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Stigmata: part I. Shame, guilt, and anger
J D Welch1, K Meriwether, R Trautman
1Department of Plastic Surgery, University of Washington, USA. jdwelch@msn.com
Plastic and Reconstructive Surgery
|December 22, 1999
Summary
This study explores surgical options for self-inflicted forearm scars, often called "hesitation marks." It proposes a deeper symbolic motivation behind these injuries and offers treatment guidelines.
Area of Science:
- Plastic Surgery
- Psychiatry
- Dermatology
Background:
- Patients with self-inflicted forearm scars, popularly termed "hesitation marks" or "suicide gestures," seek aesthetic surgical consultation.
- Unlike factitial ulcers or Münchhausen syndrome, these patients openly acknowledge the self-inflicted nature of their scars.
Observation:
- Scars typically present as multiple, parallel, white lines on the forearms, often more prominent on the non-dominant side.
- The distinct pattern of these scars is a primary driver for patients seeking surgical relief due to their common association with self-harm.
- The authors propose a deeper, symbolic motivation underlying these self-inflicted injuries, beyond the superficial appearance.
Findings:
- Analysis of three patient cases revealed a significant symbolic meaning associated with these self-inflicted scars.
- A central thesis regarding the psychological underpinnings of this type of self-harm is presented.
- Specific surgical treatment proposals are outlined for managing these unique scars.
Implications:
- Understanding the symbolic meaning is crucial for effective treatment planning in aesthetic surgery.
- Patient narratives offer valuable insights and practical warnings for surgeons.
- This research contributes to a more comprehensive approach to managing self-inflicted scars, integrating psychological and surgical perspectives.
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