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Stitches brew: A brief look at self-harm lip sewing

In previous blogs I have examined both self-harming behaviour (such as cutting off one’s own genitals, removing one’s own eye, removing one’s own ear, self-asphyxial risk taking in adolescence, and religious self-flagellation) and extreme body modification. One area where these two areas intersect is lip sewing. According to the Wikipedia entry on lip sewing:

“Lip sewing or mouth sewing, the operation of stitching together human lips, is a form of body modification. It may be carried out for aesthetic or religious reasons; as a play piercing practice; or as a form of protest. Sutures are often used to stitch the lips together, though sometimes piercings are made with needle blades or cannulas and monofilament is threaded through the holes. There is usually a fair amount of swelling, but permanent scarring is rare. Lip sewing may be done for aesthetic reasons, or to aid meditation by helping the mind to focus by removing the temptation to speak. BMEzine, an online magazine for body modification culture, published an article about a 23-year-old film student Inza, whose quest for body modifications was very varied. She spoke about her experiences with lip sewing as a form of play piercing”.

My reason for writing this blog was prompted by a case study published by Dr. Safak Taktak and his colleagues in the journal Health Care Current Reviews. (I ought to add that I have read a number of papers by Taktak and his colleagues as they have reported some interesting other interesting case studies including those on shoe fetishism, semen fetishism, and fetishes more generally – see ‘Further reading’ below). In this particular paper, they reported the case of a male prisoner who had continually sewed his lips together. Although they were aware of cases of sewing lips together as a form of protest, they claimed that there had never been any case reported in the medical literature.

lip-sewing

The case report involved a male 37-year old Turkish (imprisoned) farmer, father of two children, with only basic education. After sewing his lips together, the man was brought into the hospital by the police, along with a handwritten note that read: “My jinns imposed speech ban to me and they made me sew my lips unwillingly. Otherwise, they threaten me with my children. I want to meet a psychiatrist urgently”. (Jinns I later learned are – in Arabian and Muslim mythology – intelligent spirits of lower rank than the angels, able to appear in human and animal forms and are able to possess humans). Not only were his lips sown together with black thread but he had also sewn both of his ears to the side of his head (these are also photographed in the paper and you can download the report free from here). This was actually the fourth time the man had sewed his lips together (but the first that he had sewn his ears). Each time, the doctors took out the stitches and dressed the wounds. The authors examined previous documentation about the man and reported that the man had been in prison for four years after injuring someone (no details were provided) and had been diagnosed with both anxiety disorder and anti-social personality disorder. On a prison ward comprising ten other prisoners, he had attempted suicide when trying to hang himself (in fact, you can clearly see the marks on his neck in the paper’s photographs). The authors reported that:

[The man] had blunted affect. He wasn’t able to stay in the [prison] ward because of the directive voices in his head. He declared he needed to stay in the ward alone. He heard all the words as swearing and he was punished by some people as well as some entities. He also said that some jinns in the form of animals threatened him not to speak and listen to anyone; otherwise they were going to kill his kids. He wanted to protect his children [and] he stitched his lips not to speak anyone and stitched his ears not to hear anyone. In his family history, he stated that his uncle committed suicide by hanging himself and saying ‘the birds are calling me’; his father was schizophrenia-diagnosed”.

The authors then reported:

“The patient stated that he sewed his lips with any colour of thread he could find. He had approximately fifteen pinholes on his upper and lower lips. He tended to suicide with directive auditory and visual hallucination (sic) and reference paranoid delirium. As he was imprisoned, he wasn’t able to use drugs. The patient who was thought to have a psychotic disorder was injected [with] 10 mg haloperidol intramuscularly and he was sent to a safe psychiatry hospital”.

As I have noted in my previous blogs on self-harming behaviour (and as noted in this particular paper), there are many different definitions of what constitutes self-destructive behaviour. This particular case was said to be suited to the psychotic behaviours characterised by Dr. Armando Favazza’s three self-destructive behaviours (i.e., compulsive, typical, and psychotic) outlined in his 1992 paper ‘Repetitive self-mutilation’ (published in the journal Psychiatry Annals). In their discussion of the case, the authors noted:

“The cases like sewing one’s own lips which we observe as a different type of destructing oneself in our case are mostly regarded as intercultural expression of feelings. The ones, who sew their lips in order to protest something, show their reactions by blocking the nutrition intake organ to the ones who want to continue their superiority. It can be expected in psychotic cases that the patients or his beloved ones might be harmed, damaged or affected emotionally. Thus, the patient who is furious and anxious might react by [attempting] violence as a reaction to these repetitive threats. Auditory hallucinations giving orders can cause the aggressive behaviours to start…In our psychotic case, this kind of behaviour is a way to prevent the voices coming from his inner world, not to answer them and hence making passive defending to world which he does not want to interact. By this means, he may harmonise with the secret natural powers which affect him and he may protect himself his children…[also] there can be a relief through sewing lips and ears or strangulation against the oppression created by the person not being able to adapt the prison…It should not be forgotten that the prison is a stressful environment and stressful living [increases] the disposition to psychopathologic behaviour that the living difficulties in prisons can affect the way of thinking and the capacity of coping and it may cause different psychiatric incidences”.

