Self-Harm and Medicine’s Moral Code: A Historical Perspective, 1950–2000

“Deliberate self-harm”— acts of self-poisoning (overdosing) or self-injury (e.g., cutting)
that do not result in death — has historically provoked a moral judgment in those professionals
who treat it. Such judgments negatively value the act of self-harm and lead
to the discriminatory treatment of self-harmers in accident and emergency departments
and upon psychiatric wards. This article argues that the treatment of self-harmers in such
environments has its origins in a “moral code” that negatively values the act of self-harm
in comparison to (a) suicide, (b) the accident victim, and (c) individuals considered to
be “genuinely” physically ill. The article fulfi lls two functions. First, it tracks the history
of “medicine’s moral code” as it surrounds self-harm in the British context during the
period 1950–2000. Then it turns to examine the ways in which patients groups — so-called
psychiatric survivors — resisted such discriminatory treatment in the period 1988 –2000.
Such resistance, the article concludes, creates the opportunity for a democratic dialogue
to develop between patient groups and service providers that could potentially ameliorate
the deleterious effects of medicine’s moral code. The article’s tone is polemical and is
expressly written from a perspective sympathetic to the political claims of “survivors,”
which the authors conclude forms a central component in the development of democratic
practices within medicine and psychiatry.