The History of the Contagion Hypothesis

By Sarah Chaney

Whenever I’ve given a talk about the history of self-harm, someone asks the question, “But what about young people on the internet?” This often follows acknowledgment that self-injury – as an act and an understanding of or attitude towards an act – is contextual and historical. Yet somehow, the questioner implies, where young people and the internet are concerned this does not apply. Why should this be? Young people are no less complex than adults after all. In this blog, I suggest that we need to be careful in making quick assumptions as to what is to ‘blame’ for teen self-harm and suicide, and that while social media may seem like an easy scapegoat, there are also dangers in laying responsibility on online communities, image sharing and the potentially negative effects of teenagers on each other.

While we tend to think of self-harm as a relatively modern phenomenon, it has a much longer history. From the 1880s, psychiatrists categorised examples of ‘self-mutilation’ in asylum patients and those with no history of insanity. The acts they described ranged from amputation and castration to hair-plucking and skin-picking. Sometimes, these behaviours seemed to present as syndromes. Two American doctors coined the name ‘needle girls’ to refer to those who inserted pins and needles into their skin (Gould and Pyle, 1897).  Dermatologists referred to dermatitis artefacta: a skin lesion caused by chemical burns. There were examples of men and older women engaging in both of these behaviours. However, in both cases, the contemporary diagnosis of hysteria seemed to be the most convenient explanation for self-injury, and thus doctors focused on self-harm in young, single, middle class women who were most often diagnosed with hysteria. When men and working-class women self-harmed, they were simply labelled as malingerers – assumed to be avoiding work or seeking financial compensation.

It is important to note that in both instances – needle girls and dermatitis artefacta – the syndrome was seen only by doctors. Those who injured themselves were not aware of others in their ‘group’ and unlikely to be copying something they had encountered elsewhere. While the Victorians certainly blamed the pernicious influence of the mass media and certain works of literature – like Goethe’s The Sorrows of Young Werther (1774) – for epidemics of suicide, no one suggested that self-injury might spread in the same way. The ‘contagion hypothesis’ for self-harm didn’t emerge until much later, in the post-war period.

The most well-known of the studies that shaped the contagion hypothesis is that by criminologists Robert Ross and Hugh Bryan McKay, who spent ten years researching self-mutilation at a correctional institution for adolescent girls in Canada. Grandview School housed twelve to seventeen-year-old girls, admitted following a history of delinquent behaviour. Ross and McKay reported being appalled and dismayed by the stark environment and the harsh discipline of the institution, but the girls’ scars were their most immediate cause for concern. Out of 136 girls in the institution, 117 had ‘carved’ (as the girls called it) at least once, and the average girl had lacerated her skin eight times.

Interestingly, despite the widespread nature of self-harm at Grandview School, and the fact that Ross and McKay’s study has since been assumed to be evidence of the contagious nature of self-harm in young people, the authors decided that ‘there is really very little concrete evidence’ that self-mutilation was an epidemic phenomenon. The girls ‘carved’ for many reasons, in addition to the influence of peer coercion: as a mark of status, an initiation rite, an anti-establishment behaviour and to emphasise group membership. An earlier study in an adolescent unit in Plymouth, England, also commented on the difficulty of assuming a process of contagion in outbreaks of self-mutilation (Matthews, 1968). A systematic analysis of the communication process in a small group of young people indicated some clear lines of imitative or shared behaviour, but others that were not obviously related.  Some adolescents, moreover, were not involved at all, despite appearing just as potentially vulnerable as those who were.

When today we are told that social media communities are potential breeding grounds for self-harm and suicidal behaviour, this is often justified by the assumption that the internet must have ‘magnified tenfold’ concerns that were first raised in institutional settings. Yet this is a gross assumption, given the extremely different circumstances within a closed, intensive, rule-bound institution and the haphazard, multi-group and often casual nature of social internet use. And if we do find evidence of a link, there are other aspects of the ‘contagion’ studies that might also prove applicable, such as the tendency for restrictive interventions to increase self-injurious behaviour. Ross and McKay found that when security measures were tightened after girls escaped from Grandview (a frequent occurrence), incidents of self-harm increased. Studies in modern inpatient units have come to similar conclusions, and some have adopted policies of ‘harm minimisation’ rather than outright prevention. Indeed, research in other areas of mental health assumed to be contagious – eating disorders, for example – have indicated that restrictions placed on internet communities have no impact on reducing the sharing of promotional or glamorising messages, but do have a negative impact in reinforcing stigma and driving young people away from healthcare support (Casilli et al, 2013). As other blogs in this series have indicated, the history of the contagion hypothesis of self-harm shows that careful consideration is needed in assessing any links between self-injurious behaviour and internet use, and that the risk of further isolating and stigmatising young people, while ignoring their concerns, is a very real one.

Sarah Chaney is a Post-Doctoral Researcher at the QMUL Centre for the History of the Emotions. She is currently on a Wellcome Trust funded project on the history of compassion in nursing, in collaboration with the Royal College of Nursing Library and Archive. Her previous research focused on the history of self-harm and mental health care. Her monograph, Psyche on the Skin: A History of Self-Harm was published by Reaktion in 2017.

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