‘Then I just showed her my arms . . .’ Bodily sensations in moments of alienation related to self‐injurious behaviour.* A hermeneutic phenomenological study

Abstract

People committing self-injurious behaviour are often perceived as difficult patients; confronted with unhelpful reactions from nurses, the patients find themselves left alone in their distress. A connection between self-injurious behaviour and feelings of alienation is suggested in the literature. Alienation is described as a state in which the self is perceived as strange, machinelike and not in contact with its emotional and physical needs. On one hand, complex neuro-biological processes are seen as responsible for this; on the other hand, alienation is seen as a means of self-protection when one is exposed to a threatening or traumatic situation. Nursing interventions focus on the nurse-patient relationship and on the handling of self-injuries, but they tend to ignore the client's previous experience. Proceeding from the assumption that patients committing self-injurious behaviour are the experts on their own harm, the purpose of the present study is to get insight into their 'lived experience' and to contribute to the understanding of this vulnerable group. Adopting a hermeneutic phenomenological research perspective, methods of participant observation and qualitative interviewing were chosen to generate data. The database consists of 99 observational sequences, five interviews and a set of email texts written by a self-injuring woman. A thematic analysis as described by Van Manen was done. The main findings are that alienation is experienced in several stages, that nurses can detect early signs of an impending loss of control, and that self-injurious behaviour is an effective strategy to end a painful experience of alienation. Self-injurious behaviour is appropriately understood as a form of 'self-care'.

‘They don't understand…you cut yourself in order to live.’ Interpretative repertoires jointly constructing interactions between adult women who self-harm and professional caregivers.

“…Participant observations offer the opportunity to share certain experiences and have been used in studies conducted in psychiatric care (Bray, 1999; Johansson, Skärsäter, & Danielsson, 2007; Schoppman, Schröck, Schnepp, & Büscher, 2007). A researcher can take various roles depending on the focus of the observation.…”

Improving communication and practical skills in working with inpatients who self-harm: a pre-test/post-test study of the effects of a training programme

“…It supports them to regulate intense and overwhelming emotions and thoughts. For many self-harm patients, who often have a negative self-image and body experience, possibly caused by previous trauma and abuse, self-harm operates as a survival mechanism [7,8]. …”

Held to ransom: Parents of self-harming adults describe their lived experience of professional care and caregivers

“…Self-harm has been described as a way of dealing with severe mental suffering and is often referred to as a coping strategy (Solomon & Farrand, 1996) or a survival strategy (Pembroke, 1998; Reece, 2005; Schoppmann, Schröck, Schnepp, & Büscher, 2007). The self-infliction of physical harm in these cases makes mental suffering easier to manage (Favazza, 1996; Solomon & Farrand, 1996).…”