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Critically Exploring Self-Harm Through Lived Experience Perspectives: A Survivor-Controlled Integrative Review
C C da Cunha Lewin1,2, M Leamy3, S Baldoza2
1Health Service and Population Research, Institute of Psychology, Psychiatry and Neuroscience (IoPPN), King's College London, London, UK.
Summary
Self-harm is understood as an embodied practice influenced by social circumstances, not just individual emotional dysregulation. This survivor-led review highlights how social factors are overlooked in clinical approaches to self-harm.
Area of Science:
- Psychiatry
- Sociology
- Qualitative Research
Background:
- Psychiatric perspectives often overlook sociocultural contexts in self-harm, focusing on individual emotional dysregulation.
- Individuals with lived experience (LE) emphasize the inseparable role of relational and systemic trauma, abuse, and violence in self-harm.
- This integrative review was survivor-controlled, employing participatory methods with individuals with LE.
Purpose of the Study:
- To explore how self-harm is conceptualized, particularly from the perspective of lived experience.
- To challenge individualizing and pathologizing clinical responses to self-harm.
- To highlight the influence of social circumstances on the understanding and experience of self-harm.
Main Methods:
- Systematic search of multiple databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Global Health).
- Inclusion of qualitative studies incorporating patient and public involvement (PPI).
- Appraisal using CASP, GRIPP-2, and an adapted Equity, Diversity, and Inclusion framework, followed by reflexive thematic analysis within a social constructionist and survivor framework.
Main Results:
- Self-harm is variably constructed across research, often overlooking its social dimensions.
- Self-harm is conceptualized as an embodied practice, a 'trajectory' influenced by social experiences that induce chaotic embodied sensations.
- It serves as an emotional practice to negotiate personal experiences and reflects the liminality between the personal and social.
Conclusions:
- Self-harm is an embodied practice mediated by social circumstances, a dimension often overlooked in psychiatric knowledge.
- Clinical responses that individualize and pathologize lived experience (LE) are reinforced by this oversight.
- Survivor-led methods and PPI enhance critical, interdisciplinary understanding of self-harm, reconnecting individuals to their experiences.
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