Narrating the self-injured body

Re-posted from the CRFR Blog

Recent media reports have highlighted an apparent rise in the numbers of young people reporting self-harm. These reports should be treated with caution: surveys may well have identified a rise in the number of people who are harming themselves, but findings might also reflect an increased awareness of what self-harm is; meaning that self-harm can be more easily identified and named.

Naming self-harm can be a tricky business, and the recent debates about including ‘non-suicidal self-injury’ in the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (American Psychiatric Association, 2013) is just one example of this. My research, with people who have self-harmed, and General Practitioners, suggests that the type of practices self-harm is understood to involve, and the meanings they have, can vary widely. While for some people, ‘self-harm’ is taken to mean skin-cutting; for others it might refer to overdoses; misusing drugs and alcohol, attempting suicide, risk-taking, or maintaining an abusive relationship.

Surveys that collect data about rates of self-harm provide important information; but they do not tell us the whole story about how someone understands self-harm, what kind of practices self-harm involves, how self-harm affects and contributes to their day-to-day life. Even a particular type of self-harm, say, self-cutting, can be used and experienced in many different ways (Chandler, 2012; Chandler, 2013).

In a paper that was published recently (online first) in the BMJ journal Medical Humanities, I explore narratives about living with bodies scarred or marked by self-cutting. The paper uses Arthur Frank’s typology of illness narratives (Frank, 1995): restitution, chaos, and quest, to demonstrate the different ways in which people talked about the impact of scarring on their lives.

  • Restitution: For some participants, a focus of their story was to emphasise removal of scars, and attempts to ‘fix’ the problem of the scarred body.
  • Chaos: More rarely, people spoke of their scarred bodies as chaotic, indicating feeling out of control of their body and the scars.
  • Quest: A more optimistic account was given by others, who talked about the role of scars in ‘telling a story’ – to themselves and to others. Importantly, the story was one of hope, and of overcoming difficulties.

If rates of self-harm are increasing, there are likely to be more people living with scarred bodies in future. It is important to acknowledge that these scars may have very different meanings, and be experienced in different ways. Indeed, a common theme across the research I have done with people who have self-harmed highlights the pain caused by other people’s assumptions about what self-harm, or self-harm scars, might mean.

EDIT: The paper, Narrating the self-injured  body, is now open access in BMJ Medical Humanities.

American Psychiatric Association (2013), Diagnostic and statistical manual of mental disorders: DSM-5, Arlington, VA, American Psychiatric Association.

Chandler, A. (2012), ‘Self-injury as embodied emotion-work: Managing rationality, emotions and bodies’, Sociology, 46, 3, 442-457.

Chandler, A. (2013), ‘Inviting pain? Pain, dualism and embodiment in narratives of self-injury’, Sociology of Health & Illness, 35, 5, 716-730.

Frank, A. (1995), The Wounded Storyteller; Body, Illness, and Ethics Chicago, University of Chicago Press.

 

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Ethics, Embodiment Re/Production and the Lifecourse

Written following a symposium I was involved in organising, held on June 6th 2014 at the University of Edinburgh.

“[B]ioethics is out of touch. It is out of touch with bodies themselves” (Shildrick 2005; p. 2)

Feminist theorists such as Margrit Shildrick have been prominent in critiquing bioethical discussions which take for granted bodies and embodiment. In Ethics of the Body: Postconventional Challenges, an edited collection by Shildrick and Mykitiuk, this is explored via papers addressing a range of topics which both invoke bioethical engagement, but also unsettle and question notions of embodiment and what bodies are. For me, the book has been a useful and enduring resource, since different chapters within it address areas of empirical research or teaching I’ve been involved in: addictions (Helen Keane), mental health (Nancy Potter), disability (Jackie Leach Scully), and sex/gender (Katrina Roen).

On 5th June 2014, a symposium, Ethics, Embodiment, Re/Production and the Lifecourse, at the University of Edinburgh, interrogated questions about the relationship, and potential for mutual collaboration between, theories of embodiment and bioethics. The symposium was part of a Wellcome Trust strategic award, The Human Body, its Scope, Limits and Future, on which Sarah Cunningham-Burley, my co-organiser, is co-investigator.

What can theoretical work on embodiment contribute to discussions about the ethical implications of biomedical innovations? What can bioethics contribute to theoretical work on embodiment?

The focus of the symposium on re/production and the lifecourse reflected an attempt to look at embodiment and ethics in terms of reproduction, and especially the challenges raised by new reproductive technologies, but also to consider how biomedicine increasingly works across the lifecourse to produce different types of bodies. Such biomedical innovations and interventions raise significant ethical questions. They also raise important questions about the nature of bodies and embodiment.

