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Self-injurious behavior

Armando R. Favazza

Self-injurious behavior (SIB) has been around for a long time. Many caves in Southern France contain hand imprints on their walls and in one cave, at Gargas, the 20,000 year old imprints display the absence of all tips except for the thumb. The 5th century B.C.E. historian Herodotus described the actions of a probably psychotic Spartan leader, Cleomenes, who mutilated him by slicing his flesh into strips with a knife; starting with his shins he worked upwards to his thighs, hips, and sides until he reached his abdomen which he chopped into mincemeat. The Gospel of Mark 5:5 describes a repetitive self-injurer, a man who “night and day would cry aloud among the tombs and on the hillsides and cut himself with stones.”
Despite these early references and a number of cases and small scale studies in the 20th century, SIB has only recently become the object of focused psychiatric scrutiny. Traditionally, it has been trivialized (wrist-cutting), misidentified (suicide attempt), and regarded solely as a criterion of borderline personality disorder.
It was generally regarded as grotesque and senseless. In the words of a highly respected psychiatrist, “The typical clinician (including myself) treating a patient who self-mutilates is often left feeling a combination of helpless, horrified, guilty, furious, betrayed, disgusted, and sad” [1].
With the publication of the book Bodies Under Siege in 1987, and especially in the 1996 second edition which was subtitled ‘Self-mutilation and Body Modification in Culture and Psychiatry’, Favazza stripped away the mysterious aura that had surrounded SIB and demonstrated its purposefulness in culturally sanctioned rituals as well as in deviant, pathological disorders [2]. He showed that SIB is not alien to the human condition but rather is culturally and psychologically embedded in the profound, elemental experiences of healing, spirituality, and social amity. Culturally sanctioned and deviant SIB serve an identical purpose, namely an attempt to correct or prevent a pathological or destabilizing condition that threatens the community, the individual, or both.

Mental homeostasis and stress

Homeostasis is the property of organisms to self-regulate themselves in order to provide an appropriate milieu for cells and body tissue to function properly. Homeostasis may be threatened by stressful stimuli that can be anatomical, physical, chemical, physiological, or mental. Psychiatrists are especially concerned about disruptions in the homeostasis of the central nervous system which is the most complex organ system of the human body and is the site of the abstract ‘organ’ known as the mind. Mind implies human consciousness, but also has an unconscious component, and is manifested especially in thought, perception, emotion, will, memory and imagination.
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