As noted at the start of this article, lip sewing is typically attributed to religious reasons, reasons of protest or aesthetic reasons. In this particular case, none of these reasons was apparent (and therefore notable – in the medical and psychiatric literature at the very least). The addition of sewing his ears appears to be even more rare, and thus warrants further research.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Favazza, A.R. (1992). Repetitive self-mutilation. Psychiatric Annals, 22(2), 60-63.

Taktak, S., Ersoy, S., Ünsal, A., & Yetkiner, M. (2014). The man who sewed his mouth and ears: A case report. Health Care Current Reviews, 2(121), 2.

Taktak, S., Karakus, M., & Eke, S. M. (2015). The man whose fetish object is ejaculate: A case report. Journal of Psychiatry, 18(276), 2.

Taktak, S., Karakuş, M., Kaplan, A., & Eke, S. M. (2015). Shoe fetishism and kleptomania comorbidity: A case report. European Journal of Pharmaceutical and Medical Research, 2, 14-19.

Taktak, S., Yılmaz, E., Karamustafalıoglu, O., & Ünsal, A. (2016). Characteristics of paraphilics in Turkey: A retrospective study – 20years. International Journal of Law and Psychiatry, in press.

Wikipedia (2016). Lip sewing. Located at: https://en.wikipedia.org/wiki/Lip_sewing

My fiction ‘addiction’: The psychology of Hannibal Lecter

If I ever went on the BBC television show Mastermind, one of my potential specialist subjects would be the fictional serial killing psychiatrist Hannibal ‘The Cannibal’ Lecter (in print and on screen). I have devoured all four of Thomas Harris’ original books and all the DVDs (all five films and the TV series). In short, I am an obsessive Lecterite. While I was at university in the 1980s doing my undergraduate psychology degree, I was also the Entertainment Editor of the University of Bradford’s newspaper (Fleece). One of the perks of my part-time (unpaid) job was that I got to watch all the latest cinema releases for free and review them for Fleece. In 1986, one of the films that I watched (and loved) was Manhunter directed by Michael Mann. At the time, I didn’t realize that the film was based on Thomas Harris’ second book Red Dragon (first published in 1981 following his 1975 non-Lecter novel Black Sunday). However, I do remember the great (and understated) performance by Scottish actor Brian Cox playing the serial killing psychiatrist (spelled ‘Lecktor’ rather than Lecter in that particular film).

It was in 1991 that my real fascination with Lecter began after seeing The Silence of the Lambs directed by Jonathan Demme (and starring Anthony Hopkins as Lecter). I went to see it in the first week it was out as I was a big fan of Demme’s work particularly his musical documentary of Talking Heads in Stop Making Sense (1984), and films such as Melvin and Howard (1980), Swing Shift (1984), and Something Wild (1986). I came out of the cinema and within the space of a few weeks I had seen the film three times (and I was delighted when the film won all five of the main Oscar categories in 1992 – only the third film ever to have done so). At the time, I was a psychology lecturer at the University of Plymouth, and was teaching a weekly criminal psychology module to police inspectors on the university’s BA in Social and Organizational Studies. I was enthralled by the film’s use of behavioural profiling of criminals and the fact that the star of the film was a strange and bizarre paradox – a highly intelligent and highly cultured psychiatrist that also happened to be a serial killing cannibal.

It was at this point that I bought the two Thomas Harris novels that featured Lecter (i.e., Red Dragon and the 1988 sequel The Silence of the Lambs). I was gripped. Harris had clearly done his psychological and criminological research well (and I found the two books even better than the films). From then on I sought out anything Lecter-related and bought Harris’ further sequel (Hannibal, 1999) and prequel (Hannibal Rising, 2006), and watched and bought the big-budget Hollywood films Hannibal (2001, directed by Ridley Scott), Red Dragon (2002, directed by Brett Ratner) and Hannibal Rising (2007, directed by Peter Webber and starring Gaspard Ulliel as the young Hannibal), and most recently the US television series Hannibal (2013, starring Mads Mikkelsen as Lecter). My good friends also started buying me Lecter-related gifts (such as Daniel O’Brien’s excellent 2001 book The Hannibal Files).

