Self-harming behaviour is a global public health problem. It is one of the main risk factors for suicide and it results in extensive mortality and morbidity. Every year in the UK, self-harm results in more than 200 000 attendances to casualty departments, placing considerable strain on the National Health Service.
Favazza's original Bodies Under Siege, published in 1987, rapidly became the seminal textbook on self-harm. It contained an unparalleled cultural exploration of an array of self-harming behaviours. By dedicating separate chapters to specific variants of self-harm (the head, limbs and genitals each warrant their own chapter), and examining different beliefs, practices and customs across the world, Favazza brought into a very public discourse a previously unmentionable topic.
The third edition, although 40 pages shorter, retains most of the aforementioned trove of information, while also summarising the subsequent decades of academic and clinical endeavour into the prevention and treatment of self-harm. Notable additions include an in-depth discussion of the social forces behind the exponential increase in tattoos and body modification observed in modern popular culture, as well as the pivotal role the internet now plays in providing information about self-harm, including treatment for people who self-harm and their families. Thousands of websites, chat rooms and forums dedicated to self-harm have been created since the second edition was published in 1996.
The latest edition includes Favazza's personal reflections on his career-long exploration of self-harm and body modification, in which he reaffirms that there is hope for those whose lives have been overtaken by such potentially destructive behaviours. The book ends with a fascinating epilogue by Fakir Musafar, a pioneer of the ‘modern primitive’ body modification movement, who discusses the attractions, dangers and possibilities represented by such behaviours.
My only criticism of the book is that Favazza confusingly uses a number of interchangeable terms for self-harm, the preferred UK term. Indeed, the proliferation of terms describing the same phenomenon has arguably held back research in this field. Overall, however, the book is very well written and extremely informative, and Favazza has produced a refreshingly honest and objective account of self-harming behaviour. It is, as stated by Favazza, more than a catalogue of horrors; 25 years on, it is still an important publication in this challenging area of psychiatry and a particular strength of the third edition is its comprehensive (26-page) reference list, which spans more than 130 years of literature about self-harm. There is much to be learned from this book and, for clinicians or academics working with people who self-harm, it is an invaluable resource. Highly recommended.