‘delicate’ self-mutilation in an attempt to address the creation of a new
syndrome.9 Excluding other forms of self-mutilation such as burning, head-
banging, self-biting, ingestion of harmful items and chemicals, etc., I selected
delicate self-cutting because it is one of the most frequently observed (and
reported) forms of self-mutilation and because of the instances of cutting in
popular media. Lastly, although anorexia nervosa, bulimia, and other eating
disorders will be of interest to this article and provide suggestive parallels, they
will not be my main focus. The complexity, gravity, and import of the topic of
eating disorders merits an in-depth discussion not possible here (and is also well-
covered by many feminist, and other, analyses). In conclusion, I will return to
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the recent popular accounts in an effort to caution against the continuing

production of the delicate cutter myth. Focusing centrally on representations of
self-mutilation in a recent popular film, Girl, Interrupted, as well as the memoir
that inspired it,10 I hope to illustrate not only the perpetuation of the myth of
this ‘typical’ self-mutilator but also the writer’s and filmmaker’s inability to
recognize the constructed and gendered nature of the medical discourse in the
case of self-mutilation, despite feminist critiques of medicalization since the
1970s.

The Emergence of ‘Delicate’ Cutters as Patients

In a 1960 article in Archives of General Psychiatry, Doctors Daniel Offer and
Peter Barglow report a rash of approximately 90 incidents among young adult
patients at a general psychiatric hospital. The patients startlingly attack their own
bodies in ways ranging from a ‘mild scratch to deep lacerations made with razor
blades that required sutures’ (1960: 194). Although Offer and Barglow’s next,
more detailed, account includes 12 patients, eight female and four male, not until
a study the next year does the disparity between the sexes in cases of self-
mutilation become a focus (Phillips and Alkan, 1961). In that study of 121 muti-
lators, the ratio climbed to nearly three to one, with 93 female cases to 28 male
cases (1961: 421). Phillips and Alkan’s assessment of this difference initiates a
characterization of self-mutilation that will reach its clearest and perhaps most
influential definition in Ping-Nie Pao’s ‘syndrome of delicate self-cutting’ eight
years later; they observe that ‘the attacks of the males upon themselves were apt
to be far more violent in nature’ and, ‘whereas the great majority of the women
examined either scratched, picked or dug at their skin, often causing bleeding’,
the men tended to strike themselves violently, causing much bruising (1961: 422).
The study concludes, in comparison with the statistics on male suicide, that
‘mutilation of the body short of suicide is predominantly a female phenomenon’
(1961: 423).
Only six years later, in an attempt to address what they view as a growing
trend, researchers advance from one case history to the ‘typical young woman
who slashes her wrists’ (Grunebaum and Klerman, 1967: 527) – a case history
remarkably similar to Phillips and Aklan’s earlier account of a young woman
named ‘Alice’, who is 28 years old, blonde, a college graduate and an artist. In
their article, simply titled ‘Wrist Slashing’, the two doctors make a composite
from a group of female patients at the Massachusetts Mental Health Center ‘for
whom wrist slashing is a major symptomatic manifestation of their psychiatric
disorder’ (1967: 527). The ‘typical’ model they create is one that will become
increasingly familiar throughout the decade, into the 1970s, and one that, more
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recently, appears in The New York Times Magazine article as well as in Girl,
Interrupted: she is a ‘young, attractive, intelligent, even talented, and on the
surface socially adept woman who generally appears “normal” except when peri-
odically overwhelmed by inner emotional tensions’ (1967: 527–8). In conjunction
with another study published in The American Journal of Psychiatry that same
year which also found the cutter to be ‘an attractive, intelligent, unmarried young
woman, who is either promiscuous or overly afraid of sex, and unable to relate
successfully with others’ (Graff and Mallin, 1967: 38), Grunebaum and Klerman’s
article begins to solidify who the self-mutilator is, what she does, and why she
does it.
Identified by Graff and Mallin as ‘the new chronic patients in mental hospi-
tals, replacing the schizophrenics’ (1967: 36), female self-mutilators, who
commonly cut their wrists, quickly become the subjects of intense scrutiny. They
are also deemed by nearly every study I came across to be a source of ‘staff
friction and misunderstanding’ (Grunebaum and Klerman, 1967: 529) or, worse,
the targets of anger, disgust, horror and sadness on the part of their care providers
(Favazza, 1996: 289). In short, they are a difficult, and ever-escalating, problem
to solve. The studies mentioned above begin to search out possible roots or
causes for the problem and describe the process the self-mutilator goes through
in terms repeated in almost all studies and fictional accounts up to, and beyond,
Favazza in 1996: the patient feels a mounting internal, emotional tension (for any
number of reasons) that builds and is incredibly accelerated by the thought of
cutting, until the moment of climax – the cutting itself – which is often accom-
panied by little or no pain and results in a feeling of great release and relief. In
contrast to the consistent accounts of the process, the reasons for the tension or
causes of the self-mutilation are not quite as easily identified or simplified and
prove highly contested. Graff and Mallin, as well as Grunebaum and Klerman,
however, do not find causes so very complicated. The former are the more
specific, citing ‘maternal deprivation’ (1967: 41), while the latter prefer the more
democratic assessment that ‘the patient feels unwanted and rejected by both her
parents’ (1967: 528, my emphasis). However, Pao (1969), in his influential article,
initiates a trend of much more creative diagnosis.
Pao’s article, ‘The Syndrome of Delicate Self-cutting’, appears in the British
Journal of Medical Psychology (1969) along with studies and comments by four
other speakers at a ‘symposium on impulsive self-mutilation’ held two years
earlier. Pao, though, stands out as the only one who attempts to name a new
syndrome. He divides his patients, who ‘willingly opened a wound on their body
by using a sharp instrument’, into two groups: ‘coarse’ cutters who cut deeply,
close to vital points, and ‘delicate’ cutters who make repeated, superficial,
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‘carefully designed incisions’ (1969: 195). Out of 32 self-cutters, 27 were ‘delicate’

