A political approach to thinking about self-harm

This is a post by Dr. Guy Aitchison and Dr. Ryan Essex introducing their recent paper, ‘Self-harm in immigration detention: political, not (just) medical’. It appears on the Journal of Medical Ethics blog.

In April 2016, the Iranian refugee, Omid Masoumali, set himself on fire in front of UN inspectors at the Nauru island detention centre run by Australia. He later died of his injuries after delays in his treatment. Before carrying out his act, he shouted “This is how tired we are”. Omar’s case is extreme but not unusual. A great many people in immigration detention harm themselves. Things are especially bad in offshore facilities of the kind Australia runs in the Pacific and the UK has recently introduced in Rwanda. Indeed, one study found that rates of self-harm in an Australian offshore centre were 216 times higher than in the general community. Across the world immigration detention is known to produce anxiety, depression and PTSD, as well as high rates of self-harm and even suicide.

A number of media outlets – especially the Guardian Australia – have done important work in bringing the individual stories behind such acts to light. But for the most part, the world has turned a blind eye, dismissed or demonised these acts. Authorities dismiss self-harm by detainees as an attempt at ‘manipulation’ or as a purely medical problem. A medical approach brings with it certain assumptions. Self-harm is usually treated as something maladaptive that stems from personal (rather than collective) factors. Diagnosis and treatment by medical professionals is the preferred ‘solution’. For the most part, advocates for detainees have endorsed a medical approach. When we began the project that produced our recent paper in the Journal of Medical Ethics we wanted to uncover the political side of self-harm. We felt it was important to situate it within a broader context of resistance to punitive border controls. Self-harm is a difficult, complex topic and it inevitably brings one into contact with a great deal of human misery. We admit to a certain amount of unease at the prospect of writing about this issue. At the same time, government across the world benefit from keeping the topic taboo.

Keep reading at the Journal of Medical Ethics blog.

Short interview on hunger strikes

Guy Aitchison did a short video interview on hunger strikes for faculti, a global research repository that talks to academics about their work.

In the interview, Guy unpacks some of the ethical issues raised by political self-starvation and other themes from his paper published in the Journal of Political Philosophy. You can watch it here.

New publication in ‘Journal of Medical Ethics’

We are happy to announce that the latest research paper is out from this project co-authored by Guy Aitchison (Loughborough) and Ryan Essex (Greenwich). It looks at the ways in which self-harm by detainees caught up in the misery of immigration detention can count as a form of political resistance. The paper draws on debates on the meaning of self-harm within the psychiatric literature; on the nature of resistance within political philosophy and on the testimony of current and former detainees from Australia’s infamous offshore system of border management:

Self-harm within immigration detention centres has been a widely documented phenomenon, occurring at far higher rates than the wider community. Evidence suggests that factors such as the conditions of detention and uncertainty about refugee status are among the most prominent precipitators of self-harm. While important in explaining self-harm, this is not the entire story. In this paper, we argue for a more overtly political interpretation of detainee self-harm as resistance and assess the ethical implications of this view, drawing on interviews with detainees from Australia’s offshore system. Self-harm by detainees is not only a medical ‘condition’ arising in response to oppression but a form of political action to lessen or contest it. We first establish how self-harm could be conceptualised as resistance. We then discuss its political purpose, noting it serves at least three functions: intrinsic, instrumental and disruptive or coercive. Viewing detainee self-harm as political resistance is a supplement to (rather than a substitute for) a medical approach. However, conceptualising self-harm this way has several advantages, namely, moving away from the idea that such behaviour is ‘maladaptive’, recognising detainees as political agents, combatting government claims of ‘manipulation’ and ‘blackmail’ and clarifying the duties of healthcare workers who work in detention.

The full published paper can be downloaded from the JME website here.

Self-starvation: From the Suffragettes to Guantanamo, pt. 2

This is a follow up to part 1, exploring in more detail some of the cases of hunger strike and self-harm protests that I discovered looking through newspaper articles and secondary literature in order to create this timeline.