My own interest in embodiment and bioethics, and what the two might contribute to one another, led from work I undertook during a postdoctoral fellowship at IASH (Institute for Advanced Studies in the Humanities). While there I was working broadly on ethics and self-harm, but I focused especially on exploring the ways that academic discourse about the ethics of treating self-harm addressed embodiment. Perhaps unsurprisingly, most of what I found, which was itself limited, tended not to engage much with self-harm as an embodied practice. Indeed, this is reflective of the vast majority of academic work on self-harm – it tends to gloss over the messy, lived, corporeal aspects of being or caring for someone who self-harms.

The relative lack of engagement in (some) bioethical work with embodiment, and especially fleshy, lived bodies, was raised by many of the speakers who contributed to the symposium. I’ll be writing a more detailed blog and report of the day; but here is a brief overview of the speakers and their talks:

Session 1: Reproduction, ethics and embodiment

  • Elizabeth Ettorre, opened the day sketching out the need for an embodied ethics, which is open to and engages with bodily, embodied diversity; is empathic; and attends to embodied emotions as a part of ethical reflection.
  • Danielle Griffiths followed, taking an embodied perspective to ethical debates about new reproductive technologies; particularly those that have been proposed but not yet realised: male pregnancy and ectogenesis.

Session 2: Ethics, medicine and disabled bodies

  • The second session addressed disability and medical treatments or ‘fixes’. Fadhila Mazanderani discussed the role of patient’s embodied experiences in guiding their decision making regarding controversial treatments for MS; contrasting this type of evidence with, for example, Randomised Control Trials that are often prized in clinical decision making.
  • Jackie Leach Scully raised a series of provocative arguments regarding the development, use and representation of prosthetics. She suggested that the use of prosthetics contributes to the normalisation of certain types of disabled body; and the marginalisation of others.

Session 3: Biomedical innovations and enhancements

  • Next, Gill Haddow addressed a different type of assistive device (ICDs), though this one designed to prolong/extend/save life; discussing the embodied and relational consequences of being a ‘cyborg’.
  • Finally, Sarah Chan addressed bioethical debates about enhancement, using this discussion to problematize dominant bioethical discourse about normality, especially as applied to gender and disability.

The third session was also to have included a paper from Anne Kerr, discussing body work and emotional labour in biomedical innovation. Anne couldn’t present on the day unfortunately, but her paper would have been a great addition.

There were a number of common themes and threads running throughout the day, which I need more time to think about in order to do them justice. What was very clear was that there is a great deal of scope for further work which engages with bioethics and embodiment, especially when this explicitly includes attention to emotions.

References

Shildrick, M. (2005), ‘Beyond the Body of Bioethics: Challenging the Conventions’, in Shildrick, M. and Mykitiuk, R. (eds.), Ethics of the Body: Postconventional Challenges, London, MIT Press.

Personal troubles and public issues: Suicide among disadvantaged men in mid-life and the importance of sociology

Suicide and society

BBC Newsnight ran a story on 5th March 2013 exploring the reasons why men in the UK are around three times more likely to complete suicide than women. As well as gender, other social factors affect suicide rates, particularly age and socio-economic position. While suicide is the leading cause of death for men aged 30-44, the suicide rate among men aged 45-59 has been “increasing significantly” since 2007 (ONS 2013) becoming almost equal to the 30-44 year old rate. The group of men most likely to die by suicide is men in mid-life (aged 35-54) in the lowest socio-economic group, a fact highlighted in a report published by Samaritans last year.

The Newsnight programme featured the work of both Samaritans and CALM (The Campaign Against Living Miserably), as well as including powerful testimony from men who had experienced suicidal thoughts, and the family of a man who had completed suicide. Much of the discussion focused on the difficulties faced by men in acknowledging distress and seeking help. Barriers include ‘masculine’ ideas about appropriate behaviour, especially around communicating about distress; the design of mental health services; and wider stigma about mental ill-health. In light of these barriers, it was heartening to see suicide among men discussed so openly and in such a public setting. It was encouraging also to see the involvement of a range of professionals, perspectives and views.

What the programme also showcased (albeit not explicitly) was the importance of sociological perspectives in contributing to understanding suicide. The discussion demonstrated the extremely wide-ranging factors that impact on suicide among men including: economic hardship, changing labour markets, relationship breakdown, drug and alcohol use, socially proscribed expectations of what men and women should do, as well as mental ill-health. Many of these issues are explored in detail, using sociological approaches, in a report from Samaritans, which I contributed to: Men, Suicide and Society (2012). The report argued that the complex nature of suicide necessitates wide-ranging attempts at explanation, which go beyond clinical or psychiatric perspectives which – while important – have historically dominated suicidology.

