Book Review: Self Injury

Review by Veronica Heney

Veronica Heney reviews Why Do We Hurt Ourselves?: Understanding Self-harm in Social Life by Baptiste Brossard (Indiana University Press, 2018), and Self-injury, Medicine and Society: Authentic Bodies by Amy Chandler (Palgrave Macmillan, 2016).

Baptiste Brossard is lecturer in sociology at the Australian National University. His research agenda addresses various mental health-related issues, such as self-harm, dementia and behavioural addictions, as well as sociological theory, utopian studies and qualitative methods. He is the author of Why do we hurt Ourselves? (Indiana University Press), and of Forgetting Items: The Social Experience of Alzheimer’s disease (Indiana University Press). He tweets @BaptistBrossard.

Amy Chandler is a sociologist, currently Lecturer and Chancellor’s Fellow at the University of Edinburgh, School of Health in Social Science. Her work addresses self-harm, suicide, and substance use. Recent research has involved experimenting with arts-based methods to explore meanings of self-harm and suicide. She tweets @dramychandler.

Self-injury has increasingly become an object of sociological study, as scholars and clinicians recognise the relevance of social and cultural contexts to practices and experiences of self-injury. This is clearly demonstrated through The Sociological Review’s 2019 blog series, edited by Brigit McWade and including contributions by Akiko Hart and Chris Millard, which focused particularly on the role of social media in relation to self-harm and frameworks of contagion. Two recently published books contribute to this trend, posing a useful counter to the typical framing of self-injury solely within medicine, psychiatry, or psychology, and significantly contributing to our understanding of how self-harm might function as a social and relational practice. The two books, by Baptiste Brossard and Amy Chandler, both work to locate self-harm not only within a specific historical moment, but also a range of discourses or ways of thinking about the self, society, and the body.

Brossard’s book Why Do We Hurt Ourselves? (2018) makes the particular contribution of exploring self-harm in France, adding to existing literature typically located within an Anglo-American paradigm. The book is initially predominantly descriptive, attempting to lay out the ways in which self-harm is practiced, and thus exploring individuals’ first encounter with self-injury, their feelings of dependence upon self-injury, the pressures of secrecy, the process of ceasing to self-injure, and what a ‘typical’ experience of self-injury might entail. The work becomes more analytic in the latter half, when Brossard takes a more explanatory approach through exploring the role of discretion and social positioning within families, and experiences of gendered embodiment and sexual abuse in creating the conditions of possibility for self-injury.

Brossard’s work is especially significant in that it locates self-injury primarily in the context of family dynamics, making a valuable contribution to the existing literature in which psychological and socio-cultural factors have been explored, but relational aspects are often sidelined. Brossard frames self-injury as a strategy through which individuals manage or respond to their “social positioning” (p.90) within their families, their schools, and the wider community and as a result of broader social forces of “individualisation” (p.132) and “injunctions to self-manage” (p.175). This conclusion offers a useful alternative to existing framings which place emphasis either upon purely psychological or pathological causes, or broader social factors such as the pressures and contradictions of late-stage capitalism (Steggals 2015).

Brossard carries out this analysis primarily through detailed, extensive case studies, gathered in interviews conducted either in person or online, a useful combination of digital and traditional methodologies. This case study approach has the considerable benefit of not breaking up the rich personal accounts from which Brossard draws, thus respecting the full complexity of people’s lives and experiences in relation to self-injury, rather than simply mining them for their analytic utility. It is certainly a commendable approach and makes for compelling reading although it can, in places, result in generalised conclusions being drawn from what appears to be slim evidence.  Moreover Brossard does, at times, appear to take these narratives entirely at face value; again, this respect for the testimony of those with lived experience is admirable, but it can lead to a failure to fully consider the ways in which existing and dominant discourses might impact both understandings and experiences of self-injury.

This very interrelation is the focus of Chandler’s Self-Injury, Medicine, and Society (2016), a consideration of two qualitative studies conducted in 2005-10 and 2014 and winner of both the British Sociological Association’s Philip Abrams Memorial Prize, and the Foundation for the Sociology of Health and Illness Book Prize. The work centres Chandler’s desire to approach accounts of self-injury with empathy and understanding, but also from a critical perspective informed by theoretical and sociological literature and critiques of medical and psychiatric frameworks. She thus aims to treat accounts of self-injury as shaped by “cultural meanings, and structural possibilities” (p.16), and achieves this with considerable success; this focus on the ways in which self-harm is narrated and understood moves beyond the more descriptive and explanatory analytic framework of Brossard’s work. Chandler uses this critical perspective to trace themes of duality and of authenticity through successive chapters that focus on corporeality, emotions, ideas of release, visibility, and biomedical terminology.