While self-starvation at the very start of the twentieth century was primarily deployed by the Suffragette and Irish liberation struggles, it became more broadly used by anti-colonial and civil rights movement over the next few decades. One of the most famous proponents of hunger strike was Mohandas K. Gandhi. Like those undertaken by Irish republicans, these were strikes aimed at the power and might of the British Empire, symbolising the hunger strike as a David and Goliath struggle. But Gandhi’s public fasting – distinct, he claimed, from the hunger strike – proved to be a successful tool precisely because of his public profile as leader of the Indian National Congress.

Sidney Rowlatt, whose recommendations informed the repressive legislation introduced by the colonial government

According to Nayan Shah, Gandhi’s proposal of a mass public fast – including one of the earliest examples in February 1919 against the repressive Rowlatt Act – served the same purpose as a general strike.1 But Gandhi’s use of fasting was varied – some were indefinite, most were of timed duration, some individual and some public, mass fasts. Gandhi’s first hunger strike from jail in 1932 was fairly controversial. The British authorities wanted to reform India’s voting system to reserve seats for lower caste Dalits in parliament, which Gandhi claimed split Indians based on caste. But critics such as Ambedkar argued that Gandhi was simply defending his power base which was distinctly anti-Dalit.2 The British authorities rescinded the measure to avoid Gandhi dying.

Thích Quảng Đức
Thích Quảng Đức

One of the most famous and iconic images of self-harm is the photo taken of the Vietnamese Buddhist monk Thích Quảng Đức. Thích Quảng Đức’s self-immolation in Saigon in 1963 was in protest against the treatment of Buddhists by South Vietnam’s government. In the immediate build up to the American invasion and occupation of South Vietnam, the image of this self-immolation – directed specifically against the anti-Buddhist violence and forced conversions of Ngô Đình Diệm’s regime – became an iconic depiction of the strength of political resistance in Vietnam, and is a searing image for contemplating paradoxical implications of non-violent protest.

The war in Vietnam produced a vast anti-war movement in the United States where a growing civil rights movement was fighting the racial discrimination of African Americans. With the repression of that movement, black activists found themselves arrested and imprisoned at the hands of racist police and judges, and a prisoner rights movement grew in support of the likes of Huey Newton and Angela Davis. Davis went on hunger strike in October 1970 against prison conditions and as a result was moved out of solitary confinement.3 That same year saw the first Palestinian prisoner to die on hunger strike, Abdul Qader Abu al-Fahm, who died as a result of force-feeding by the Israeli authorities.

Mural in West Belfast of Bobby Sands, who died on hunger strike in May 1981

During the 1970s, the many anti-colonial and anti-authoritarian protest movements around the world saw a growing number of political prisoners going on hunger strike. This included the 100 students in Nicaragua hunger striking for the release of political prisoners following intense government repression. Basque separatists and trade unionists went on hunger strike in Franco’s prisons. In 1974, Irish republican Michael Gaughan died on hunger strike in prison on the Isle of Wight as a direct result of force feeding – this prompted a review of its use and ultimately the end of force feeding in British prisons.4 Holger Meins of the West German Red Army Faction died after a protracted hunger strike and force feeding later the same year, and hunger strikes by Irish republicans in Northern Ireland led to ten deaths in 1981.5

The greater visibility given to self-starvation protests during the 1960s and 1970s included some more obscure examples. Some were political, such as the Italian Radical Party politician Marco Pannella who went on hunger strike in 1972 in favour of legalising divorce, and again two years later in aid of legalising abortion. Both Sirhan Sirhan and James Earl Ray – killers of Robert Kennedy and Martin Luther King respectively – went on hunger strike over prison conditions. The disgraced British politician John Stonehouse who had faked his own death went on hunger strike in Australia protesting his extradition. Perhaps the strangest hunger strike case I found was Billy Marks’ June 1977 hunger strike in Skidmore, Maryland protesting a ban on horse traffic across Chesapeake Bay Bridge.

There were increasing cases of self-starvation by political refugees in the 1970s, particularly in Latin America. Cases of Chileans and Uruguayans on hunger strike in Argentina awaiting settlement, as well as Basques in France fleeing Franco’s Spain. Hunger strikes as industrial action were rare but did occur – in May 1978, three men in the Irish town of Tuam won government concessions after a hunger strike to stop the closure of the town’s rail service and potato plant.

