When not working at the Archives and Museum, the part-time Friends Secretary is also researching the nineteenth century casebooks. She presented at the Madness and Literature conference, examining representations of self-mutilation (a term introduced and defined by psychiatrists, including Bethlem superintendents George Savage and Theo Hyslop, in the 1880s) in nineteenth century literature and psychiatry. The title bears reference to Nathaniel Hawthorne’s The Scarlet Letter, first published in 1850. Set in puritanical seventeenth-century Massachusetts, the novel tells the story of the punishment of Hester Prynne, forced to wear an embroidered “A” on her chest (the “scarlet letter” of the title) as punishment for having borne an illegitimate child. At the close of the novel, this “A” is exhibited burnt into the chest of the Reverend Arthur Dimmesdale, publicly revealing him to be the child’s father, made physically and mentally ill through the long-guarding of his guilty secret. In Hawthorne’s work, the origins of the wound are debated, although to late nineteenth and early twentieth century psychiatrists, as well as certain of the spectators described by Hawthorne, the only “rational” explanation was that Dimmesdale’s self-punishment had been “followed out by inflicting a hideous torture on himself.”
Although Hawthorne’s representation of Dimmesdale was certainly not intended as a medical case history, the case was referenced by medical writers who had no problems with what some later authors, including Henry James, saw as a crude use of symbolism in an otherwise psychologically interesting novel. Indeed, many nineteenth century medical writers on self-mutilation expected their patients’ acts to be similarly symbolic, analysing motives and “hidden meanings” in a manner often starkly at odds with that in which other problematic behaviours were portrayed (in the Bethlem casebooks, refusal of food or persistent removal of clothes, for example, is usually simply dismissed as troublesome).
We can find many examples in the Bethlem casebooks of these attempts – by patients and practitioners – to give meaning to self-damaging actions such as face-picking, hair-plucking and self-cutting. In 1889, James Hipwood’s attendant stated that the former had cut his face because “he liked to see the blood that followed.” To his mother, meanwhile, Hipwood said that he cut himself because “he wanted to see if he could feel anything.” Yet, in Bethlem, an alternative explanation was implied. Although the doctors found it hard to get anything out of their patient at all, he did tell them “that he does not want to live & hints at something dreadful that is going to happen & at great suffering which he will have to bear.” The medical officers suggested that “he is apparently trying to prepare himself [for this] by inflicting pain on himself now.”
Photograph of Mary Stoate, admitted to Bethlem in 1895