In the book’s introductory chapter and throughout the text, you frame self-injury as a phenomenon that can help us understand the body and embodiment in the twenty-first century. To what extent would you say that the ‘epidemic’ of self-injury in the past thirty years — and our scholarly and popular sensationalized fascination with it — is a product of biomedicalization? What can be gained for sociologists studying the body and embodiment by taking this approach to self-injury? (This is just a broad question to get some of the interesting arguments in the book out there. Feel free to rephrase at will!)
The concept of biomedicalization is a really interesting one in relation to self-injury. In the book I suggest that accounts in some cases frame self-injury as a method of ‘working on’ mental health via bodies. This type of explanation relies on knowing about other ways we might ‘work on’ our mental health via bodily, biological processes – for instance, the ingestion of pills which we understand to ‘work on’ our ‘brain chemicals’ (Martin, 2006 - https://link.springer.com/content/pdf/10.1017/S1745855206003012.pdf).
However, whilst I am taken by the idea that we can understand self-injury through the prism of biomedicalization – e.g. that it is indeed a product to some extent of biomedicalization; there are aspects of the practice itself which simultaneously unsettle this position. Firstly, and perhaps crudely, while accounts of self-injury may sometimes draw on ‘clean’ clinical terminology such as endorphins, pain-relieving chemicals, or serotonin/dopamine; the practice of self-injury in many cases involves much more mess, perhaps less precision, and certainly less technoscience than the ingestion of psycho-pharmaceuticals. Elsewhere, accounts of self-injury speak much more to corporeal, visceral, often bloody aspects as being central to the ‘success’ of the practice. Rease, one of the interviewees, talks of the difficulty of finding a replacement for self-injury: “because it involves the body so strongly … the actual cutting and the… blood thing, there’s not much else that can kind of, stand in for that really”. Further, another way in which self-injury is framed as appealing is that – in contrast to pharmaceutical comforts to a distressed mind/body – self-injury is more readily accessible, and indeed free.
I think for sociologists studying self-injury there has been a tendency to avoid engagement with medicine – perhaps as a way of affirming the ‘social’ nature of the practice. However, I argue in the book that we have to account for and try to understand the role of ‘medical ways of knowing’ in shaping practices and accounts of self-injury. This argument resonates strongly with those developed by scholars such as Adele Clarke and Nikolas Rose (and their collaborators), in underlining the importance of medical and other ‘technoscientific’ knowledges in shaping how bodies are understood, experienced and accounted for. I suggest that even where self-injury is being practised well away from ‘the clinic’, the meanings it has can be tied to medicine in a range of ways – both in terms of the biomedical language used, and in terms of self-injury being seen more broadly as a sign of mental ‘distress’ – or indeed illness.
Authenticity is a central concept in the book. How do practices of self-injury help construct the ‘authentic self’ and why is the spectre of the ‘attention-seeking other’ so threatening?
I think that practices of self-injury can work in a number of ways to produce authenticity. Firstly, practices of self-injury can be drawn on narratively to construct a self that is ‘authentically’ in pain. However, as I discuss in the book, this can be a treacherous path to tread. Accounts sometimes struggle with a desire to show that self-injury is ‘authentic’ – often through comparisons to inauthentic ‘others’ (particularly the ‘attention-seeking other’). My research suggested this was particularly the case with self-injury that became visible to others, there was something about self-injury that could be seen by other people that seemed to invite potential charges of inauthenticity and/or attention-seeking.