More recently, hunger strikes have taken place on a mass scale in American prisons in protest against conditions such as solitary confinement, in detention centres against the indefinite imprisonment of migrants, and in the Guantanamo Bay Detention Camp where prisoners have pursued legal means to stop the use of force feeding. Like the suffragette hunger strikes over 100 years ago, more recent examples tend to take place in prisons or detention centres as a last resort for people with very little political voice, and often in conjunction with other self-harm protests such as sewing lips together.  

  1. Nayan Shah, Refusal to Eat: a Century of Prison Hunger Strikes, p. 113.
  2. Ambedkar: “There was nothing noble in the fast. It was a foul and filthy act… [I]t was the worst form of coercion against a helpless people to give up the constitutional safeguards of which they had become possessed… How can the Untouchables regard such a man as honest and sincere?” – quoted in Arundhati Roy’s essay The Doctor and the Saint, the preface to B.R. Ambedkar, Annihilation of Caste: The Annotated Critical Edition (London: Verso, 2014).
  3. ‘Angela Davis Is Transferred to a Regular Cell’, 7 November 1970, The New York Times Archive, https://www.nytimes.com/1970/11/07/archives/angela-davis-is-transferred-to-a-regular-cell-court-order-carried.html.
  4. Ian Miller, A History of Force Feeding: Hunger Strikes, Prisons and Medical Ethics, 1909-1974 (London: Palgrave Macmillan, 2016), p. 213.
  5. See Leith Passmore, ‘The Art of Hunger: Self-Starvation in the Red Army Faction’, German History, Volume 27, Issue 1 (January 2009), pp. 32–59; David Beresford, Ten Men Dead: The Story of the 1981 Irish Hunger Strike (London: Grafton Books, 1987); Brian Campbell, Laurence McKeown, Felim O’Hagan, Nor Meekly Serve My Time: The H-Block Struggle 1976–1981 (Belfast: Beyond the Pale, 2001).

Offshore detention: A warning for the UK from Down Under

Guy Aitchison: I have a new article in openDemocracy looking at the UK’s latest scheme to send asylum-seekers to Rwanda for offshore “processing”. The piece draws on my interviews over recent months, as part of this project, with victims of Australia’s failed experiment in offshore detention in the Pacific:

The first 50 asylum-seekers in the UK have now received notice from the Home Office that they face deportation to Rwanda, where they risk being permanently resettled even if officially confirmed as refugees. With a taste for irony reminiscent of a certain Russian leader, British ministers defend this plan for the mass transit of “tens of thousands” of human beings against their will as a “solution” to the problem of human trafficking.

In reality, the Rwanda deal – which promises the East African country an initial £120m to host those who have made ‘illegal’ entry into the UK – borrows from the same semi-colonial playbook as Australia’s recent failed experiment in offshore ‘processing’.

From 2012 onwards, asylum-seekers arriving by boat to Australia were forcibly sent to the small pacific island nation of Nauru and to Papua New Guinea’s Manus Island, where they were detained indefinitely in squalid and repressive conditions.

Read the full piece at openDemocracy.

Self-starvation timeline part 1: the Suffragettes and Irish republicanism

Since starting research for this project, I have sifted through various English-language newspaper articles from the last sixty years or so looking for stories on hunger strikes. We decided to put together a timeline of instances of hunger strike and self-harm carried out as acts of protest or civil disobedience, primarily in order to collate a lot of this information and present it visually over time. So here is a bit of a deeper dive into some of the key events, many of them well known, and some lesser-known cases too.

It’s difficult to start a timeline of hunger strikes chronologically, since instances of hunger strike stretch back to antiquity. But in order to trace the origins of the modern phenomenon of political hunger strikes, carried out primarily by prisoners, the Suffragette hunger strikes are some of the earliest, most visible examples. These were undertaken by women who had been imprisoned for politically-motivated crimes and were striking to demand recognition as political prisoners. The first was Marion Wallace Dunlop, a Scottish member of the Women’s Social and Political Union, who went on hunger strike in 1909 for political status. Marion had been arrested on numerous occasions, and in July 1909 was caught stencilling a passage from the Bill of Rights on a wall on the House of Commons. She applied to be placed in the first division of Holloway Prison upon entry, which would have required acknowledging her offense as political, and when this was rejected embarked on a hunger strike. She was released after four days.1

