On the Risks of Medicalization of Adolescents Self-Injuring Acts

Abstract

Although common among community adolescents, self-injuring acts are mainly studied by psychiatrists and psychologists and rarely by social work researchers. The preponderance of medical research in the field has come to associate self-injuring acts with mental issues. This view has to a large extent been adopted among professionals as well as among laypeople. When examining adolescents' unsolicited internet published narratives, this medicalization of self-injuring acts was found to have negative consequences for disclosure and help-seeking, and hence limit the adolescents' possibilities to get adequate help and support. The main objective of this work is to study adolescents' views on hampering factors for help-seeking for self-injuring acts and the role of medicalisation for their willingness for disclosure and help-seeking. Disclosure of self-injuring acts within the social network was described as met with demands to seek professional mental help. Seeking professional help was accompanied with fear of being perceived as crazy or diagnosed as mentally ill. Internet websites were described as value free and safe arenas giving opportunity to disclose self-injuring acts without fear of being stigmatized and labelled as mentally ill. An extended involvement of social work researchers and professionals, approaching self-injuring acts not primarily as a sign of mental problems, but as an adolescent way of trying to manage a complicated social context, could enhance finding adequate support systems. It is also necessary that the medical profession contributes to a demedicalization of self-injuring acts.

The “good” and the “bad” subject position in self-injury autobiographies

“…To understand self-injury more fully and to develop better support systems for people who use acts of self-injury to cope, self-injury needs to be de-medicalized, and the social contexts need to be considered (Brossard, 2014(Brossard, , 2018Ekman, 2016;Ekman and Jacobsson, 2021;Steggals, 2015). Consequently, the knowledge gained through analyzing the autobiographies includes the importance of taking social aspects into consideration, as well as an understanding of how the psychomedical discourse affects not only other people's perceptions of individuals who self-injure, but also how it affects the self-injuring individuals' view of themselves.…”

“…The psychomedical discourse can be observed in the autobiographies and has clearly resulted in negative consequences for the authors and their perception of themselves and their sense of self. The medicalization of self-injury means that the “gaze” on self-injury is directed and focused on individual deficiencies rather than societal aspects, and the “burden” of suffering is thus put on the individual (Conrad, 1975; Ekman and Jacobsson, 2021). Through the authors’ descriptions, it seems clear that they accept the notion that the problem is individual, and that they seldom consider the social aspects that might have contributed to their suffering and their need to cope through self-injuring acts.…”

“…The discipline and practice have been “gradually pushed” in a direction of psychological measurements and methods, thus ignoring the social context in which subjects live their lives. In line with this, Ekman and Jacobsson (2021: 42) describe how a medicalization of self-injury may affect the encounter between social workers and adolescents as it may “hamper non-medical professional to identify or recognize the social context of self-injuring acts.” They conclude that social workers are important actors when it comes to de-medicalizing the practice, for instance, by focusing on what is going on in the social context and listening to the young individuals in a trusting and non-judgmental way.…”