In 1879, nearly thirty years after the first publication of Nathaniel Hawthorne’s ‘The Scarlet Letter’ (1850) novelist Henry James reassessed the novel. Despite the considerable praise, Henry James objected to the “overdone” symbolism of Nathaniel Hawthorne’s work, which he felt, at times, “grazes triviality.” The symbol Henry James found most problematic was the “mystic A,” which the adulterous Arthur Dimmesdale found “imprinted upon his breast and eating into his flesh,” illustrative of his physical, moral and spiritual breakdown. Yet, for British and American psychiatrists (or alienists) in this period, the symbolic nature of such literary depictions appeared to provide a method of comprehending something, which through other contemporary approaches, seems inexplicable — self-inflicted injury in their patients.

This phenomenon emerged in psychiatric literature in the second half of the nineteenth-century, along with a new descriptive terminology: self-mutilation. This article provides a contribution to the historiography of self-mutilation by examining published and archival psychiatric sources (including the casebooks and other materials at the Bethlem Royal Hospital) in conjunction with fictional literature of the period, to indicate the ways in which medical and literary depictions were combined in efforts to create universal psychological meaning around self-mutilation1. This approach emphasises the importance of fictional depictions in psychiatric and lay exploration of the phenomenon of self- mutilation. As Roger Smith has persuasively demonstrated, in the nineteenth-century, psychology was by no means a specialised and distinct academic science and psychologists, alienists and writers in other genres, including literature, shared ideas and influenced each other. In this article, I indicate the ways in which reading psychiatric texts and fictional literature — focusing on ‘The Scarlet Letter’ — as complementary sources can illuminate critical aspects of nineteenth-century concepts of the self and the ways in which this was framed and understood within psychiatry of the period.

A general idea that self-inflicted injuries might indicate insanity in an individual is evident early in the English asylum movement: from January 1844, standardised admission papers to the Bethlem Royal Hospital asked whether a patient was “disposed to suicide, or otherwise to self-injury,” suggesting separate, albeit related, symptoms of mental disorder. The term “self-injury,” while ostensibly distinct from suicide, was used in case notes, textbooks and journals to refer to a wide variety of acts, ranging from the refusal of food to many attempted suicides. In newspapers and non-medical journals, “self-injury” might refer to bodily injury but could also be used symbolically, most often in reference to politics, as seems to have also been the case in many early uses of the term “self-mutilation.” Thus the Liverpool Mercury referred to Sir Robert Peel’s emigration scheme as “selfishness and self-injury in one,” while The Times claimed that “the Conservative party, since its self-mutilation in 1846, has been condemned for 20 years to political extinction.” Such political associations, along with the way that the “self” within the term could be used to refer either directly to an individual or collectively to a broader group or, indeed, British society as a whole, should be considered; as this article and further ones will show, medical use of the term certainly did not divorce “self-mutilation” from such metaphorical implications. Moreover, the very term “mutilation” had entered the English language from Scottish law where it signified a specific criminal act. As we shall see, discussion of self-mutilation cemented this connection with criminality, associating the term with those on the fringes of society.

From the 1860s, alienists began to adopt and define the new term, “self-mutilation,” paying it particular attention in the period 1880–1900. Self-mutilation in these descriptions could range from disabling to quite minor injuries: however, it was used more specifically than “self-injury,” in that it did not refer to food refusal or anything regarded as obviously suicidal, such as hanging, self-poisoning or suffocation. Indeed, this distinction might provide one explanation as to why self-cutting, often regarded a prevalent method of self- harm in the mid to late-twentieth-century, is not emphasised in nineteenth-century writings: such wounds, often made with a “cut-throat razor,” were frequently regarded as suicidal. By the 1880s, the definition extended to flesh-picking, biting, hair-plucking, punching or knocking against objects, cutting or otherwise removing part of the body, swallowing or inserting foreign bodies such as needles and eating rubbish. While published case studies often concentrated on the extremities of castration, enucleation (removal of the eye) and amputation, it was the more common minor injuries which required regular intervention by asylum medical staff and frequently formed matters of concern in asylum casebooks and Annual Reports. Individual case histories, like those published on self-mutilation, have often been discounted by historians of asylum psychiatry, who instead prefer to focus on the development of theoretical approaches to madness, emphasising the work of psychologists outside the asylum. I would argue, however, that the presentation of self-mutilation indicates the high value placed on such individual case histories by many alienists. In particular, it was felt that elaborating individual cases might provide a broader understanding of human motivation, often in similar ways to the exploration of a protagonist in the contemporary novel.

This emphasis is evident in one of the significant contributions on self-mutilation, alienist James Adam’s five-page entry for Daniel Hack Tuke’s comprehensive ‘Dictionary of Psychological Medicine’ (1892). Among the case histories used to support James Adam’s definition were examples from fictional literature, not an uncommon practice in psychiatric accounts of the period.