cutters and 23 of those were women. Perhaps related to the female to male ratio
of more than five to one and reminiscent of Phillips and Alkan’s study, the
delicate self-cutters were also less often ‘psychotic’ than their coarse counter-
parts.11 For the rest of the paper, Pao develops a profile of the delicate self-cutters
from his own intensive therapy with three of the females in his sample, nearly
entirely ignoring the four male cases. Like Graff and Mallin, he finds a history
of maternal deprivation, as well as an inability to fit in socially; contrastingly, his
patients do maintain a kind of ‘normal’ life, holding down jobs, etc., but they also
often exhibit other troubling symptoms, such as bulimia or anorexia, swings of
depression and elation, promiscuity, ingestion of sharp objects, attempted arson,
and the burning of their own skin, usually with cigarettes (1969: 196).
In his search for a cause, Pao discovers more suggestive roots for the behavior.
Most of the cutters in his study of ‘both sexes showed an incredible uncertainty
of sexual identity’ (1969: 197) and the greater emphasis on sexual identity
problems enables Pao to arrive at a different conclusion from his predecessors:
for his patient whose ‘primary struggle was concerned with her penis envy and
her anxiety about castration,’ cutting seemed ‘to be a symbolic expression of a
denied, yet accepted, castration’ (1969: 202). Pao’s tentative conclusion provides
a perfect answer for the question of the higher incidence of female cutters and,
here, one begins to see the path offered for the unfortunate few male delicate
cutters, who were ‘pretty boys’ and ‘quite effeminate’ (1969: 197); according to
the medical discourse, these male cases must almost inevitably be the result of
inversion. Further, this ‘sexual identity crisis’ reading is supported by articles
about the most troubling coarse cutters: self-castrators. Other researchers find
that the most commonly cited reasons for self-castration ‘involve[d] a wish to be
or delusion of being female, homosexual feelings, real or imagined somatic
illness, and problems with heterosexual feelings’ (Greilsheimer and Groves, 1979:
443). For these doctors and psychiatric researchers, self-mutilation, even in men,
can be nothing other than a feminine disorder centered around the initial denial
of, and then subsequent symbolic or surgical acceptance of, castration – a reliving
of that defining feminine lack.
However, before I address how the explanations of this feminine epidemic of
self-mutilation arise from and reinforce cultural myths about gender, I would like
to mention an intriguing, yet minor, point in Pao’s study. During a description
of one female patient’s pattern of cutting behavior, Pao remarks in a footnote that
the ‘events leading to this cutting are strikingly similar to the description of
Deborah Blau given by Green (1965, pp.501)’ (1969: 200). In the midst of refer-
ences from nearly 40 other medical texts and journals, Pao cites a character from
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a novel published five years earlier without further reference to the nature of his
source or any discussion of whether or not his patient may have read the novel.
The thinly-veiled autobiographical novel I Never Promised You a Rose Garden
was published in 1964 and written by Joanne Greenberg under the pseudonym
‘Hannah Green’. A national bestseller and later a Warner Brothers film directed
by Anthony Page (1977), the novel follows the mental anguish and eventual
healing of a possibly schizophrenic 16-year-old girl named Deborah Blau, who
enters a private psychiatric hospital after an episode of ‘silly and theatrical wrist
cutting’ (Greenberg, 1964: 16). She insists that she ‘was not attempting suicide,
but making the call for help’ (1964: 40), and her parents take this action as the
final sign that Deborah is sick, soon after which she enters the hospital.
Deborah’s episode cited by Pao does noticeably resemble the accounts given
in case histories in the earlier self-cutting articles. As she begins to feel further
and further removed from outside ‘reality’, the tension builds and she takes the
only sharp object nearby, the top of a tin can, and drags it down the inside of her
upper arm: ‘There was no pain, only the unpleasant sensation of the resistance of
her flesh’ (1964: 51). After the cuts were made ‘ten times or so up and back until
the inside of the arm was a gory swath’, Deborah, now relaxed, falls asleep.
Luckily, with the help of a gifted and kind (and famous) psychiatrist – based on
Frieda Fromm-Reichmann, who was the author’s own doctor (Favazza, 1996:
250) – Deborah gets the help she needs. In the inside cover of the New American
Library edition, Karl Menninger himself assures the reader that the novel ‘will
have a good effect on lots of people who don’t realize that this sort of exploration
can be done and this sort of effect achieved’. What I would like to emphasize
here is the clear representation in Pao’s article of the ‘continuum’ Paula Treichler
finds between popular and biomedical discourses. Pao blends ‘scientific’ fact and
novelistic fiction effortlessly and without comment, while Menninger can offer
Greenberg’s book as a promotion and validation of the difficult work of
psychiatry. These two spheres not only cannot be separate, but refuse to be.
Following Pao’s declaration of a syndrome, few studies question the existence
of a female cutting phenomenon.12 Indeed, the most notable of Pao’s successors
(Rosenthal et al. at Mt Sinai Psychiatric Institute) dutifully support his findings:
the ratio of female to male cutters is more than two to one and the researchers
eventually exclude those male cutters from the study, since ‘the findings were so
different from those of the women’ (Rosenthal et al., 1972: 1363). They reiterate
that the ‘typical chronic cutter’ is an ‘attractive, intelligent young woman, but a
wanderer who forms impaired relationships’ and that ‘there was a striking
history of maternal deprivation’ among the young women in their study (1972:
1364). However, this study concerns itself mostly with the ‘meaning of the
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gesture’, rather than with the description of a typical cutter, and here it differs
slightly from Pao’s hypothesis. Rosenthal et al. tie the self-mutilatory ‘gesture’ to
the cutters’ ‘marked difficulties with menarche’ and ‘confusion about their sexu-
ality’, causing them to deal with ‘genital trauma and conflict centering around
menstruation’ by cutting themselves and thus controlling their own bleeding far
away from the genitals (1972: 1364, 1367). Without calling it castration anxiety,
preferring the more scientific-sounding ‘genital trauma’, the study returns the
self-mutilatory act to the haunting female wound that will not heal and also
conjures up the spectre of hysteria, the original womb disorder: these hysterical
girls deal with the betrayal of their out-of-control bodies by striking out (though
in the end only harming themselves) in mute protest. It is no wonder the 11 male
cutters did not quite fit in the study.

