A critical 'insider' story of self-harm

Abstract

This thesis is a qualitative study of self-harm employing a theoretical framework somewhere between social constructionist and critical realist. For some time I had been of the view that not enough was being done to successfully support and intervene in the lives of those who engaged in self-harming. There seemed to be a gap in the research literature and clinical practice which could possibly be filled by seeking answers to research questions such as: What meanings can be extracted from data on self-harm provided by individuals who considered that they had never self-harmed, had mildly or moderately self-harmed, or, who had seriously self-harmed? What is self-harm from a phenomenological and functional point of view? Has the phenomenon of self-harm been appropriately named and defined? What implications might there be for support and intervention, and staff training? The method of open, unstructured discussion rather than structured or semi-structured interviewing for collection of raw data was used, and the principal analytic tool was thematic analysis upon which were grafted parts of other qualitative methods such as narrative analysis and interpretative phenomenological analysis. Findings and conclusions included the following:- Piloting work produced 8 themes (addiction, control, coping, depression, emotion regulation, anti-suicide, suicide, and miscellaneous) and the main study added at least 11 more (purpose in life, pain, punishment, attention-seeking, unattractive/attractive, attacking to be attacked, communication, cry for help, dissociation/depersonalisation, someone to look after, and, manipulation). Four overarching themes were identified. First, what self-harm is – culturally unacceptable self-harming activities (CUSHAS) and culturally acceptable self-harming activities 5 (CASHAS); secondly, causes and functions; thirdly, support and intervention; and, fourthly, contradictions or dilemmas. From these overarching themes, and associated data extracts, synoptic stories on each of the six main study participants were assembled. A new name for self-harm was produced, namely, body self-harm or body self-harming (BSH) and a new definition: Body self-harming is behaviour which occurs when individuals, intentionally or unintentionally, give precedence to their mental health over their physical health by the process of damaging their own bodies. And, the beginnings of a new conceptual framework were put forward. Conclusions were reached about support and intervention which, I argued, could usefully take a form that was not necessarily different from what might be required by anyone in need of psychological assistance, irrespective of the presenting issues. Finally, some suggestions were made about staff training which would consider culturally acceptable and unacceptable Body self-harming activities (CABSHAS and CUBSHAS) as essentially similar phenomena.