Time frames and self-hurting: that was then, this is now

Abstract

In this article, we explore the different time frames through which 25 adults who have used non-suicidal self-hurting throughout their lives evaluate their experiences. Participants in the study on which this article is based were drawn from a non-clinical population recruited mainly through dedicated websites. All were interviewed in 2008 in South London. The participants all used time frames to structure their narratives about their use of self-hurting. Short time frames placed around the act of self-hurting itself let them focus on the immediate effects, including pleasure. Longer time frames enabled them to reflect on the causes of self-hurting, as a way of managing emotions and difficult social situations, and introduced consideration of the risks involved, such as escalation in use and fear of discovery. Looking back through a longer time frame, participants recognised how their use of self-hurting changed over time with some ceasing to use it and others using it less frequently. Reflecting on the use of selfhurting across their life span, some participants expressed regrets, but the majority described it as an important way of coping with intense feelings and intolerable situations, which could be seen as reasonable under the circumstances. Participant's selection and use of time frames, whether short-, medium-or long-term, orientated towards the past, the present or the future had an important impact on how they assessed the balance between the risks and benefits of this behaviour and the shifting compromises that they made between them. Future research could focus on the use of time frames in different settings and on the likely consequences of choosing short-, medium-or long-term lens for calculating risk. In applied clinical settings it would be useful to find out whether strategies to encourage clients to see their behaviour and construct narratives bracketed by different time frames has therapeutic potential.

Uncertainty work and temporality in psychiatry: how clinicians and patients experience and manage risk in practice?

“…The episodic nature of bipolar disorder brings out the importance of time when considering risks and uncertainties in clinical encounters (see, Alaszewski & Brown, 2016;Brown & de Graaf, 2013;Juhila et al, 2015;Klingemann, 2000;West et al, 2013). The onset of a serious illness can be interpreted as a disruption in the patient's everyday life, normality and biography (Alaszewski & Brown, 2016;Bury, 1982).…”

“…Through the analysis, I show how temporality is essential in this practical labour of professionals and patients. The uncertainty work in clinical encounters is structured by two different time frames: clinical time and experienced time (see, Alaszewski & Brown, 2016;Brown & de Graaf, 2013;Juhila, Gunther, & Raitakari, 2015;Klingemann, 2000;West, Newton, & Barton-Back, 2013).…”

Rethinking risk: a narrative approach

“…Narrative can create order to these experiences and events. West et al (2013) research exploring the narratives of people who 'self-hurt' showed the importance of temporality in framing the experience. For many participants, the past framed the appearance of the present, though crucially this was past lived experiences as narrated by the individual in which their biographical experience gave meaning to their present actions of self-hurt.…”

Health care through the ‘lens of risk’: reflections on the recent series of four special issues

“…One article was hastily reoriented so that it could be published in the time special issue because the writers had missed the earlier deadline for papers on risk categorisation! The same project, investigating the accounts of their actions given by people who selfharm, was drawn on in relation to both the value (Barton-Breck and and time-framing (West, Newton and Barton-Breck, 2013) issues.…”

“…However, we ended up with sufficient material for a double special issue. The published papers covered: home drinking in relation to concerns about the present and future (Foster and Heyman, 2013); the decision-making of older women about when to become pregnant (Locke and Budds, 2013); constructions of their futures by patients with advanced cancer (Brown and De Graaf, 2013); the temporal considerations of individuals who self-harm (West, Newton and Barton-Breck, 2013); and accounts of their time management given by patients who develop malignant melanoma (Topping, Nkosana-Nyawata and Heyman, 2013). The original call for papers referred to 'time-framing', drawing attention to the propensity of policy-makers, healthcare professionals and public to set temporal horizons beyond which risk assessment is not considered, as with the convention of assessing five-year survival for cancer treatments.…”