‘Why can’t you just be fine?’: An autoethnography of self-harm from a lived experience and nursing perspective

TL;DR

This paper explores self-harm through personal and professional experiences, challenging psychiatric views and offering a compassionate, sociocultural understanding.

Contribution

It introduces a novel lived experience perspective framed within survivor epistemology to re-theorize self-harm.

Findings

Self-harm can be an embodied response to sociocultural and relational conflict.

Self-harm supports integration, self-care, and connection with oneself and others.

The lived experience perspective critiques dominant psychiatric views and promotes compassionate understanding.

Abstract

Psychiatric discourse problematises self-harm as a psychopathological behaviour indicative of individualistic deficiency. This guides clinical priorities in treatment whilst negating salient components and individual preferences. Conversely, survivor-controlled research emphasises underacknowledged aspects of self-harm, such as its embodied emotionality as embedded within sociocultural context. This suggests a need for re-theorisation. Autoethnography (AE) utilises the researcher as the main source of data to elucidate social phenomena. Through AE, I consider my lived and professional experiences, as a registered general nurse, of self-harm by referring to my medical notes, memory reflections and personal diary entries as contextualised to self-harm literature. This lived experience (LE) perspective of self-harm is derived from subjective experience and contemporary literature, framed within survivor epistemology. This novel understanding argues that people with self-harm may experience immersive, aversive embodied emotionality arising from sociocultural and relational conflict. It considers self-harm as supporting the person to (1) be an integrated whole; (2) employ self-care; and (3) connect with oneself and others. This LE perspective directly critiques dominant psychiatric conceptualisations, instead compassionately framing self-harm as socially implicated. This could improve societal understanding, reduce pejorative attitudes and benefit people with LE.

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