Self-Harm is a Modern Phenomenon, Right?

In February 2025 I invited ‘unanswered questions’ about self-harm and throughout March 2025 I will be responding to these questions in a series of blogs. In these blogs I draw on my personal and professional experience, as well as survivor and academic literature. The purpose of these blogs is to bring together a range of perspectives and pose ideas and questions for further reflection. I welcome feedback and questions – thanks for reading!

The Unanswered Question: Do people know how long self-harm has been with us?

Over 10 years ago, as a young(er) and enthusiastic new co-ordinator of a national self-harm helpline, I sat listening to a talk by the suicidology researcher David Webb. I had completed all the new and innovative training available in the sector, including ASIST and Mental Health First Aid and I had 5 years’ experience working in mental health advocacy. I was all about having the most up-to-date knowledge and understanding about mental health, suicide and self-harm, and undoubtedly, I was working in the most progressive, informed era there had ever been in this field.

David’s talk began and he started to talk about how suicide has been conceptualised in different historical periods. About not only medical understandings of the human condition, but the impact and influence of religion, politics, culture, legal structures and more. About the strong moral judgements associated with suicide which still echo today. But also, about periods where suicide was sometimes understood as a rational act, and most striking of all to me, wasn’t generally considered to be a sign of mental illness or disorder.

A New Way of Thinking

All of this seems obvious now, but this was something of a revelation to me at the time. The idea that there might be much to learn from historical conceptualisations of suicide or that suicide hadn’t always been seen as a symptom of mental illness or distress made me stop in my tracks. Maybe I had been thinking about this all wrong.

As I look back now, I have a little more sympathy for my younger self than I did in that moment. I had been running a project actively questioning the social and societal construction of the diagnosis of personality disorder and a key component of the project was pushing back against the dismissiveness which people with this diagnosis were treated after self-harm and suicide attempts. My job had been all about trying to emphasise the validity of these experiences and their reflection of genuine mental distress and illness. But somehow, I had never thought about the fact that understandings of self-harm and suicide are also very much socially, societally and culturally constructed.

Long story short, as I’m sure you’re hoping I’ll get to the main point soon, David’s talk really broadened my thinking in this area and I soon discovered the work of Sarah Chaney who has extensively researched understandings of self-harm in the Victorian period and Chris Millard whose work has focused on how changing perceptions of self-harm are rooted in the changing social, political and cultural context of the twentieth century. I also more recently came across the work of Alanna Skuse, who has studied self-wounding in the early modern period, drawing on serious and comic literature and song lyrics to inform her work.

Learning from History

So, what can we learn from looking at historical understandings of self-harm that’s relevant to today? The first thing is to say that this is not an exact science. Terminology adapts and shifts over time, social and cultural context and influences extend way beyond the confines of written records and most work I can find in this area focuses very much on Western societies, and this blog focuses on the UK.

With all that in mind, this blog does not attempt to be a comprehensive review of all the knowledge in this area and future blogs will go into more depth about each period which has been studied.

What this blog does attempt to do is show just how much conceptualisations of self-harm and responses are shaped by social, political and cultural context, today as much as in the past. This opens the door to potential new ways of understanding self-harm and considering the factors that influence current attitudes and responses. It also aims to provide a robust response to the idea that self-harm is a modern phenomenon or fad and unworthy of careful thought, compassionate responses and wider societal consideration.

Self-Harm as Self Expression

Some of the earliest mentions of self-harm in literature include the Bible (First Kings 18:24–29, Mark 5:2–5) and the writings of Herodotus in ancient Greece, and self-harm for religious purposes has been part of certain sects of many religions, including Hinduism, Islam and Christianity, for thousands of years. So, it’s safe to say that self-harm in some form or another has been with us for a very long time. What has significantly changed over time is how we as a society understand and conceptualise self-harm and how we respond to people who engage in self-harm, also there are also some clear themes that have stayed consistent.

Alanna Skuse’s work explores self-wounding in the early modern period and points out that self-wounding features in a range of literature, including Shakespeare and Marlowe plays. Self-wounding is understood mainly as a form of self-expression and is more common in men. It is rarely framed as a symptom of mental illness or ‘insanity’, until the later 18^th century when there is an association with emotional sensitivity in romance novels which can tip over into despair for some.

