Psycho-Medical and Feminist Theory

Reconsidering the models of self-injury offered by the psycho-medical and

feminist literatures, we see that the former is still useful in defining the scope
of this behavior and differentiating among the levels of its severity, especially
Favazza’s (1987) early categorizations of moderate or superficial self-mutila-
tion with its three distinct subtypes (compulsive, episodic, and repetitive),
which gave a primary emphasis to skin cutting and burning. Psychiatrists
have categorized self-injury as an outcome of mental disorders that are envi-
ronmentally rather than organically caused, rooted in psychological or situ-
ational problems incurred during people’s maladaptive childhoods. We saw
many people who suffered traumatic childhoods, and some percentage of
these formed the longer-lasting group of people who were unable to grow
out of this practice and replace it with more socially accepted and useful
means of coping or who stayed with it for much longer periods of time.
However, we add to this literature by expanding the understanding of how
this behavior is practiced by people who do not have diagnosed mental dis-
orders. This research has illuminated the ways that self-injurers were influ-
enced by other environmental factors within the social realm. This shift and
expansion has transformed self-injury from a strictly psychological phenom-
enon into a more broadly sociological one. Groups of people who are poor,
weak, and powerless may have high prevalence rates because they are struc-
turally disadvantaged. Teenagers and young adults frequently learn about
this behavior through interaction with their peers, from adults close to them,

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and through the media. They learn to recognize and to interpret it, via their
subcultures, as an acceptable, albeit deviant, way of dealing with the anger,
confusion, and frustration so common at their age. They also learn how to do
it and how to understand its social meaning. Older, long-term self-injurers
have learned how to manage it. While the psycho-medical model individual-
izes the problem and deflects responsibility away from social structure,1 our
analysis, grounded in the perceptions and interpretations of real-life partici-
pants, highlights the role of interactional, cultural, and structural forces and
their contributions to the spread of self-injury. Self-injury can now be seen as
a practice of individuals who lack severe trauma in their lives but who turn
to this behavior as a means of self-expression, comfort, affiliation, identifica-
tion, sexuality, and rebellion, for myriad reasons.
Addressing the feminist model, we add to the arguments against Sheila
Jeffreys’s (2000, 2005) radicalized feminist view of self-injury, joining schol-
ars such as Alison Guy and Maura Banim (2000) in their writing on fashion,
Deborah Pollack (2003) on eating disorders, and Sarah Riley (2002) on body
art. Like them, we employ the plurality of both a top-down and bottom-up
approach to self-injury. We recognize this behavior as an outcome of cul-
tural and structural oppression but do not box it within a strictly patriarchal
mode or a discourse of oppression disguised as liberation. Disadvantages
other than gender left some people so structurally oppressed and unable to
cope with their life situations that they self-injured; these other disadvan-
tages included their race/ethnicity, social class, family situations, and age.
Self-injurious acts, moreover, were not limited to women, men with sub-
ordinated masculinities, the disabled, or other disadvantaged and despised
groups. Rather, they extended over a broader and growing population. The
framework of the meanings of self-injurious acts was forged in the context
of their production by the contingencies of people’s structural life situations,
the cultural constructions of their male and female gender roles, and by their
interactional, agentic choices.
We contribute to and expand a feminist understanding of self-injury by
describing its gendered population, practice, and reception. Women commit
more of these acts, as most studies show and as our research confirms. They
do them in more secretive ways and places. Women’s gender socialization
leads them to turn their stress inward and to harm themselves, while men
are taught to express their stress through anger, outwardly. Yet this research
shows that self-injury is not the “female disease” that it was originally con-
sidered. Intentionally self-injurious acts committed by men are not always
perceived and interpreted into the same categories that they are for women.

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 At the same time, though, that gender norms lead more women to self-
injure, they also foster its greater acceptance when it is done by men. Women
are more socially stigmatized for self-injuring than men are. When men are
confronted with the same structural, cultural, and interactional stresses and
their socialization leads them to self-burning, branding, or cutting (some-
times in groups) or even more commonly to punching walls or trees, this
is interpreted as masculine venting, bonding, or typical masculine behav-
ior (“boys will be boys”). But because women’s bodies serve as the text of
their femininity,2 any damage or misuse of these bodies violates strong gen-
der roles and generally leads women to more severely negative self-images
than it does for men who self-injure.3 The panopticon of institutional control
demands that women enact more “docile”4 bodies than men. Women thus
disempower and discipline their bodies-as-objects by conforming to social
strictures governing their size and shape, their gestures, posture, movement,
and general bodily comportment, and their ornamental surfaces including
their clothes, hair, dress, and (most especially, for our purposes) skin.5
Both men and women extend the harsh patriarchal social gaze against
female acts of self-injury, condemning them as harmful, damaging, men-
tally disordered, and wrong. In doing so, both genders identify too closely
with what Abigail Bray (1996) has called the “social text,” subscribing to the
deviance label and enforcing the oppression associated with it. Their judg-
ments are too often poisoned not only by the oppression of the Foucauld-
ian institutions that discipline and punish, including schools, hospitals, and
workplaces, but by the “unbounded” institutional control rooted in the dis-
course of the dominating psycho-medical establishment. This paradigm per-
vades not only their treatment by the counseling and therapy professionals to
whom they are subjected but the larger society’s psycho-biologically deter-
mined model of the actor, weakening their capacity for critical structural,
cultural, or situational interpretation.
There are also gendered ways of committing self-injurious acts. When
men conform to these gender roles, by cutting or burning themselves visibly
and harshly, flaunting their behavior, and thrusting it into the public gaze,
they are defined as manly and tough. Men who hide these acts like women
violate their gender role and sacrifice their masculine image. Women who
hide their acts and seek out others to comfort them in subculturally appro-
priate places and ways are more welcomed and supported. But when women
make larger, more serious cuts or display them too openly, they violate their
gender role and are regarded by their peers as needy, showy, whiney, unsta-
ble, disturbing, and potentially socially contagious.

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 Yet at the same time, self-injurers, both alone in private and through
semipublic cyber subcultures, have challenged these meanings. They have
created and shared multiple explanations and social connotations for their
acts, defining them as self-empowering. Although Jeffreys (2000, 2005) has
challenged these interpretations as the false consciousness of neoliberal ratio-
nalization, suggesting that self-injurers are buying their logic of choice when
their actions are more culturally and structurally constrained than they rec-
ognize, these interpretations are real to them and guide them in their lives.
These interpretations represent social constructions created from the bottom
up of society, forged by people in the context of exercising their free will.
Through their own acts, self-injurers achieve the ethic and aesthetic of
self-mastery and self-transcendence through which they experience and
present themselves as exhibiting superior self-control.6 In this way, self-injur-
ers also accord with the newer discourses of public health, in which people
are structurally accorded the responsibility for regulating their own bodies.7
Yet these social meanings may evolve and change over the course of individ-
uals’ self-injurious careers, as they transition out of dependence on cutting
and burning toward other forms of self-soothing and self-expression. They
thus move away from the “justifications” of their active self-injuring periods,
during which they assert their claim to being responsible for their actions
while denying the wrongfulness of their acts, to the “excuses” of their postin-
jurious careers, when they reflexively look back on their earlier actions as
less legitimate and suggest that they were not fully in control of themselves.8

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