So why am I – and millions of others worldwide – so fascinated, and – for want of a better word – ‘hooked’ on Hannibal the Cannibal’s fictional exploits? In 2005, the American Film Institute voted Hannibal Lecter the No.1 villain of all time (and who would argue against?). I suppose one of the scariest things about Lecter is that he’s the composite of real serial killers. People like Lecter actually exist and Harris clearly did his homework in writing his novels. In July 2013, Harris gave a rare interview and claimed that his inspiration for Lecter was a real-life Mexican murdering doctor (that he gave a pseudonym ‘Dr. Salazar’) and that he met in the 1960s while he was a newspaper crime reporter. Harris claimed that ‘Salazar’ had a “certain elegance”. It has also been noted that Harris attended the trial of Pietro Pacciani, a suspected serial killer nicknamed the ‘Monster of Florence’. The Wikipedia entry on Lecter claims that Pacciani’s serial killing modus operandi was used in his Hannibal novel. The Wikipedia entry also went on to say:

“According to David Sexton, author of The Strange World of Thomas Harris: Inside the Mind of the Creator of Hannibal Lecter, Harris once told a librarian in Cleveland, Mississippi, that Lecter was inspired by William Coyne, a local murderer who had escaped from prison in 1934 and gone on a rampage that included acts of murder and cannibalism. In her book Evil Serial Killers, Charlotte Greig asserts that the serial killer Albert Fish was the inspiration, at least in part, for Lecter. Greig also states that to explain Lecter’s pathology, Harris borrowed the story of serial killer and cannibal Andrei Chikatilo’s brother Stepan being kidnapped and eaten by starving neighbours (though she states that it is unclear whether the story was true or whether Stepan Chikatilo even existed)”.

I was surprised to find that there are dozens of academic papers written from many perspectives including psychology, psychiatry, criminology, media/film studies, and literary criticism (and I may well come back and write further blogs on Lecter using some of these). However, the rest of today’s blog concentrates on a really interesting trilogy of papers about Lecter written by Professor James Oleson in the Journal of Criminal Justice and Popular Culture (during 2005-2006). Oleson did a thorough review of various academic literatures and noted (in his 2005 paper) the following in relation to (i) the appeal of serial killers, and (ii) the appeal of Lecter more specifically:

“Apter (1992) suggests that serial killers transfix people because dangerous things – like serial killers – tend to create a state of invigorating psychological arousal. To neutralize the feelings of anxiety that accompany dangerous threats – like serial killers – we use protective frames such as narrative explanations or criminological theories. In explaining the serial killer’s behavior, we allow ourselves to succumb to the exciting magnetism of evil (Kloer, 2002) and can thereby ‘experience the excitement of arousal without being overwhelmed by anxiety’ (Ramsland, 2005)…Why do we love Lecter? Perhaps because he is the ‘perfect gothic hero’ (Dunant, 1999) or because he is the perfect gothic antihero (Dery, 1999). Perhaps it is because the heroic and the villainous co-exist within him. Because he is Obi Wan Kenobi and Darth Vader rolled into one (Hawker, 2001), because he is Darth Vader and Superman rolled into one (Cagle, 2002), or because he is Sherlock Holmes and Professor Moriarty rolled into one (Sexton, 2001)”.

Professor Oleson spends a lot of the first paper examining whether Lecter fits any of the serial killer typologies that various criminologists have formulated over the last three or four decades. According to Oleson, various researchers have identified two key precursors that have a high association with serial homicide – a pathological fantasy life and childhood trauma. Oleson argues that Lecter fits “this basic etiological model” because “he enjoys a rich and detailed fantasy life” and “he suffered serious childhood trauma”. Oleson also recounted the FBI’s research into ‘organized’ and ‘disorganized’ serial killers, and argued that there was evidence across all Harris’ books that Lecter displayed all 14 profile characteristics of an organized serial killer: (i) average to above-average intelligence, (ii) socially competent, (iii) skilled work preferred, (iv) sexually competent, (v) high birth order status, (vi) father’s work stable, (vii) inconsistent childhood discipline, (viii) controlled mood during crime, (ix) use of alcohol with crime, (x) precipitating situational stress, (xi) living with partner, (xii) mobility with car in good condition, (xiii) follows crime in news media, and (xiv) may change jobs or leave town.

Oleson also notes there are some models of serial killing that Lecter does not fit at all. For instance, the ‘addiction model’ of killing argues that some serial killers have a compulsion to kill and that they become addicted to killing (as put forward in the 1988 book Serial Killers by Dr. Joel Norris, and the 1996 book The Psychopathology of Serial Murder by Dr. Stephen Giannangelo). Another psychological model associated with serial killers is the concept of ‘sociopathy’ and ‘psychopathy’ (now termed ‘antisocial personality disorder’). Throughout Harris’ novels there are various references to Lecter being a sociopath and in the films he is described as being a psychopath (most notably by the psychiatrist Dr. Frederick Chilton, Director of the Baltimore State Hospital for the Criminally Insane, where Lecter was sent after being caught by his former profiling partner at the FBI (Will Graham). Oleson uses Dr. Robert Hare’s commonly used Psychopathy Checklist (first published in a 1980 issue of the journal Personality and Individual Differences) and convincingly shows that there is little evidence that Lecter is a psychopath.