Suicide research, policy and practice should incorporate a similarly wide disciplinary lens; and suicide prevention strategies too need to be wide-ranging. Although suicide is very much a ‘personal trouble’ it is also an inherently ‘public issue’ (Mills 1959). As such, policy and practice in a range of areas can and do impact on suicide. It already appears that the current economic climate is impacting negatively on rates of suicide, particularly among men living in areas with high rates of unemployment (Barr et al., 2012). These ‘public issues’ will not be solved by improvements in mental health services alone; but require bolder action in terms of addressing gender inequalities and gendered expectations of men and women, tackling socioeconomic inequalities, reducing social isolation, and improving the chances that men and women have of living fulfilled and content lives.

References and Resources

Barr, B., Taylor-Robinson, D., Scott-Samuel, A., McKee, M. and Stuckler, D. (2012), ‘Suicides associated with the 2008-10 economic recession in England: time trend analysis’, BMJ, 13, 345.

Mills, C. W. (1959) The Sociological Imagination New York, Oxford University Press

ONS (2013) Suicides in the United Kingdom 2011

Samaritans (2012) Men, Suicide and Society, why disadvantaged men in mid-life die by suicide
 

Self-injury and embodied emotions

This is a slightly edited version of the first blog I ever did, reproduced from CRFR’s blog, which you can see here. This post was originally posted in 2012, when the first article from my PhD research on self-harm was published in the BSA journal: Sociology.

Self-injury is an under-theorised and little understood behaviour, despite reports that rates of self-injury are on the increase. Measuring the prevalence of self-injury is notoriously difficult: the number of people who present at a hospital reporting self-harm and self-injury are only a small proportion of all cases. Studies that have sought to measure prevalence have tended to focus on adolescent groups, and to date, there is no data on the incidence of self-injury and self-harm among the general adult population in the UK.

This blog on self-injury and emotions, is based on an article published in 2012, in Sociology.

Self-injury is usually studied from a clinical perspective: however, sociological approaches have the potential to greatly improve understandings of the practice. Recognising the emotional aspects of doing self-injury or understanding more about the societal and life factors that might lead someone to injure themselves can be an important way of exploring self-harm. Such approaches challenge some clinical psychological and psychiatric perspectives which tend to frame self-injury as ‘a problem’ located within the individual.

I undertook research to explore the ‘lived experience’ of self-injury, gathering the life stories of 12 people who had self-injured. People involved in the study were identified from non-clinical community sites, to increase the chances of including people who had not engaged with formal support services. Participants were aged between 21 and 37 years old from mixed backgrounds, although the majority were studying for, or had gained, higher educational qualifications.

Self-injury was defined as the cutting, burning or hitting the outside of the body, resulting, in most cases, in visible, lasting and sometimes permanent marks on the skin. As part of the study people frequently explored the reasons they had self-injured and, in most cases, they referred to how it enabled them to ‘work on’ their emotions through their body:

Control and Release: Release, relief and control were used by many participants when describing their self-injury. For some it allowed them to regain ‘control’ over their emotions, and their lives, while for others it was about controlling otherwise uncontrollable feelings.

“when the situation seems to spiral and I’m whooo losing it. Em and it was like right, regain control, this is what I’m gonna do, I’m going to cut myself…and it’s like, releasing something…and then when that whatever it is is released then your sortie regaining control…” (Anna)

Participants in the research suggested that when they felt they had little or no control over their body or life, control enacted through self-injury could be experienced positively. These explanations for self-injury reflect tensions between being ‘in control’ whilst at the same time needing to have a ‘release’. Similar language is used when people describe other embodied practices such as drinking, smoking and exercising.

Eliciting or Creating Emotions: Others suggested that they had used self-injury to bring out emotions that were ‘missing’. Self-injury in these cases generated a feeling of ‘something’ in response to ‘emotional numbness’:

“I wasn’t pretending that I wasn’t upset but I would just, I wasn’t letting people to know I was upset, if you see what I mean…I wanted to be able to feel I wanted to, you know, live or experience stuff, or… and so, self-harming was, you know a way of, feeling, pain, you know feeling pain ‘cos it was something.” (Francis)

In contrast, some participants talked about self-injury generating positive feelings:

“I think the first time it was associated with kind of a rush and, and a buzz.” (Justin)

These accounts, by indicating that ‘work’ is done on the emotions, through the body, demonstrate the interconnected nature of mind and body, challenging idea that they are, or could ever be, separate.

Reference to the article below, and clicking will take you to the article itself. A pre-pubulication version is available via my academia.edu profile. The research was supported by an ESRC funded PhD studentship, at the University of Edinburgh (2005-2010).

Chandler, A., (2012) Self-injury as Embodied Emotion Work: Managing Rationality, Emotions and Bodies, Sociology, 46 (3).