With regards to duality Chandler lays out with admirable clarity how accounts of experiences of self-injury are structured by and through medical understandings of the separation between mind and body. Chandler’s decision to take a critical perspective, rather than to assume that such accounts are simply given, allows her to more fully account for the pervasiveness of medicalised discourses in people’s understandings of their experiences. In particular, it enables her to demonstrate the social and cultural assumptions behind widely used and seemingly neutral terms or frameworks of self-injury such as “emotional regulation” (p.86). The benefits of Chandler’s approach are also evident in her detailed, thoughtful analysis of the ways endorphins and addiction are mobilised in accounts of self-injury and in her valuable critique of Adler & Adler’s (2011) argument regarding the de-medicalisation of self-injury. This strain of thinking culminates in an interesting deconstruction of the discourses and contradictions at work in the recent entry for Non-Suicidal Self-Injury in the DSM-V, and the continued relevance of “definitions, names, [and] diagnoses” (p.180) as an area of study with regards to self-injury. This is an exceedingly useful contribution to the broader study of self-injury, in which terminology abounds, and thus a critical understanding of the values and judgements at work in both labels and definitions is particularly beneficial.

Chandler’s exploration of authenticity is equally valuable. Chandler presents authenticity as one of the governing discourses through which self-injury is conceived, experienced, and narrated, outlining the connection between understandings of self-injury as a way of authenticating pain and available cultural scrips about “bodies, emotions, and social life” (p.194), in which negative emotions are unacceptable in many social situations. Chandler’s approach thus accounts for how society and culture is able to “get under the skin” (p.83) of narratives and experiences of self-injury. In her analysis of both authenticity and duality Chandler productively draws upon the idea of “formula stories” (p.62), informed by Hacking’s concept of Looping, to explore the way in which, for instance, medical studies and terminology might influence personal accounts. Alongside this, Chandler introduces the idea of an “acceptable account” (p.130), exploring the way in which even narratives of a supposedly non-normative practice, such as self-injury, continue to be shaped by and respond to certain normative and moralistic pressures and discourses, allowing for (or necessitating) the rhetorical construction of less-worthy others. This is an intriguing and productive analytic frame, and one which makes a significant contribution to existing sociological literature on self-injury.

Given this consideration of moralising and acceptability, it is notable that Brossard consistently locates self-injury within the sociology of deviance, drawing on the well-known work of Howard Becker (1963). Within this literature the term ‘deviance’ is intended to explore social relations rather than to indicate a moral judgement; however, given the current and historic stigmatisation of self-injury, it may have been beneficial to make this explicit, and to consider whether continued study of certain practices as ‘deviant’ might simply reproduce the social relations it seeks to problematize. At times this language sat uneasily alongside Brossard’s own open, interested, and sympathetic approach to those he interviewed. The prominence of ‘deviance’ aligns with Brossard’s general tendency to draw primarily on classical sociological literature, such as Elias’ civilising process, Merton’s vocabulary of social mobility, and Goffman’s work on saving face, perhaps at the expense of recent work in queer and feminist theory. This was particularly evident around themes of embodiment and recognition, both of which Brossard explores, and where contributions such as those of Sara Ahmed, Linda Alcoff, Judith Butler, and Elizabeth Grosz might have allowed for a more thorough consideration of the cultural and social narratives and values within which practices of self-injury are situated. These literatures were more clearly influential in Chandler’s work, and their inclusion allows us to situate her book within (and the contribution of her work to) broader current theoretical discussions and debates regarding the interrelation of self, society, narrative, and embodiment, as social and cultural theorists grapple with the legacy of postmodern and poststructuralist approaches.

Finally, it is worth acknowledging that in centring her own experience of self-injury within and as part of her analysis and research, Chandler provides thoughtful reflections on both her research practices and her positionality. This sort of constructive, considered reflexivity adds much to her account, and would certainly be equally beneficial in the work of those without lived experience of self-injury where its absence is often notable and limiting. Chandler concludes with a call for the acknowledgement of the benefits of sociological work in understanding “the diverse, socially mediated practices that make up self-injury” (p.203). Through their commitment to the experiences and testimonies of those who have experienced self-harm, and through their nuanced exploration of family contexts, social and educational pressures, pervasive medicalised dualistic frameworks, and the persistent social requirement of authenticity, both books discussed here certainly make valuable contributions to this project. Brossard and Chandler contest historical pathologising assumptions and make an exciting space for future studies that centre self-injury as an experience that is both social, cultural, and relational.

Veronica Heney is a PhD student at the Wellcome Centre for Cultures and Environments of Health at the University of Exeter. Her research looks at cultural representations of self-harm as experienced and interpreted by individuals who have self-harmed, taking an interdisciplinary and engaged approach. Veronica tweets @VeronicaHeney.

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