Another model that Lecter does not fit is the “homicidal triad” of warning-sign behaviours (i.e., bed-wetting, animal cruelty, and fire starting) outlined in the many books of the FBI’s Dr. John Douglas and Mark Olshaker. This FBI research asserts that these three warning behaviours (particularly when they co-occur in adolescence) signal an elevated risk of subsequent serial homicide. However, Oleson shows that Lecter does not fit this profile at all. In his second (2006) paper, Oleson also assesses to what extent Lecter is insane. According to the M’Naughten test for insanity:

“It must be clearly proved that, at the time of committing the act, the party accused was laboring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing, or that [if] he did know it, that he did not know he was doing what was wrong (Finkel, 1988)”.

Oleson argues that Lecter “flunks the M’Naughten test on all counts”. In fact he goes on to say that:

“[Lecter] does not suffer from a defect of reason – if anything, as a genius with an infinitely rare IQ score, he may suffer from a superhuman perfection of the reason… Similarly, Lecter knows perfectly well the nature and quality of the crimes he commits, and he knows that they are denounced as wrong by society…The character of Hannibal Lecter would be deemed sane under more recently developed tests for insanity, as well. Lecter, in perfect command of his will, does not commit his crimes because he is compelled. Accordingly, he would not be insane under any formulation of the irresistible impulse test (Finkel, 1988). Nor would he be found insane under the American Law Institute test. ‘A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of law’ (Finkel, 1988). Lecter possesses both near-infallible cognitive ability and an iron will. He in no way fits the categories of insanity articulated under prevailing rules”.

Oleson’s papers also examine the idea that Lecter may be a non-human monster, a vampire, a superhuman, and/or the Devil. He also speculates that his crimes may be the product of his superhuman intellect (as Lecter’s IQ is so high that it cannot be assessed by any instruments that are currently used). As Oleson concludes in the second of his three papers:

“It has been suggested that the character of Hannibal Lecter is so memorable because he emerges from paradox…It could simply be the case, however, that Lecter is such a successful villain because we love monster stories…because we need monsters…and because the Lecter novels skillfully combine the police procedural with particularly resonant elements of the supernatural horror story”.

I (for one) love the paradox of Lecter’s personality and character. Both (super)man and monster. I admire some of his character traits but (of course) despise others. He is a highly flawed criminal genius and polymath. A serial killer and a cannibal. Victim and villain. In his third paper on Lecter, Oleson asserts something that I agree (and will leave you) with:

“By asking why Hannibal Lecter commits his crimes, criminologists may be able to use the Lecter novels and movies as a catalyst for the study of the etiology of serial homicide. The character of Hannibal Lecter is, after all, based on real life serial killers, and provides readers and viewers with an intimate (if hyperbolic) case study of an organized serial killer. Characters drawn from novels can serve as valuable heuristic devices…teaching us a great deal about the nature of crime and evil”.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

American Film Institute. (2005). Heroes and villains. Located at: http://www.afi.com/tvevents/100years/handv.aspx

Finkel, N. J. (1988). Insanity on Trial. New York: Plenum Press.

Hare, R.D. (1980). A research scale for the assessment of psychopathy in criminal populations. Personality and Individual Differences, 1, 111-119.

Hare, R.D. (1996). Psychopathy: A clinical construct whose time has come. Criminal Justice and Behavior, 23, 25-54.

Hare, R. D. (2003). Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, ON, Canada: Multi-Health Systems.

Hickey, E. W. (1991). Serial Murderers and Their Victims. Pacific Grove, CA: Brooks/Cole.

Oleson, J. C. (2003). The celebrity of infamy: A review essay of five autobiographies by three criminal geniuses. Crime, Law, and Social Change, 40, 409-16.

Oleson, J. C. (2005). King of killers: The criminological theories of Hannibal Lecter, part one. Journal of Criminal Justice and Popular Culture, 12, 186-210.

Oleson, J. C. (2006). Contemporary demonology: The criminological theories of Hannibal Lecter, part two. Journal of Criminal Justice and Popular Culture, 13, 29-49.

Oleson, J. C. (2006). The devil made me do it: the criminological theories of Hannibal Lecter, part three. Journal of Criminal Justice and Popular Culture, 13, 117-133.

Raine, A. (1993). The Psychopathology of Crime. New York: Academic Press.

Sexton, D. (2001). The Strange Mind of Thomas Harris. London: Faber and Faber.

Wikipedia (2013). Hannibal Lecter. Located at: http://en.wikipedia.org/wiki/Hannibal_Lecter