by Brenton L. Delp
The modern act of cutting is usually approached through the language of pathology, crisis, and psychiatric risk. Those dimensions are real and should never be minimized. Yet history permits another perspective. For much of antiquity and the medieval world, the deliberate release of blood was not regarded as mutilation but as medicine. Bloodletting was prescribed to reduce fever, relieve pressure, calm agitation, disperse inflammation, and restore balance within a distressed organism. If we widen our frame, contemporary self-cutting can be interpreted—without romanticizing it—as a private and tragic attempt to achieve through the body what earlier cultures often sought through sanctioned healing: immediate relief from an unbearable state.¹
Ancient medicine operated with a different image of the body than modern biomedicine. Health was not primarily the absence of disease entities but the right proportion and movement of humors, qualities, and vital forces. Illness could arise through excess, stagnation, corruption, or improper mixture. To remove blood was therefore not merely to subtract fluid; it was to restore order. In the Hippocratic corpus, medicine repeatedly proceeds through evacuation, timing, and the redirection of bodily processes. One therapeutic passage advises that in severe thoracic pain “one should open the inner vein at the elbow,” and blood should be drawn until the dangerous excess has passed.² The principle is unmistakable: suffering may be lessened when pressure is given an exit.
This therapeutic image was not confined to emergencies. Bloodletting was used for headache, fever, inflammatory pain, bodily fullness, menstrual disturbances, and states associated with agitation or congestion. Medieval medicine inherited and expanded the practice, integrating it with regimen, seasonal cycles, and astrological correspondences.³ However strange these systems now appear, they preserve an enduring intuition: when something accumulates beyond tolerable measure, health may require release.
Galen systematized this worldview with extraordinary influence. In On the Natural Faculties, he describes blood not as inert matter but as part of the living economy of nourishment and temperament. “The blood,” he writes, is generated for the sake of nutrition and distributed through the organism as part of nature’s purposive activity.⁴ Elsewhere he distinguishes proper and improper heat, linking bodily well-being to proportion and disease to disturbance. In such a framework, bloodletting becomes intelligible because illness is not merely damaged tissue but disordered process. To alter the movement of the organism is to alter the course of suffering.
Galen also defended venesection directly against rival schools. In his polemical treatises he insists that properly judged evacuation can avert danger and restore equilibrium. Medicine, in this sense, does not passively observe distress; it intervenes by creating an outlet.⁵ Whatever the empirical limits of these theories, their psychological significance remains profound. Entire civilizations recognized a connection between inward distress and the experience of relief through controlled bodily discharge.
This historical memory becomes illuminating when we turn to contemporary self-injury. Many who cut themselves do not report a wish to die. More often they describe unbearable tension, numbness, panic, dissociation, self-hatred, or emotional flooding. The act can produce a temporary sense of calm, clarity, grounding, or release. Contemporary psychology has repeatedly found that non-suicidal self-injury often serves affect regulation. Matthew Nock summarizes the literature plainly: “the strongest and most consistent support has been found for affect-regulation functions.”⁶ E. David Klonsky similarly concludes that self-injury is frequently used to “alleviate intense negative emotions.”⁷
The comparison with bloodletting must be stated carefully. Ancient venesection was socially authorized, theoretically interpreted, and usually administered by a healer. Self-cutting is often private, stigmatized, and bound to trauma or fragmented identity. They are not the same act. Yet structurally they share something essential: both treat suffering through the body when suffering feels otherwise unmanageable. Both rely on the intuition that inner torment can be altered by a controlled wound. Both seek immediacy where slower forms of healing are absent or inaccessible.
This contrast also reveals something about modern consciousness. In premodern medicine, distress was held within a public symbolic order. The physician, the humoral theory, the seasons, and the wider cosmology supplied meaning. Relief came through recognized forms. In modernity, many individuals inherit intense inward burdens without a shared framework capable of containing them. Anxiety, emptiness, and psychic overload are often privatized. The subject is left to manage alone what earlier cultures distributed across ritual, theology, communal medicine, and inherited forms of life.
Under such conditions, the body can become the final available instrument of regulation. The person who cuts may not seek pain as such, but interruption: an end to escalating pressure, a return from numbness, a boundary against psychic diffusion, a momentary sense that chaos has become manageable. The wound becomes an emergency technique.
None of this justifies self-harm. Temporary relief is often followed by shame, secrecy, scarring, escalation, and renewed dependence on injury as coping. Clinical care should always seek safer and deeper forms of regulation: trauma-informed therapy, emotional literacy, medication when appropriate, relational repair, and the slow growth of symbolic capacities that make suffering thinkable rather than merely dischargeable. But historical understanding matters. When we see that earlier cultures once used bloodletting to relieve distress, contemporary self-cutting appears less as incomprehensible deviance and more as a tragic improvisation within a psychologically burdened age.
The larger lesson is that symptoms often preserve truths that theories forget. Ancient medicine was mistaken about many mechanisms, yet it grasped something enduring: unbearable states demand transformation, and when no adequate path is available, the body is recruited to perform the task. The modern challenge is not to repeat bloodletting in literal form, nor to condemn those who cut as irrational, but to build forms of life in which psychic pain can be contained, interpreted, and relieved without the necessity of injury. In that sense, the history of bloodletting is not a curiosity of the past. It remains a mirror for the present.
Notes
¹ Roy Porter, Blood and Guts: A Short History of Medicine (New York: W. W. Norton, 2002), 46–52.
² Hippocrates, Diseases II, in Hippocrates, trans. W. H. S. Jones and E. T. Withington, Loeb Classical Library (Cambridge, MA: Harvard University Press, 1923).
³ Nancy G. Siraisi, Medieval and Early Renaissance Medicine: An Introduction to Knowledge and Practice (Chicago: University of Chicago Press, 1990), 101–118.
⁴ Galen, On the Natural Faculties, trans. Arthur John Brock, Loeb Classical Library (Cambridge, MA: Harvard University Press, 1916), I.13–15.
⁵ Galen, On Venesection against Erasistratus, in Galen: Selected Works, trans. P. N. Singer (Oxford: Oxford University Press, 1997).
⁶ Matthew K. Nock, “Self-Injury,” Annual Review of Clinical Psychology 6 (2010): 339–363.
⁷ E. David Klonsky, “The Functions of Deliberate Self-Injury: A Review of the Evidence,” Clinical Psychology Review 27, no. 2 (2007): 226–239.
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