Cases of mental illness in the classics served to illustrate the apparently universal nature of a disorder, a weighty background, which seemed to legitimise the alienist and his ideas. James Adam naturally found most of his early examples in religious texts, supporting his claim that self-mutilation had its origins in religious enthusiasm. Nonetheless, his biblical examples were used interchangeably with the classics; he quoted the Attis of Catullus at length and recounted stories from Herodotus’ ‘Histories.’ Other asylum professionals used literature more directly to disseminate their ideas: Bethlem superintendent Theophilus Bulkeley Hyslop penned a “sort of novel” (in the words of his obituarist) using satire to present his degenerationist philosophies of mental and physical illness through a re-working of ‘Gulliver’s Travels’ (1726). The inhabitants of Theophilus Bulkeley Hyslop’s Laputa provide an unashamed commentary by the author on contemporary society: they have physically degenerated owing to their unhealthy lifestyle and the “artificial” nature of modern city life, are all obsessed with diagnosing their own “real or imaginary ailments,” and most of the population are slowly making their way towards the asylum. Such social commentary was often implicit in medical texts.

Concepts of self-mutilation were thus not developed wholly in the isolated medical context of the asylum. For alienists like James Adam, building on one of the central purposes of Romantic literature — as an exploration of the rational self — literary characters were presented as case studies, concrete and genuine examples of particular traits within normal or abnormal psychology, which could be exploited to generate a more detailed understanding of individual motivation that might be available from disordered or otherwise uncommunicative patients. Such assumptions were underpinned by a widespread belief that psychology could uncover universal truths concerning human nature: traits transcending national, historical, cultural and individual (or authorial) boundaries. These assumptions were supported by contemporary scientific thought in other areas, in particular, the natural sciences and the new “science of man,” anthropology, utilising the language of Darwinism. Anthropological investigation of “mutilations” in other cultures was put forward by psychiatrists to prove the universal nature of human behaviour, while the underlying assumption that motivation was also universal was rarely questioned before the twentieth century: hence, for example, the fascination with such practices as the self-castration of the Russian religious cult, the Skoptzy, or castration in Imperial China. In ‘The Descent of Man,’ Charles Robert Darwin himself built on the work of evolutionary anthropologists when he noted the propensity of “savages” to mutilation, claiming that “[h]ardly any part of the body, which can be unnaturally modified, has escaped.” Moreover, drawing on the work of Alfred Russel Wallace, Charles Robert Darwin also emphasised the value of the “social instincts” in the process of evolution by natural selection in man, while relating mutilation for the purposes of adornment directly to the “selfishness” that anthropologists such as Edward Burnett Tylor saw as characteristic of “primitive” societies. As George W. Stocking Jr. has argued, biological evolution of the species was seen by anthropologists as metaphorically extendable to both the evolution of civilization and the education of the individual; such associations were also prominent in psychiatric discussions of self-mutilation. Indeed, the metaphorical nature of these arguments was often lost in their juxtaposition, so that the association of self-mutilation with impulsive, and thus primitive, behaviour was frequently seen as an actual (biological) relationship via the new discipline of neurology. Within such an evolutionary framework, geographical boundaries diminished in significance, and individuals were grouped by level of civilization above nationality. Thus, when literary critics placed much emphasis on the “psychological interest” of the work of American novelist, Nathaniel Hawthorne, it seemed only natural for alienists also to refer to his work, popularly received on both sides of the Atlantic.

Nathaniel Hawthorne’s ‘The Scarlet Letter,’ retrospectively associated directly with self-mutilation, is particularly relevant within such a context. First published in 1850, the novel quickly created Nathaniel Hawthorne’s reputation, selling out in days, and receiving much critical interest on both sides of the Atlantic. Its writing was, however, mired in political and emotional turmoil; Nathaniel Hawthorne’s ousting from his post at the Salem’s ‘The Custom House’ is reflected in his introduction, while the death of the author’s mother in 1849 had apparently brought on an episode of “brain fever” shortly before writing the book.

Much of the wide field of scholarship on both ‘The Scarlet Letter’ and ‘The Custom House’ has thus dealt with the social and political commentary implicit in Nathaniel Hawthorne’s work. Besides certain psychoanalytic readings of ‘The Scarlet Letter,’ which have cast Arthur Dimmesdale’s act as one of many pieces of evidence of a “fearful self-interest,” Arthur Dimmesdale’s “A” has been largely ignored by Nathaniel Hawthorne scholars. Most critics, even those taking a medical historical perspective, tend to downplay the physical depiction of Arthur Dimmesdale’s guilt, treating it (like Henry James) as a dubious symbol of psychological pain or guilt or simply describing the case unquestioningly as an act of “self-mutilation,” perpetuating the idea that the latter describes a universal behaviour, rather than a cultural construct.

Indeed, in the novel itself, the origins of the wound are debated, although self-injury is given certain emphasis: Arthur Dimmesdale’s “course of penance” has already been referred to, and to some spectators, it seemed natural that this had been “followed out by inflicting a hideous torture on himself.” Nathaniel Hawthorne uses Arthur Dimmesdale’s descent into self-punishment to illustrate his physical and mental breakdown; his “bloody scourge” is mentioned shortly after a medical encounter over “disordered nerves,” while his self-torture provokes visions, increasingly regarded as a symptom of insanity in the nineteenth-century2. Nathaniel Hawthorne turns to the language of reason to drive his points home.

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