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Självskadande handlingar: ungdomars berättelser: kontextualisering av ett medikaliserat socialt fenomen
Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
2018 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2018. , p. 94
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 89
Keywords [en]
Self-injuring acts, adolescents, narratives, Internet, interaction, social context, arenas of comfort, social work, medicalization, demedicalization
National Category
Social Work
Identifiers
URN: urn:nbn:se:umu:diva-145941ISBN: 978-91-7601-856-9 (print)OAI: oai:DiVA.org:umu-145941DiVA, id: diva2:1192536
Public defence
2018-04-20, Hörsal C, Samhällsvetarhuset, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2018-03-27 Created: 2018-03-22 Last updated: 2018-06-09Bibliographically approved
List of papers
1. Beyond medicalization: Self-injuring acts revisited
Open this publication in new window or tab >>Beyond medicalization: Self-injuring acts revisited
2016 (English)In: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 20, no 4, p. 346-362Article, review/survey (Refereed) Published
Abstract [en]

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.

Keywords
demedicalization, gender, medicalization, research context, self-injuring acts
National Category
Public Health, Global Health, Social Medicine and Epidemiology Social Work
Identifiers
urn:nbn:se:umu:diva-125595 (URN)10.1177/1363459316633280 (DOI)000380140900002 ()26944632 (PubMedID)
Available from: 2016-10-04 Created: 2016-09-13 Last updated: 2018-06-09Bibliographically approved
2. Adolescents’ self-injuring acts in a social contextual framing: The importance of arenas of comfort
Open this publication in new window or tab >>Adolescents’ self-injuring acts in a social contextual framing: The importance of arenas of comfort
(English)Manuscript (preprint) (Other academic)
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-145949 (URN)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2018-06-09
3. Adolescent’s self-injuring acts: A strategy based on stored knowledge and bounded agency
Open this publication in new window or tab >>Adolescent’s self-injuring acts: A strategy based on stored knowledge and bounded agency
(English)Manuscript (preprint) (Other academic)
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-145950 (URN)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2018-06-09
4. Consequences of medicalization for adolescents’ disclosure of self-injuring acts
Open this publication in new window or tab >>Consequences of medicalization for adolescents’ disclosure of self-injuring acts
(English)Manuscript (preprint) (Other academic)
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-145951 (URN)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2018-06-09

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