'At the cutting edge - experts by experience, care by experts': a study of two interpretations of the language of self-injurious behaviour in a group of women

Self-harming behaviour is prevalent in modern society and occurs across genders from an early age (Horrocks, 2003; Wilhelm 2003). The thesis examines one component notably, self-injury. Self-injury remains prevalent in a high percentage of people accessing health services. A recent survey in an NHS Trust estimated cutting in people who accessed their services as being 50% of their total self-harming population (Horrocks et al 2003). To understand this phenomenon the researcher investigated the language utilised by a group of women to describe and interpret what self-injurious behaviour meant and their need to self-injure. These women (Experts by Experience) had utilised mental health services. The others were a group of nurses (Experts) with various experiences of self-injurious women. Self-injury has attracted considerable academic and popular attention and is contentious, with differing interpretations and language utilised for description and definition. The language may have different significance for men and women in both those who injure and those working to support them. In general the number of women who self-injure was higher and was part of the rationale for examining the behaviour of women alone. The thesis explores some contextual and suggested causative factors thought to initiate the behaviour, including childhood sexual trauma. Data is obtained from interviews (including electronic, face to face and telephone) with both groups and additional examination of published literature and testimonies of women who self-injure. Such testimony (including grey literature, Jones 2004) is an integral part of the study and provides "triangulation" of data source analysis (48 "Bibbits" were analysed). The study is framed in a grounded feminist framework as interpreted by Kirby & McKenna (1989), whose methodological approach is utilised. Data analysis evolved a series of models which served to ground the study. From these models the conclusion is drawn that simplistic, behaviourally driven clinical solutions are not always feasible. Numerous complexities surround the behaviour, which this study ultimately termed "Converging Complexities". Both groups agreed on the significance but interpretation differed between groups. In order that these complexities are more fully understood, recommendations are made that greater use of survivor literature, articulating the depth of feelings in selfinjurious women, is used to prepare nurses. In addition, greater emphasis might be placed on the value of feminist and embodiment theory in training curricula. The study proposes a "model of hope" to provide an insight into the understanding of self-injury between the groups.