The question of why the ‘attention-seeking other’ is so threatening is an important one, and something I’m not sure I fully have the answer for yet! I think the spectre of attention-seeking is threatening for multiple reasons, and likely this explains its enduring power. Firstly, it relates to what ‘attention-seeking’ seems to mean for many people: e.g. a ‘dramatic’ practice associated with youth, and with a desire for attention that is perceived as undeserved. Secondly, and specifically relating to self-injury, I would suggest that an increasingly entrenched view of self-injury as ‘private’ makes it very difficult to contemplate or practice self-injury that is ‘visible’. I explore this in more detail in a paper published last year in YOUNG (Chandler 2017 - http://journals.sagepub.com/doi/abs/10.1177/1103308817717367 ), but even that analysis is not quite sufficient. For instance, I think there is likely a lot more to be done in terms of exploring the different ways in which self-injury is made visible online and off line
Despite the popular imagery of self-injury as a ‘hidden’ or ‘secret’ world, those who practice self-injury sometimes either voluntarily or involuntarily seek help for their injuries. In your compelling chapter on this, you outline how often those who self-injure are brutalized by health professionals. Even in the face of thirty years’ worth of work to destigmatize and raise awareness about self-injury, these accounts continue. What do you think could meaningfully be done to reduce the brutalization of those who self-injure when they seek help? What changes are necessary in healthcare to make seeking help less stigmatizing for those who self-injure?
This is such an important question. I despair at the regularity with which I still hear more stories of people who self-injure being treated poorly by health, social care and indeed law enforcement. Unfortunately, I think that changes are going to be hard won, since they relate – in my view – to fairly deeply embedded issues with healthcare design and delivery. Notably, the way in which healthcare privileges physical over mental distress. In the UK, where I am based, there have been a lot of recent pressure on the Government to increase spending on mental health research and services, but despite calls for ‘parity of esteem’ there is such a long way to go. More than this, the separation of ‘mental’ from ‘physical’ health in how healthcare provision and research is organised, while increasingly untenable, is so entrenched in how medical systems, training and knowledge are organised, that I don’t think there are any easy answers.
Given the above, I think that ‘more training’ for people in healthcare roles is a little bit like sticking a band-aid over a bullet hole. There is evidence that this can help improve staff attitudes (e.g. see a review by Saunders et al 2012 - http://www.jad-journal.com/article/S0165-0327(11)00496-4/abstract), but I wonder that in contexts of resource limitations, funding cuts, and the stigmatisation of people with mental health difficulties, such training may have limited impacts on practice.
With regard to self-injury the situation is further exacerbated because of views about the responsibility and control that individuals are understood to have over their practice; and also the association with ‘attention-seeking’ discussed above. Each of these interpretations can combine to make it easier to dismiss (whether benignly or more forcefully) the needs and bodies of people who self-injure.
Throughout the book, you engage critically with the corporeality of self-injury: the act of wounding, the care that goes into healing wounds, the ‘evidence’ left behind of self-injury. You are also deeply reflexive about your own experiences living with self-injury. How did your own experiences shape the way you approached this topic as a scholar? How did this shape your interviews with participants? Do you have any advice for scholars working on topics with which they share an embodied experience, especially those that are stigmatized?
My experiences with self-injury have irrevocably shaped my approach to the topic as an area of study. These experiences affected the choice of topic in the first place, how I responded to existing literature, and from that how I designed my own research. As I note in the book, I think a lot of my desire to focus more on the corporeality of self-injury was shaped by my experience of ‘being someone who self-injured’ and seeing embodied aspects of this experience absent in much of the existing literature.
That said, it has taken a long time for me to feel more comfortable with discussing the role of my own experiences in relation to my academic work. I spent a lot of time as a doctoral student sitting in meetings with colleagues, other researchers, or mentors and having discussions about self-injury, whilst self-consciously pulling at my sleeves and making sure I wasn’t ‘outed’ to those not in the know. It took me five years into life as a postdoctoral researcher before I ‘stopped hiding’ my arms and began, tentatively, to name my experiences more explicitly – this is despite these experiences being written up in my thesis, and communicated openly to those I interviewed!