Self-Harm as ‘Insanity’

Sarah Chaney’s work picks up this theme and the emergence of self-harm being conceptualised as part of mental illness or ‘madness’ during the early 19^th century, following ongoing societal shifts in thinking about what was socially acceptable and what was deemed illness. At this time in the UK people who were considered mentally disturbed were often confined in an asylum or if that was not financially possible, a workhouse. Views on the reasons for self-harm ranged from demonic possession, a spiritual rite, a ritual of group bonding, a political statement and potentially individual pathology. There was a school of thought which attributed self-harm to a lack of pain sensation in these patients, which in turn was caused by ‘madness’ and it was this madness that doctors sought to treat.

Shifts in Western European thinking about the nature of society at the time focused on the value or altruism, emotion and social feeling as essential. It also around this time that the framing of self-harm as a selfish act begins to appear, as well as the idea it might be a response to emotional pain. This is also where we begin to see self-harm as a selfish and manipulative act specifically associated with women, who were deemed to have these motives as a result of hysteria caused by a malfunctioning reproductive system and their overly emotional minds.

Exploring understandings of self-harm in the 20^th century, Chris Millard maps changing conceptualisations to changes in legal frameworks and public policy and subsequent social and cultural attitudes in the UK. For the early part of the 20^th century, self-harm seen as attempted suicide was strongly associated with a high risk of violence and considered to be the realm of the police. Changes in the law in the 1930s introduced ‘mental observation wards’ where such patients could be treated, and this also offered the opportunity to spend time exploring the reasons behind each patient’s self-harm or suicide attempt.

Self-Harm as Communicative

In 1945, the introduction of the welfare state and the establishment of the NHS in 1948 in the UK opened up mental health care to a far greater number of people, as well as mainstreamed the idea of a collective, government-led response to health, housing and social care. From the 1950s onwards in the UK, hospitals observed a trend of overdoses taken without the intention of dying and in this context, these were understood as ‘collective, communicative and embedded’. Self-harm in this form was understood as communication about the person’s relationships, social situation and wider social context and responded to as such.

With the advent of the 1980s, the welfare state began to be reduced, and as the concepts of capitalism and individualism took hold, a shift also took place in conceptualisations of self-harm. The focus now was on self-inflicted injury, and this was no longer seen as being about communication, but about internal regulation, and consideration of social context was much reduced.

Significant work was done in the late 20^th and early 21^st centuries by survivor and experience-led organisations such as Bristol Crisis Service for Women and the National Self Harm Network in broadening understandings of self-harm (I will go into detail about their achievements in another blog).

Where Are We Now?

This brings us into the 21^st century, where it could be argued that the ever-increasing focus on outcome measures, financial efficiency and being expected to do more with less has impacted attitudes to and understandings of self-harm. Austerity measures and cost saving initiatives across the public and voluntary sectors have meant that people in roles focused on supporting others, find themselves more and more frequently having to explain why, in fact, they cannot help an increasing range of people, who often have nowhere else to turn. It’s impossible to underestimate the devastating impact this has on people on both sides of this relationship and might go some way to understanding where we are now. It can feel like offering curiosity, time and space to understand why someone might be self-harming is now a luxury that can’t be afforded in times of austerity, gone the way of free training lunches.

It’s not a very positive place to end up in this reflection on understandings of self-harm, but equally looking at historical perspectives does give hope for change. The common thread for me in all conceptualisations of self-harm is communication, the most fundamental of human skills. It’s not about being wrong, or right, it’s about listening and really hearing what the other person has to say. It seems like a good place to start.

This blog draws on the work of Alanna Skuse, Sarah Chaney and Chris Millard. Any mistakes in the interpretation or presentation of their work are entirely mine.I would also like to thank Murphy Pickard, acta community theatre and Alanna Skuse of the Self Injury Through Time project who opened my eyes to the possibilities of using historical perspectives to challenge stigma.Perhaps this is not an unanswered question as such, but more a question that it seems like has an answer, but when you start looking into it, things are not so clear.