The Meaning of the Gesture

As I suggest in the introduction, some feminists have challenged ‘the social
relations of science and technology, including crucially the systems of myths and
meanings structuring our imaginations’, particularly those myths surrounding
the female subject and/or body (Haraway, 1991: 163). De Beauvoir (1953) made
famous the myth of woman and her feminine ‘nature’ – both passive and danger-
ous, masochistic and destructive, infantile and motherly, frigid and sexually
predatory – the same myth supported by scientific experts and medical
professionals (particularly psychiatric or psychoanalytic) since at least the 19th
century. Furthermore, those feminists alluded to by Donna Haraway exhaus-
tively examine the way that science has reinforced each of the elements of the
feminine myth. For example, Jacobus (1990) and Poovey (1990) challenge the
representations of female desire and sexuality as dangerous or in need of control,
especially in relation to prostitution and reproduction. Similarly, other feminists
contest the accounts of supposedly inherent masochism in women, a masochism
that leads ‘experts’ to encourage motherly sacrifice (Ehrenreich and English,
1978: 244). Of course, behind this idea of inherent masochism lies the central
notion of passivity so important to Freud’s own conception of femininity and its
associated neuroses. In nearly all the examples cited above, feminist protest pits
itself against this passivity. In fact, Bordo recognizes the dichotomy of
active/male and passive/female, first manifested in the mind/body duality of
Aristotelian philosophy, as ‘one of the most historically powerful of the dualities
that inform Western ideologies of gender’, and she notes that the implications for
the (female) body are that it ‘simply receives and darkly, dumbly responds to
impressions, emotions, passions’ (1993: 11, original emphasis). As I think I have
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already begun to show, the medical discourse on ‘delicate’ cutting employs these
myths of femininity in the process of pathologizing both the behavior of the
female bodies and the bodies themselves.
Rosenthal et al.’s interpretation of the gesture of cutting as a reaction to the
genital trauma of menstruation, which they admit is ‘largely speculative’ and
countered by Pao’s own note that his patients’ ‘reaction to the first menstrual
experience was not consistently traumatic’ (1969: 197), is reinforced not only by
the statistical elision of male patients but also by the employment of descriptive
language and the traits historically marked as female. Beyond the female
biological functions the Rosenthal study envisions being mirrored by the cutting,
their argument relies upon cultural conceptions of femininity. Adolescent girls
first experiencing menarche are confronted by a ‘passive, frightening process’ and
gain control through cutting, though they ultimately express ‘fear at their own
aggression’ (1972: 1367, 1366). This study, along with many others, views self-
mutilation as the demi-aggressive act (only turned on oneself and generally
feared) of a passive individual – the position most often presumed for the female
in our society. Graff and Mallin assert that ‘this pattern of behavior is usually
explained by the fact that a girl is trained to be more passive than a boy’ (1967:
40), and a later study assures us that young, attractive female mutilators ‘appear
incapable of an aggressive thought or impulse’, and ‘certainly passivity and
submissiveness are two of their outstanding characteristics’ (Asch, 1971: 604).
The psychoanalytic discourse, in the conclusions of Robert Burnham,
predictably connects the passivity of the female with its paired term, masochism,
contending that ‘the occurrence of such a masochistic symptom mainly in
females simply follows from normal feminine masochism’ (1969: 223). State-
ments such as these make one wonder why every adolescent girl is not a cutter,
since they would only be following their ‘normal’ feminine impulses.
The passive ‘nature’ of the female, her inability to act out, affirms her essen-
tial femininity and makes self-mutilation a foregone conclusion. The female is
too passive and enjoys pain too much to reply to the frustrations, disappoint-
ments and terrors of life – parental deprivation, childhood illness, castration and
penis envy and hormonal surges – in any other way. Accordingly, many studies
eagerly note the undeniable ‘femininity’ of their subjects. The cutter never fails
to be ‘attractive’ or ‘appear’ normal. For Pao’s patients, even though ‘they might
have lived through a prolonged period as a tomboy, most of them were still strik-
ingly feminine’, and I have already noted the ‘pretty boys’ in his study (1969:
197). He further shares that ‘though [one patient] was over six feet, with a heavy
frame, this still did not detract from her feminine look when she was dressed up’.
Despite the troubling recognition of sexual confusion, the studies insist on the
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notable ‘femininity’ of their subjects, which goes hand in hand with masochistic
female passivity and further supports the image of the typical mutilator as
‘attractive’ to the almost exclusively male doctors and researchers. (Rosenthal et
al. include one female researcher; all the others cited above are men.) Also notable
here, in the insistence on femininity, might be the doctors’ anxious disavowal of
the active masculinity in their patients. In her work on ‘female masculinity’,
Judith Halberstam recognizes a ‘compulsory femininity’ that is pressed on all
adolescent girls, especially ‘tomboys’: ‘tomboyism for girls is generally tolerated
until it threatens to interfere with the onset of adolescent femininity. At that
point, all attachments to preadolescent freedoms and masculine activities must be
dropped’ (1998: 193, 268). Perhaps the studies on self-cutting are reacting to
active, ‘masculine’ acts by insisting upon and reinforcing that compulsory femi-
ninity.
The passive, masochistic model is joined by another disquieting element found
across the studies. Self-mutilation is an ‘infantile’ and ‘primitive’ act performed
by someone who refuses the responsibilities and social pressures of adulthood or
who cannot properly express herself in a civilized manner (i.e. speech). At the
time of puberty, when faced with the coming pressures of adulthood, the muti-
lator ‘regresses to an earlier stage of development’: ‘Frequently these girls, like
infants, appeared to be totally self-centered, unable to delay gratification of their
needs, demanding attention and preoccupied with their bodies and bodily
processes’ (Ross and McKay, 1979: 53). Asch and Graff and Mallin both describe
patients as ‘infantile’ or ‘child-like’ and many other studies recognize the role of
‘regression’ as a way for the self-mutilator to repress or deny the conflicts of
puberty (Asch, 1971; Pao, 1969; Rosenthal et al., 1972). Again, these same studies
note the ‘primitive’ form of expression chosen by the self-mutilator, who prefers
‘physical, preverbal messages over other more accepted methods’ (Graff and
Mallin, 1967: 39). Accordingly, Nelson and Grunebaum suggest that ‘increased
verbal expression of feelings’ enables some mutilators to be ‘clinically and
socially improved’ (1971: 1347). Masochistic, passive, child-like, preverbal, and
more physical sound like descriptors tailor-made for the woman’s disorder: femi-
ninity. The ‘entrenched, pervasive, and stubbornly conservative cultural narra-
tives about gender’ certainly prepare one to recognize a ‘delicate’ but inarticulate,
or even manipulative, form of communication as female (Treichler, 1999: 45–6).
In fact, the claims in these studies deny any other possibility: cutting is
performed by females because femininity and cutting are nearly identical.
One could even question the naming of the disorder itself. Pao’s terminology,
‘delicate’ self-cutting, clearly engenders connotations of frailty, daintiness and
fragility and, after reading description after description of attractive, young
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females, one begins to wonder if ‘mutilation’ would be used so readily to describe

