Umeå University's logo

Självskadande handlingar relateras ofta till psykisk ohälsa vilket medfört att de som skadar sig själva uppfattas vara i behov av psykologisk eller psykiatrisk behandling. Med hänvisning till att ett stort antal ungdomar skadar sig själva finns anledning att ompröva konnotationen mellan självskadande handlingar och psykisk problematik. För att förstå ungdomars självskadande handlingar bör dessa relateras till en sociokulturell kontext med fokus på unga människors handlingsutrymme. Att skada sig själv kan vara en strategi för att hantera de känslor som kan uppstå i problematiska situationer inom familj eller skola. Vi argumenterar för vikten av ett samhälleligt preventivt arbete för att motverka att ungdomar börjar skada sig själva, och menar att konkreta åtgärder i den sociala kontexten även kan stödja dem som redan börjat skada sig.

Although common among community adolescents, self-injuring acts are mainlystudied by psychiatrists and psychologists and rarely by social work researchers.The preponderance of medical research in the field has come to associateself-injuring acts with mental issues. This view has to a large extent beenadopted among professionals as well as among laypeople. When examiningadolescents’ unsolicited internet published narratives, this medicalization ofself-injuring acts was found to have negative consequences for disclosure andhelp-seeking, and hence limit the adolescents’ possibilities to get adequate helpand support. The main objective of this work is to study adolescents’ views onhampering factors for help-seeking for self-injuring acts and the role of medicalisationfor their willingness for disclosure and help-seeking. Disclosure ofself-injuring acts within the social network was described as met with demandsto seek professional mental help. Seeking professional help was accompaniedwith fear of being perceived as crazy or diagnosed as mentally ill. Internet websiteswere described as value free and safe arenas giving opportunity to discloseself-injuring acts without fear of being stigmatized and labelled as mentally ill.An extended involvement of social work researchers and professionals, approachingself-injuring acts not primarily as a sign of mental problems, but asan adolescent way of trying to manage a complicated social context, could enhancefinding adequate support systems. It is also necessary that the medicalprofession contributes to a demedicalization of self-injuring acts.

The aim of this thesis is twofold; to explore adolescents’ own views on self-injuring acts and to analyse the field of research on self-injuring acts. Together, these two aims comprise the overall aim of the thesis; to increase knowledge on self-injuring acts among adolescents.The material for the first study consists of scientific publications from 1913 to 2018. The material for the three following studies consists of adolescents’ Internet published unsolicited first-person narratives on their experience of self-injuring acts.Based on an examination of the research literature over a hundred year period, it was found that self-injuring acts have been medicalized since the beginning of research. Studies in the 1960’s and 1970’s were mainly conducted through observations of female psychiatric inpatients, establishing a picture of the typical cutter as a young, attractive, emotionally unstable woman. Although later research has found self-injuring acts to be common among community adolescents, the dominance of medical and psychological studies has continued to reinforce the view on self-injuring acts as related to intrapersonal difficulties.In the narratives studied, the adolescents described their self-injuring acts as closely related to an unstable social context, consisting of problems within the family, problems at school and the loss of dear ones. The recurrently described lack of access to an arena of comfort, a place or a relation providing trust and security, was found to be significant with respect to the initiation of self-injuring acts among these adolescents.In contrast to the common view on self-injuring acts as an outcome of individual characteristics, the findings point to adolescents’ self-injuring acts as a cognitively motivated and planned strategy to endure otherwise unbearable situations. Due to their adolescent position, their options to act, to take control or make changes are severely restricted.Disclosure of self-injuring acts within the social network was described as met with demands to seek professional mental help. Thoughts on seeking professional help were accompanied by fear of being perceived as crazy or diagnosed as mentally ill, thus causing social stigma. Thus, the medicalization of self-injuring acts was found to have negative consequences for disclosure and help-seeking, thereby limiting the adolescents’ options for finding adequate support. Internet websites were described as value-free and safe arenas, providing an opportunity to disclose self-injuring acts without fear of being stigmatized.The main conclusion is that adolescents’ self-injuring acts are closely related to problems in the social context, and need to be understood and related to the restrictions inherent in an adolescent position. From this perspective, it is the social context, not the self-injuring acts that should be in focus in research and practice. Social work research, focusing on social context and interaction, could develop the research field, broaden perspectives on these acts, and develop knowledge and understanding that goes beyond the established medicalized view of self-injuring acts.

For too long, medical/psychiatric and psychological studies, with focus on emotional sensitivity, personality traits, and correlation with psychopathology, have dominated research on self-injuring acts. The phenomenon thus has been defined as a predominantly medical issue. However, a large body of community prevalence studies show self-injuring acts to be a common phenomenon in society, and most of those who self-injure are unknown in psychiatric or other clinical settings. This article describes and analyzes the medicalization of self-injuring acts and argues a need to move research on self-injuring acts out of the medical paradigm. There is a need to explicitly explore the impact of social, cultural, structural, and gendered factors surrounding and influencing self-injuring acts. A non-medical approach, beyond the limits of the medical perspective, would feed research forward and create a more nuanced view on this widespread social phenomenon.

While the psychiatric therapeutic community is focused on individual diagnostic tools to understand deliberate self harm, self-destructive behaviour among young persons in Western society is increasing to a level where it arguably must be regarded as a cultural rather than an individual problem. While psychiatry adheres to its expert role, trying to find explanations for the individual behaviour in past life experiences and subsequent personality formation, the world outside of the therapy room is changing. In this outside world, on the Internet deliberate self harm is not described as a pathological behaviour that needs to be corrected, but as a powerful tool to cope with present life stressors, a way to form an identity and even as a way of staying alive. Against a background of present trends in society and how these influence identity formation, these narratives give important clues for finding new approaches to the experiences and life strategies of young persons living in modern society. In encounters with young persons whose self-harming behaviour has become intimately woven into the fabric of life, the keys to opening up different perspectives and find other ways to cope probably can not be found without accrediting the strength and determination in the present behaviour and closely and attentively pay attention to her own understanding of her situation, her own strengths and her own abilities.