In terms of the interviews with participants, my identity as someone who shared the practice of self-injury was a really useful resource. It allowed for moments of humour, it gave me a platform to ask questions, to compare experiences, as well as to acknowledge differences. In terms of advice to scholars working on similar issues I would say make sure you have a back-up team. My experiences of being ‘out’ as someone who has self-injured and who researches this have been entirely positive; but I haven’t been doing it long (indeed, for most of my academic career I have not been terribly open about my experience with self-injury), and the contexts in which that knowledge is out have been relatively safe. I’m currently drawing a lot of inspiration and enthusiasm from a group of researchers who I connected with via a symposium I organised (with Tineke Broer, and Martyn Pickersgill in 2016) on the role of personal experience in sociological research on mental health [link here https://mentalhealthandreflexivity.wordpress.com/blog/]. These scholars (many of whom are at the start of their careers) are writing and researching on topics such as anorexia and suicide, whilst being open about sharing these experiences. I see this as a really hopeful sign, though also one that raises all sorts of interesting questions, some of which we are exploring in a forthcoming special issue in Social Theory and Health.
One of the arguments you make about scholarship on self-injury is that it individualizes emotional experiences. You argue convincingly that scholarly and popular accounts of self-injury frame it as a way to deal with negative emotions that either cannot be named or cannot be expressed in the presence of others. While the feeling rules of families are often to blame for why people might start to self-injure, what aspects of our cultural and/or societal constructions of emotion also set these feeling rules? What does gender have to do with it?
This is a really useful question – there is a lot of focus on the role of families, but much more to be said I think about the importance of wider cultural scripts and rules regarding emotions. In my research participants did refer sometimes to ideas about a ‘British (or Scottish) culture’ of inhibition regarding emotions – the famous ‘stiff upper lip’. I related these accounts to theories of emotion developed by Elias, Hochschild, and Lupton, each of whom – in different ways – have shown how feeling rules and expectations about emotional management are context dependent and change over time. There are debates though about the extent to which emotions are more or less repressed in contemporary, industrial societies – and in many ways accounts of self-injury mirror these. The practice can be understood both as a way of ‘privately’ managing emotions, away from others, in order to maintain a ‘stiff upper lip’; as well as at the same time being read as a dramatic expression of ‘excessive’ emotion.
There is much more work to be done on gender, self-injury and emotion. Research and commentary on self-injury is so suffused with gendered framings that is difficult to see the wood for the trees. In the book I draw on historians Millard and Brickman, who have shown how gender intimately shaped the ways that psychiatric knowledge about self-injury was produced in the mid 20th Century. Building on these insights, I would argue that part of the reason that the story about self-injury being a peculiarly ‘feminine’ endeavour has stuck can be related to the way that ‘emotion’ in general is seen as something that women ‘do’ (men being allegedly more ‘rational’ and ‘unemotional’); and if self-injury is framed as being about emotions, then it makes more sense that it is something that women and girls do. However, a number of things unsettle this interpretation. Firstly, the evidence about gender and self-injury is very mixed, and most survey studies find at least one third of respondents endorsing self-harm identify as male. Secondly, there is persuasive work from the sociology of emotions which directly challenges the characterisation of men as unemotional and women as emotional; as well as the view that ‘rationality’ is somehow the absence of emotions (a recent paper by de Boise and Hearn does a great job of summarising some of these arguments http://journals.sagepub.com/doi/abs/10.1177/0038026116686500).
Finally, and to return to the centrality of embodiment to self-injury, the framing of emotions as ephemeral, and hard to control, was clearly present in some accounts of self-injury, which sought to underline why the embodied practice of self-injury was so important. This ties in to the core theme of the book – authenticity – and the challenges that participants spoke of in having their distress validated or recognised. Because emotions are not ‘seen’ they can be subject to charges of inauthenticity (and this too has deep historically gendered roots, where female emotionality has been tied to manipulation and hysteria). In the face of this, self-injury is framed as a way of ‘showing’ distress. At the same time – perversely – the practice of self-injury, when seen, is also subject to charges of authenticity. This complexity is, I would suggest, an important part of the enduring stigma associated with self-injury, and the ongoing challenges faced by those who self-injure in having their distress recognised, validated and attended to.
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