wounded skin on a less appealing body. The very appearance of the delicate
feminine skin being savaged must play some role in the shock and discomfort
experienced by the health care professionals on the scene. The action could only
produce such a severe response, noted by Offer and Barglow, Favazza, and
others, if this skin was perceived as more precious, more fine, and more in need
of protection. Similarly, one might ask the same questions of studies on self-
castration. Would such an act be singled out for documentation if a less prized
pound of flesh was chosen? Simply put, the term ‘self-mutilation’ itself assumes
a certain privilege or sanctity for certain flesh that dictates how the behavior is
perceived. Violations of that sanctity are often viewed as grotesque or outside the
bounds of ‘normal’ or accepted behavior.13 Mutilation by definition presumes an
ideal that the cutter or burner maims and mars, thereby committing an almost
sacrilegious act – an act in defiance of the cultural mores professing faith in the
ideal body.
To summarize, the studies above, most published between 1960 and 1979, are
influenced by and reinforce the myths and meaning of gender difference. During
those years in the countries where the studies took place (mostly Canada and the
USA), the women’s rights movement was actively and vocally seeking equality
for women in every aspect of society. I would contend that the psychiatric
discourse on self-mutilation above reflects, counters and often seeks to under-
mine the changes sought by the women’s rights movement, and, as feminists like
Poovey (1990) and Jacobus (1990) have shown, one of the most often opposed,
pathologized and feared sources of power is female sexuality or desire. Promis-
cuity and other sexual ‘abnormalities’ certainly appear in many of the self-muti-
lator case histories. Graff and Mallin observe the opposite ends of sexual
deviancy, finding that half of their subjects ‘had excessive sexual experience,
promiscuity, homosexuality, and even overt incestuous activity (though none
experienced orgasm)’, while the other half ‘were almost painfully frightened of
the opposite sex’ (1967: 38). Predictably, Pao is guided by his sexual identity
confusion thesis, observing that female patients, ‘themselves being tomboys,
usually preferred male companions. They had no girlfriends’ (1969: 197), while
Asch, in his collection of depressed cases, attributes ‘their characteristic promis-
cuity’ to a ‘need to maintain contact and closeness with their objects at any price’
(1971: 604). On the other hand, Rosenthal et al. take it upon themselves to refute
Graff and Mallin and report that in their study ‘only three of the patients could
be considered promiscuous, and one had had homosexual experiences. Promis-
cuity was more common in the control group’; however, they do still propose
‘confusion of sexual identification among the cutters’ because 65 percent of them
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‘felt more like their fathers than their mothers’ (1972: 1365). One might wonder
whose definition of promiscuity or sexual deviance is being offered here and
what gender norms are being desperately defended. The cutters are at one
moment feminine, infantile and passive victims and, at the next, unsettling sexual
deviants. A lot of work is going into the maintaining of the status quo and, almost
predictably, not only the wayward girls but also their parents must be brought
into line.
As the Rosenthal et al. citation above hints, the changing family situation
brought about by the women’s movement wherein more women were seeking
independence outside of the home, often by entering the workforce, produces a
new female culprit for examination and control. Many of these studies cite
maternal deprivation as a major contributing factor from the childhood histories
of self-mutilators. I have already mentioned the diagnosis of Graff and Mallin’s
study, but the parental descriptions cannot be ignored: the mothers are ‘overcold,
obsessive, nagging, perfectionist women who overpowered their husbands’ while
the fathers are ‘passive or cold and hypercritical, distant men, dominated by their
wives’ (1967: 38). Similarly, the father in Grunebaum and Klerman’s study is
described as ‘inadequate at his occupation’ and the mother repels the child by
being ‘cold, punitive, and unconsciously provocative’ (1967: 528). Like James
Dean’s classical dysfunctional family in Rebel Without a Cause (1955), nothing
good can come of a household where the gender roles have been so terribly
reversed, where Jim Stark (Dean’s character in the film) reels from the confusion
his home causes for him.14 Pao particularly draws attention to the dangers of the
‘lack of maternal handling during infancy’ and ‘frequent changes in the quality
and quantity of maternal care’; he even tells the story of one mother ‘who could
perform better in the business world than in the role of a mother’ (1969: 196–7).
Once again, Pao’s study points to the confusion about sexual identity and this
time the mother is to blame. The implication is, of course, that if women did not
choose to work or change their status in society, then their children would not
be suffering from sexual identity confusion and, therefore, cutting themselves.
Medical discourse has again pathologized the female, both the working mother
and the cutting daughter, by utilizing established conceptions (de Beauvoir might
call them myths) of femininity, such as passivity, masochism, primitiveness and
delicacy, to discipline and control those bodies.