Cat and Mouse Act represented in a political poster

These hunger strikes are key to understanding self-starvation as a political tactic. Force feeding was introduced in 1909 to avoid the creation of political martyrs. It was a tool already used in asylums, and in September that year was used on Mary Leigh in Winson Street Gaol, Birmingham. The use of force feeding by the prison authorities was brutal and regularly described as torture. During this period, hunger striking women were belittled as psychologically troubled, denying their political motivations as well as their bodily autonomy. In response to public outrage over force feeding, the government introduced the so-called Cat and Mouse Act in 1913, allowing hunger striking prisoners to be released and re-arrested when they had returned to full health.

Self-harm was widely used by suffragettes – Emily Davison jumped from the top floor of prison after force feeding, which she suffered on 49 occasions, and later died by jumping in front of the King’s horse at Epsom.

The influence of the Suffragette hunger strikes on subsequent political movements has been significant. Indeed when three English suffragettes went on hunger strike in Mountjoy Prison in Dublin in August 1912 they were joined by four Irish suffragettes who had been imprisoned in June for throwing stones at government buildings, including Hanna Sheehy-Skeffington.2 Sheehy-Skeffington’s  Irish Women’s Franchise League supported Irish republican James Connolly’s 1913 hunger strike.

Whilst James Connolly’s hunger strike protested his imprisonment for involvement in industrial action, Thomas Ashe’s 1917 strike was for political status, having been imprisoned for his role in the 1916 Easter Rising. Three years later Terence Macswiney, Lord Mayor of Cork, died in Brixton prison whilst taking part in a hunger strike for political status along with prisoners in his hometown. Macswiney, like Ashe, had been force fed. Joe Murphy and Michael Fitzgerald died in Cork, but it was Ashe and particularly Macswiney whose names would take on legendary status amongst Irish republicans as examples of martyrdom – Macswiney’s words “It is not those who can inflict the most, but those who can suffer the most who will conquer” became a key motivating sentiment for later generations.

Demonstration following the death of Terence Macswiney on hunger strike

  1. Ian Miller, A History of Force Feeding: Hunger Strikes, Prisons and Medical Ethics 1909-1974, p. 39.
  2. Miller, A History of Force Feeding, p. 71.

Publication in ‘The Journal of Political Philosophy’

I’m very pleased to share a new paper on the ethics of hunger strikes, which has just been published in The Journal of Political Philosophy (edited by Professor Robert Goodin): ‘Fragility as Strength: The Ethics and Politics of Hunger Strikes’.

The paper explains the distinctive political role of the hunger strike in terms of three core functions (communicative, coercive and expressive) and offers an ethical justification for indefinite hunger strikes that aim to coerce the authorities (and hence frequently get derided as ‘blackmail’). The paper benefitted from research assistance and support provided by the BA/Leverhulme grant.

You can read the version of the paper here. And if you don’t have access, please contact me and I can share a draft.

Read on here.

‘Starving for Dignity’ research project launches

Hello! Thanks for checking in. We’ll be using this blog to post updates about the ‘Starving for Dignity’ project, giving a taste of the research as it progresses and linking to relevant material. We’ll also be posting details about planned future events.

The hunger strike and other extreme methods of protest, such as self-immolation, are of course deeply shocking and counter-intuitive. It is the strange, paradoxical character of these protests that provides the impetus for this project.

In recent years, many people became acquainted with the grizzly reality of hunger strikes thanks to Steve McQueen’s brilliant 2008 film, ‘Hunger’. The film depicts perhaps the most famous hunger strike of all; by Bobby Sands and his fellow Irish republican prisoners in Maze prison, Belfast, in 1981. Ten prisoners eventually died through self-starvation, including Sands, who was elected MP for Sinn Fein while on hunger strike.

In one of the most gripping scenes of the film, a Catholic priest (played by Liam Cunningham) attempts to dissuade Sands (played by Michael Fassbender) from starting a hunger strike which will almost certainly lead to his death. The scene covers some of the most fascinating ethical questions raised by hunger strikes to do with martyrdom, self-killing, violence, and other important issues. It also contains some terrific acting.

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