The social life of self-harm in general practice
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The social life of self‑harm in general practice Amy Chandler1 · Caroline King2 · Christopher D. Burton3 · Steve Platt1
© Springer Nature Limited 2020
Abstract Research engaging qualitatively with clinical practitioners’ understanding of, and response to, self-harm has been limited. Self-harm offers a particularly compelling case through which to examine the enduring challenges faced by practitioners in treating patients whose presenting symptoms are not clearly biomedical in nature. In this paper, we present an analysis of 30 General Practitioners’ (GPs’) accounts of treating patients who had self-harmed. Our analysis demonstrates the complex ways in which GPs seek to make sense of self-harm. Illustrated through three common ‘types’ of patients (the ‘good girl’, the ‘problem patient’ and the ‘out of the blue’), we show how GPs grapple with ideas of ‘social’ and ‘psychological’ causes of selfharm. We argue that these tensions emerge in different ways according to the social identities of patients, with accounts shaped by local contexts, including access to specialist services, as well as by cultural understandings regarding the legitimacy of self-harming behaviour. We suggest that studying the social life of self-harm in general practice extends a sociological analysis of self-harm more widely, as well as contributing to sociological theorisation on the doctor–patient relationship. Keywords Self-harm · General practice · Primary care · Doctor–patient relationship · Qualitative
Introduction When considering the ‘social life of self-harm’ (Steggals et al. 2019), it is impossible to avoid also engaging with the ‘clinical life of self-harm’. Elsewhere, Chandler has argued that even where self-harm is enacted entirely away from the ‘clinical gaze’, how it is understood, accounted for and experienced may be inflected
* Amy Chandler [email protected] 1
University of Edinburgh, Edinburgh, UK
2
NHS Health Scotland, Glasgow, UK
3
University of Sheffield, Sheffield, UK
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by medical ways of knowing (Chandler 2016). Similarly, when considering the clinical life of self-harm, it is impossible to avoid engaging with the social. In this paper, we present an analysis of General Practitioners’ (GPs’) accounts of treating patients who had self-harmed, demonstrating the complex ways in which ‘the social’ is entangled with ‘the clinical’. Indeed, whilst some analyses of health frame biomedical and social understandings as separate, perhaps oppositional, authors writing from several positions have established that (bio)medicine itself is social, even as much of the ‘power’ of biomedical models comes from a pretence that ‘biology’ can be understood in separation from social worlds (Bendelow and Williams 1995; Pickersgill et al. 2013; Rose 2001; Stepnisky 2007). The case of self-harm in the context of general practice is particularly challenging to a biomedical model of health, and to a view of biomedicine and social life as separate. Self-harm shares with other practices, such as al
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