Conclusion: A Popular Legacy

The mistakes of the past – the questionable sampling techniques, the undue
interest in certain attractive flesh and the highly suspect explanations for a ‘female
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phenomenon’ (Phillips and Alkan, 1961: 423) – become of great concern when
they are reproduced, often unwittingly, in contemporary medical, academic and
popular texts.15 The legacy of the studies above can be found in the most popular
of discourses, Hollywood film. The first flashback of James Mangold’s Girl,
Interrupted (1999), based on Susanna Kaysen’s memoir of the same name, finds
attractive ingénue Winona Ryder, Kaysen’s screen double, in an emergency room
having her stomach pumped. Out of the commotion of the emergency room
comes one clear and distinct sentence: ‘We’ve got a wrist-banger.’ Susanna
Kaysen, in addition to attempting suicide (or something close to it) by ingesting
a bottle of aspirin washed down by vodka, has been mutilating herself prior to
the more severe act. While the hospital staff attempt to restrain her, there is a
momentary close up on the bruised underside of Susanna’s wrist. The film, set in
1967, offers the view of a suburban, intelligent and seemingly ‘normal’ teenage
girl struggling to find her way in changing times, battling the prejudices and
expectations of her parents and the still relatively conservative (and sexist)
outside world. Self-mutilation, for Susanna, is the result of depersonalization; she
feels as if there are no bones in her hand and that she can never stay in one place.
However, when later pushed to reveal the ‘truth’ of her condition, Susanna
confides tearfully that she understands the urge to mutilate and perhaps kill
oneself: ‘You hurt yourself on the outside to kill the thing on the inside.’ Perhaps
not surprisingly, when she enters the mental institution Claymoore for a ‘rest’,
she discovers she is not alone in this practice. Three of the other attractive, white
teenage girls in the institution mutilate themselves. Seriously ‘self-damaging’ or
‘self-injurious’ behavior or acts are motivated, in the film as in the research above,
by two contradictory strains in these adolescent girls’ lives: depersonalization or
numbness of body and intense psychic pain from which they seek relief on the
very surface of their bodies.
Three of the central group of girls, including Kaysen’s character in the film,
exhibit self-mutilative behavior or have scars from previous acts, and one girl has
another form of attack on the body, anorexia. Kaysen, as mentioned above, bangs
her wrists, selecting again the most commonly chosen body part among self-
mutilators – the arm (see note 10). Similarly, the character Daisy (played by
Brittany Murphy), who initially appears to be a bulimic, is revealed as a self-
mutilator towards the end of the film; she has been cutting her arms. In a scene
that is perhaps the climax in the relationship between Kaysen and the temptress-
antagonist Lisa (Angelina Jolie), the latter attacks Daisy and exposes the under-
side of her arm, which is covered in cuts up to the elbow, possibly made by a
razor. One might note here how the close-up of Daisy’s arm rhymes cinemati-
cally with the close-up of Susanna’s bruised wrist at the opening of the film (the
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two arms extend diagonally across the screen, though in different directions).
Lisa insists that the cutting is Daisy’s reaction to the years of sexual abuse by her
own father that she has endured (and, Lisa proposes, enjoyed). Along the lines
of Menninger’s 1938 hypothesis, Lisa interprets Daisy’s mutilative acts as a partial
suicide, although her reasoning differs from Menninger’s; she assumes that Daisy
simply lacks the nerve to kill herself, not that she is making a conscious attempt
to save herself by sacrificing her arms. Also, perhaps not coincidentally, in line
with many studies of self-mutilation since the 1960s, Daisy’s story supports the
commonly cited link between childhood abuse and self-mutilation (Conterio
and Lader, 1998; Strong, 1998). The third self-mutilator, Polly (Elizabeth Moss),
has terrible burn scars over most of her face, which we are told result from an
episode from her childhood. During an emotional fit over the loss of a puppy,
Polly poured gasoline on herself and set herself on fire. Except for this one
outburst and its bodily repercussions, neither the film nor Kaysen’s memoir
offers another reason for Polly’s institutionalization. Self-mutilation, apparently,
is reason enough for a long-term stay in a mental institution like Claymoore.
Here, the film and memoir reinforce the claim that this group has displaced
schizophrenics as the ‘new chronic patients in mental hospitals’ (Graff and
Mallin, 1967: 36).
Kaysen’s memoir (1993) itself attempts to provide a more clinical analysis of
self-mutilation. Interestingly, though, she differentiates between her own self-
mutilative behavior and the other factors involved in her placement in the mental
hospital. The description of her wrist-banging is one of the few places in her
book where she openly expresses fear that her audience might judge her as
mentally ill. After reproducing her chart from the hospital, she gives the medical
definition of her diagnosis, ‘Borderline Personality Disorder’, as it appears in the
Diagnostic and Statistical Manual of Mental Disorders. However, in her analysis
of the Manual’s definition, Kaysen stresses that nearly every feature of her diag-
nosis is either biased against women or so vague as to be ridiculous, with the
notable exceptions of self-mutilation and suicide. One by one, she dismisses the
Manual’s list of features for her disorder, such as ‘instability of self-image, inter-
personal relationships, and mood . . . uncertainty about . . . long-term goals or
career choice’, as simply ‘a good description of adolescence’ (1993: 152). She
laughs off the finding of ‘social contrariness’ and admits to the charge of a ‘gener-
ally pessimistic outlook’, only with the qualification that ‘Freud had one too’
(1993: 154). Her conclusion puts her at odds with her parents and teachers, in
whose world and among whose expectations she was a misfit and a disappoint-
ment: ‘My self-image was not unstable. I saw myself, quite correctly, as unfit for
the educational and social systems’ (1993: 155). The film faithfully repeats these
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sentiments. During a late-night break-in, the girls at Claymoore find their charts
in the doctor’s office and read aloud from them. Susanna lists the features of her
disorder, including ‘self-damaging behavior’, ‘promiscuity’, ‘uncertainty about
goals’ and a ‘generally pessimistic attitude’, conceding, ‘oh, that’s me’ – to
which her friend Lisa replies, ‘That’s everybody.’ In this scene, among many
others, the film contests society’s labeling or naming of deviance, its arbitrary
placing of the borderline between sanity and insanity or normal and abnormal:
‘everyone’s sad’, ‘everyone’s fucking crazy’, what do the hospital staff ‘know
about being normal’? However, the film and the memoir do differentiate, in one
instance, between sanity and insanity: a girl has crossed over when she harms
herself.
While both texts are eager to locate sexist double standards in the psycho-
analytic discourse of diagnosis, they deny ‘political’ or socially formed status for
self-mutilation. Kaysen shrewdly points to the Manual’s revealing wording in the
category of ‘Sex Ratio’; it states not that the disorder is more common in women
but rather ‘more commonly diagnosed in women’, along with other disorders
present in the hospital’s population such as ‘compulsive promiscuity’ (1993: 157).
Although possibly riding a current wave of 1960s and 1970s nostalgia and ulti-
mately falling back on conservative Hollywood plot resolution – the heroine’s
relieved assimilation back into (sane) society – the film does seek to raise ques-
tions about the sexual double standards in our society, for example by perform-
ing Kaysen’s interrogation of the labeling of ‘promiscuity’ for women versus
men. In a move toward feminist contrariness, Girl, Interrupted dramatizes a
particularly rebellious story of female maturation. Susanna is a girl who inter-
rupts her own passing into womanhood in an attempt not to become her mother
or what her parents and teachers expect of her as an adult woman. She resists
some of those expectations, as well as their medical validation provided by the
psychiatric discourse, but only to a point. The memoir admits, ‘This is where
people stop being able to follow me’ (1993: 152). Wrist-banging ‘is the sort of
stuff you get locked up for’. So far, the list was giving just ‘a good description of
adolescence’, but then enters pathology. Kaysen sets apart her self-mutilating
behavior as an ‘inward condition’ expressed in private:
I was in pain and nobody knew it; even I had trouble knowing it. So I told myself, over and
over, You are in pain. It was the only way I could get through to myself (‘counteract feelings
of numbness’). I was demonstrating, externally and irrefutably, an inward condition. (1993:
153)

