Background: Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). There are gaps in our knowledge of DSI as an indicator of severity of psychopathology, as moderator of outcome and with regard to its response to different treatment programs and settings. Methods: We compare 2 samples of PD with (n = 59) and without (n = 64) DSI in terms of clinical presentation, response to psychosocial treatment and relative outcome when treated with specialist long-term residential and community-based programs. We test the assumption that DSI is an appropriate indicator for long-term inpatient care by contrasting the outcomes (symptom severity and DSI recidivism) of the 2 DSI sub-groups treated in the 2 different approaches. Results: PD with DSI had greater severity of presentation on a number of variables (early maternal separation, sexual abuse, axis-I comorbidities, suicidality and inpatient episodes) than PD without DSI. With regard to treatment response, we found a significant 3-way interaction between DSI, treatment model and outcome at 24-month follow-up. PD with DSI treated in a community-based program have significantly greater chances of improving on symptom severity and recidivism of self-injurious behaviour compared to PD with DSI treated in a long-term residential program. Conclusions: Although limitations in the study design invite caution in interpreting the results, the poor outcome of the inpatient DSI group suggests that explicit protocols for the management of DSI in inpatient settings may be beneficial and that the clinical indications for long-term inpatient treatment for severe and non-severe PD may require updating.
This article develops a critique of ethnography in educational research. It is argued that ethnography concerns the study of the phenomenal forms of everyday life. Beyond these phenomenal forms are inner relations, causal processes, and generative mechanisms which are often invisible to the actors. A science of social totalities, deriving from Marx, is advocated which can elaborate the relationship between phenomenal forms, the world of appearances, and deeper social structural causal mechanisms. This science cannot be generated by ethnography alone but only through historical and comparative analyses of modes of production in history. The argument is illustrated by an imaginary ethnographic study of a typical “fascist” school in Germany and by a discussion of developments taking place in schooling systems in the contemporary world. A theory of reproduction is required which locates the analysis of capitalist schooling systems in a broader theory of the reproduction of all the economic, political, and ideological requirements for capitalist accumulation and the role of the state in this process. Ethnography carried out in schools informed by such a theory has a political rationale. It can lay the foundations for a critique of the world of appearances in everyday life, a necessary part of any political practice designed to produce a society in which essence and appearance are at one.
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