Yet she insists that no one knew of her actions and, later, that her self-image was
not unstable. Nevertheless, she has chosen to express her inward condition on
the surface of her body, and skin – being a membrane that is both an outside and
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an inside – can be seen as the ideal location for the move between inner and
external selves she describes.
Self-mutilation, like suicide, acts as a brief aberration in an otherwise strong
argument against the ‘social relations of science’ in the form of psychopatho-
logical diagnosis. Provocatively, she chooses a significant point beyond which no
one follows her. Borderline personality disorder happens to be the only ‘official’
mental illness for which self-mutilation is a major diagnostic criterion (Favazza,
1996: 110). Perhaps one might argue that feeling unstable is one thing, but acting
on it is quite another. However, I would like to argue to the contrary. I propose
that Kaysen was headed in the right direction but could not see her argument
through to its conclusion, nor, for that matter, could the filmmakers. The diag-
nosis of self-mutilation, especially in the work on ‘delicate’ cutters, possibly
depends as much on myths of femininity and female pathology as the other
aspects of her illness and has been unfairly constructed by psychiatric discourse,
as I tried to show above. Further, the film looks back at the era of the late 1960s
from a perspective, in 1999, well aware of the struggles for equal rights and does
address the conflict between the medical diagnosis and the changes in the world
outside the institution. Kaysen confronts her psychiatrist about the ways his
science determines pathology in women, particularly in diagnosing her border-
line personality disorder. She reacts against dominant cultural narratives voiced
by her parents, her teachers and her peers that demand she be passive, feminine,
or dependent and childlike and embraces her social contrariness and unsuitabil-
ity for her parents’ world. However, although Kaysen can astutely expose the
double standards in her borderline diagnosis, she fails to push further and
question the medical discourse on self-mutilation which – hopefully, I have been
able to show – deserves a challenging inquiry.
One might even argue that Kaysen’s self-mutilation was as much a part of her
rebelliousness and feminist protest as were her challenges to her psychiatrist. In
fact, there exists a good deal of literature which reinterprets acts that in the past
have been perceived as destructive to the body as instead a rebellion against the
social forces that attempt to control and shape the body. Especially resonant for
this discussion of self-mutilation, some feminist work on eating disorders argues
that anorexia, for instance, is a kind of ‘hunger strike’ wherein the female
anorexic protests with her body the culture that would have her control and stifle
her appetite (Giddens, 1991; Orbach, 1986; see also Bordo, 1993). Another view,
more common to the discussions of ‘body modification’ or ‘modern primi-
tivism’, perceives ‘work’ on the body as integral to the creation of a unique,
autonomous self-identity, often accompanied by a kind of spiritual enlighten-
ment through pain: ‘anorexia as both an attempt to transcend the self by
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becoming pure and self-controlled and a simultaneous attempt to create an

autonomous self’ (Hewitt, 1997: 41). Directly opposed to the passivity associated
with self-mutilation in the studies above, these individuals take control of their
own bodies to forge actively their own self-identity (Giddens, 1991), and the
means to this self-fashioning can vary from working out to tattooing, or from
plastic surgery to anorexia:
whether normalizing, transgressive or pathological, resting upon the deployment of sophisti-
cated technologies and upon physical effort and willpower, what all seem to share is a kind of
corporeal absolutism: that it is through the body and in the body that personal identity is to
be forged and selfhood sustained. (Benson, 2000: 236; see also Lloyd, 1996; Myers, 1992; Pitts,
1998; Rosenblatt, 1997; Sassatelli, 1999; Vale and Juno, 1989).16

However, caution might be warranted in response to the galvanizing theories of

empowerment and resistance offered above. As Bordo argues (mindful of
Foucauldian models of power), protest can function ‘paradoxically, as if in
collusion with the cultural conditions that produce [it], reproducing rather than
transforming precisely that which is being protested’, or, in other words, as it
relates to anorexia, ‘to feel autonomous and free while harnessing body and soul
to obsessive body-practice is to serve, not to transform, a social order that limits
female possibilities’ (1993: 177, 179).17
In conclusion, after an examination of how the ‘delicate’ cutter diagnosis is
made in medical discourse, I wonder at the perseverance of the myth in popular
media at the end of the 20th century and beginning of the 21st – a time when
many mothers work, when, supposedly, women are not thought of as solely
passive, masochistic or delicate, when women have won battles for their rights,
and when a feminist theorist like Treichler can take for granted the recognition
of the antagonism between science and the female bodies it surveys. Because it
persists into the present, I stress the need for an understanding and examination
of this myth-making. Can we hope to address the bias of scientific discourse
when we continue to reproduce it, even in the very texts that claim to offer a
counter-discourse? Kaysen gives in her memoir her own insight into the
cultural bias found in her doctors’ diagnoses. In turn, the feature film deftly
recreates her criticisms of part of her diagnosis, of her ‘social contrariness’,
‘promiscuity’, etc. Nevertheless, the film also personifies, in Winona Ryder
(Susanna) and in Brittany Murphy (Daisy), the white, suburban, attractive
mutilator myth and packages it as a testament to female empowerment. The
film’s heroine takes back her life through the help of a brilliant psychiatrist
(certainly echoes of I Never Promised You a Rose Garden here), while the
doomed Daisy takes her own life. The film’s pointed attack on the gender
inequalities of medical diagnosis stops short at self-mutilation and disappears in
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the whitewash of classical Hollywood resolution as Susanna determines that

there’s no place like home.
Perhaps most importantly, this article seeks to challenge pathologization of
the female body by authoritative discourses, like the medical, because of the very
real bodies facing examination. I think of Jill McCardle in The New York Times
Magazine article, unwittingly an accomplice in this mythmaking, expressing
‘adolescent self-loathing’ with her ‘imposing figure for 16’ (Egan, 1997: 21) and
confronted with the shock, engrossment and, most importantly, attention of the
journalist. Egan further explains her fascinated reaction to another cutter, Jane,
who reminds her of Jill: ‘It is virtually impossible to imagine this polished,
friendly young woman doing any of these things’ (1997: 24). How impossible
could it be when every time these acts are discussed the same polished, friendly
young woman appears as the transgressor? Despite recent efforts by psychiatric
researchers and treaters of self-mutilation to rid the studies of gender bias, the
female cutter myth remains and influences nearly every popular and medical text.
Therefore, I take Kaysen’s lead and ask questions of those diagnosers and contest
that bias, even in the case of self-mutilation. While it may seem simple enough
to show how the earlier medical discourse, in Treichler’s words, comes ‘to enact,
and . . . reinforce deeply entrenched, pervasive, and stubbornly conservative
cultural narratives about gender’ (1999: 45–6), the image of Jill reminds me of
why one must do so.

Notes
I would like to express my appreciation for the comments provided by the anonymous readers for
Body & Society and to several others who read this article at different stages. Particularly, the earliest
reader, Lisa Cartwright, helped immensely by encouraging any writing at all, and the final reader,
Karen Beckman, managed to make it worthy of print. Thank you both.

1. Favazza states in The New York Times Magazine that ‘[s]elf-injury is probably a bit of an
epidemic’ and calculates the number of self-mutilators at about two million, though the actual figure
‘may be higher’ (Egan, 1997: 22).
2. In fact, even Strong (1998: 32) repeats the findings of that early research, praising Graff and
Mallin’s study as ‘one of the best’ and noting its finding of a typical cutter who is young, intelligent
and female, although Strong chooses to leave out their attention to the cutter’s attractiveness.
3. This list of popular works could continue indefinitely with the number of websites and chat
rooms devoted to the topic of self-mutilation; however, I would like to mention a few other notable
popular accounts: Caroline Kettlewell’s memoir Skin Game (1999), Steven Levenkron’s novel The
Luckiest Girl in the World (1997) and the USA Network’s made-for-TV movie, based on Levenkron’s
novel, aired in the summer of 2000, Secret Cutting. Also, even more recently, Catherine Hardwicke’s
(2003) film Thirteen (co-written with one of its 13-year-old stars, Nikki Reed) draws attention to
cutting, along with other acts of ‘deviance’ by teenage girls, so much so that the recent episode of The
Oprah Winfrey Show focusing on the film includes the testimony of another female adolescent cutter
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in the audience (‘Is Your Child Leading a Double Life?’, 2003). Each of these examples faithfully
reproduces the typical ‘cutter’ profile.
4. The same sort of confusion about who the typical cutter might be occurs in another recent
study (Hewitt, 1997). First asserting that ‘most of the individuals who self-mutilate are adolescent girls
or young women’, the author later gives a ratio that tempers the initial claim: ‘women who self-
mutilate outnumber men who do 1.5 to 1’ (Hewitt, 1997: 55, 64).
5. In a note Bordo (1993: 303) adds the following ‘classics’ of (Anglo-American) second wave
feminism as primary sources for the views of the contained body listed in her quotation: Susan Brown-
miller, Against Our Will (New York: Bantam, 1975); Mary Daly, Gyn-Ecology (Boston: Beacon, 1978);
Angela Davis, Women, Race and Class (New York: Vintage, 1983); Andrea Dworkin, Woman-Hating
(New York: Dutton, 1974); Germaine Greer, The Female Eunuch (New York: McGraw Hill, 1970);
Susan Griffin, Rape: The Power of Consciousness (New York: Harper and Row, 1979) and Woman and
Nature (New York: Harper and Row, 1978); Adrienne Rich, ‘Compulsory Heterosexuality and
Lesbian Existence’, Signs 5(4) (1980): 631–60.
6. Also, some feminists valued Foucault’s incredible insights but felt a lack of focus on female
subjects, finding that medicalization takes different forms for different genders. Particularly, Elaine
Showalter challenged the ‘little attention paid to gender’ by historians of psychiatry (1985: 5).
7. Medical-scientific discourse (in the guise of psychoanalytic or psychiatric diagnosis and
treatment options) relies upon an ‘empirical’ truth, based on biology, chemistry, scientific observation
and statistical analysis, to define and designate someone as ‘ill’. Science is objective; it studies the facts.
If a patient takes a razor blade and cuts (‘delicate’ or ‘coarse’) gashes in his or her arm, that patient is
sick. Science promises to be above or outside ideology, but recent historians of science, particularly
from feminist or queer perspectives, have questioned this very basic ‘objectivity’. Influenced by the
work of Michel Foucault, these historians and/or theorists insist that scientific or medical discourses
cannot reside outside of the power relations running through and around every member of Western
society. Science, like any ‘grand narrative’, and scientists, like any ‘social subjects’, produce and are
produced by dominant ideologies but, therefore, are also as distanced from ‘Truth’ or ‘the Real’ as
anything else in this network of power and resistance. Self-mutilation as a medical category cannot, in
this light, be removed from social influences or ideology. Psychoanalytic or psychiatric studies of self-
mutilation, while relying on their status as ‘objective’ findings, reveal simultaneously the bias of the
societies from which they came. For examples of other feminist studies addressing medical discourse
see Balsamo (1997), Cartwright (1995), Laquer (1990) and Moore and Clarke (1995).
8. Perhaps predictably enough, although not to be addressed in this article, self-mutilation also
occurs in other commonly designated ‘deviant’ populations. Male prisoners apparently use it to
combat institutional life and self-injury is supposed to relieve the strain felt by sexually ‘confused’ men
and by people with disabilities. A number of separate studies were done in the 1970s documenting
self-mutilation in prison populations in the USA and elsewhere (Bach-Y-Rita and Veno, 1974; Yaro-
shevsky, 1975), as well as cases of male self-castration thought to be caused by sexual guilt or confusion
(Blacker and Wong, 1963; Greilsheimer and Groves, 1979). Interestingly, if a mentally retarded or
autistic person harms him or herself without a clear suicidal intent (very often taking the form of head-
banging or self-biting), this behavior is placed under a separate category and more often termed ‘self-
injurious behavior’ (Favazza, 1996; Walsh and Rosen, 1988). Although for this article I will be
concerned with the development of female ‘wrist-cutting’ and then ‘delicate self-cutting’, I cannot
ignore the affiliation of the same, feminized deviant others – the homosexual, the criminal, the
mentally deficient and the woman. Self-mutilation occurs most commonly in populations that have,
in the past, been compared and described as more ‘primitive’ or ‘abnormal’ and, therefore, more in
need of surveillance, marking and segregation. These familiar ‘others’ pose a risk not only to their own
bodies but also to the social body, hence the need for segregation. For accounts of the history
comparing these different deviant populations, see Davis (1995) or Horn (1995).
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9. I have selected a dozen studies for detailed analysis. These studies represent the most frequently
cited and influential early studies with regard to the particular form of self-mutilation known as
delicate cutting or ‘delicate self-harm syndrome’ (Pitts, 1999). I relied on two later studies of self-muti-
lation (Favazza, 1996; Walsh and Rosen, 1988) as sources for the comprehensive literature reviews
which listed the studies I selected as representative texts. My article does not provide a full review of
all research on self-mutilation or an analysis of every article written on the ‘delicate’ strain (see the
studies above for such a review). Instead, I have chosen a select group of very influential, initial studies
in an attempt to understand the original diagnosis of the syndrome and how that diagnosis has been
reproduced in many recent popular and academic texts. For example, Kaplan (1991) reproduces Pao’s
findings about ‘delicate’ cutters in her feminist reading of perversion, femininity and Madame Bovary,
and Pitts cites several recent studies (Favazza, 1996; Hewitt, 1997; Walsh and Rosen, 1988) to assert
that delicate self-harm syndrome is ‘much more prevalent among girls and women’ (1999: 297) when,
in fact, Favazza directly counters such a notion by noting suspect ‘sampling techniques’ in the early
studies (1996: 240)
10. Girl, Interrupted contains both ‘delicate self-cutting’ of the arms, which is the body part chosen
by 74 percent of cutters (Favazza, 1996: 279), and other manifestations of the disorder (hitting and
bruising of one’s own body parts, or burning).
11. In Pao’s differentiation between ‘coarse’ and ‘delicate’ there is also a division between psychotic
and ‘borderline’ and, predictably enough, male and female (1969: 195–6). Out of the five ‘coarse’
cutters in the study, four were male and manifested a ‘form of psychotic depressive syndrome’ while
the ‘delicate’ cutters were overwhelmingly female and ‘seemed to vacillate between being psychotic
and being “normal” ’ (p. 195).
12. Only two articles before Ross and McKay’s book (1979) question the authenticity of the
syndrome and the statistics in the earlier studies – Clendenin and Murphy (1971) and Weissman (1975).
These authors feel the female profile is unwarranted because the previous reports were based on very
small samples from almost exclusively private psychiatric hospitals and therefore showed a bias toward
wealthy young women. Favazza counters their claims by noting the biases of their samples, which
were collected from police reports and large hospital reports of attempted suicide that often show bias
toward young males (1996: 252). Also, Weissman’s sample explicitly excluded all cases of ‘compulsive
minor self-mutilation’ (1975: 1167), which would clearly affect the applicability to studies on ‘delicate
self cutting’.
13. The resistance against the ideal body may be a way of imagining some of the cutting as rebellion
against social norms. Pitts cites Bakhtin’s theory of the carnivalesque or grotesque body as a way of
understanding ‘body modification’, particularly scarification, as a form of resistance against the ideal,
socially approved body:
The contemporary Western body is normally closed and impenetrable, avoids bleeding and
proliferating itself via scars and bumps, does not gape. The mode of bodily representation
chosen by scarifiers deviates from contemporary Western bodily norms in its use of fluid body
boundaries, its messiness, its carnivalesque character. (Pitts, 1998: 69; see also Hewitt, 1997)
It is important to note, however, that scarifiers differentiate themselves from ‘cutters’ who cannot
control their urge to break the bodily boundary (Pitts, 1998: 83).
14. This film is often cited as a popular enactment of the dangers of what Philip Wylie (1946)
famously called post-war ‘momism’, wherein Jim does not suffer from an over-protective and coddling
mother, but from an emotionally distant viper.
15. For example, one source mentioned above (see note 9) offers a thorough and well-supported
account of the pathologization of certain nearly mainstream forms of ‘body modification’ (such as
piercing, tattooing, scarification and branding) in the popular news media – a pathologization
performed by experts in the psychiatric community – but simultaneously the author also reproduces
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the view of self-mutilation presented by that community in the 1960s and 1970s (i.e. that most muti-
lators are female; Pitts, 1999: 297, 301).
16. Although some discussions do differentiate between self-mutilation and body modification on
the question of ‘agency’ or the ability to control the cutting and when it ends (Benson, 2000; Pitts,
1998, 1999), it is significant to note that Favazza’s comprehensive study concludes with an epilogue
from perhaps the most famous American ‘modern primitive’, Fakir Musafar, wherein he declares that,
instead of belonging to ‘a father, mother, or spouse; or to the state or its monarch, ruler, or dictator;
or to the social institutions of the military, educational, correctional, or medical establishment’, the
body is controlled by the individual (1996: 326). One could also propose another form of agency in
the writing of a memoir about the individual body. Kaysen chooses to define her own ‘illness’ and
narrate the acts of her own body in the form of a memoir, forging in print at least one version of her
self.
17. Similarly, one might argue (and I have been concerned about this problem myself) that relying
too heavily on Foucauldian notions of the ‘docile body’ or the body constructed by discourse is to
forget the historical reality of lived bodies or the individuality of each body and its everyday existence.
Bordo (1993) and Giddens (1991) caution against such forgetting, as in Shilling’s summarizing of
Foucault’s work:
Bodies are produced, but their own powers of production, where they have any, are limited
to those invested in them by discourse. As such, the body is dissolved as a causal phenom-
enon into the determining power of discourse, and it becomes extremely difficult to conceive
of the body as a material component of social action. (1993: 80)
While this article has focused on the discourses that attempt to manage ‘docile bodies’, my hope,
finally, is to inspire very real bodies to social action or to self-definition. With Susan Bordo, I seek to
work somewhere in the middle, recognizing the insidious maneuvers of powerful discourses, while
still believing that actual, material bodies can resist:
I view our bodies as a site of struggle, where we must work to keep our daily practices in the
service of resistance to gender domination, not in the service of docility and gender nominal-
ization. The work requires, I believe, a determinedly skeptical attitude toward the routes of
seeming liberation and pleasure offered by our culture. (Bordo, 1993: 184, original emphasis)

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Barbara Brickman received her MA from the University of Georgia in 1999 and is completing a PhD
in English and Film Studies at the University of Rochester in New York. Her current research investi-
gates the intersections of gender, adolescence and spectatorship both in teen narratives (literary and
cinematic) from the 1950s and in later films looking back on the period.