Academic journal article Creative Nursing

At the Cutting Edge: Creative and Holistic Responses to Self-Injury

Academic journal article Creative Nursing

At the Cutting Edge: Creative and Holistic Responses to Self-Injury

Article excerpt

This article draws from a larger research project in which I used creative methodologies to explore self-injury in a holistic and harm reduction ethos. The conscious presence and refl exive self-awareness of the researcher (and practitioner) is essential to hearing the voices of the participants and understanding their experiences. Here, the participants share the creative and holistic practices that have supported them. These insights offer practitioners opportunities to build a broad repertoire of healing interventions and supports for their clients.

"Self-injury" refers to actions in which the intention and purpose is "infl icting pain and/or injury to one's own body, but without suicidal intent" (Babiker & Arnold, 1997, p. 3). These include cutting, burning, and scalding; infl icting blows on or banging the body; scratching, picking, biting, and scraping; inserting sharp objects under the skin or into body orifi ces; interfering with wounds; tying ligatures; pulling out hair (trichotillomania); scrubbing away the surface of the skin (sometimes using chemicals); and swallowing sharp objects or harmful substances- usually called "overdosing" when these substances are medications or drugs (Babiker & Arnold, 1997; Inckle, 2007; Spandler & Warner, 2007).

Practitioners off en report having little training specifi c to the issues and needs of people who hurt themselves (Shaw & Shaw, 2009). This training defi cit leaves staff vulnerable and insecure in terms of understanding the risks and needs of patients alongside their own responsibilities and practices (Hadfi eld, Brown, Pembroke, & Hayward, 2009). This is compounded by environments in which policies prioritize preventing self-injury rather than working more deeply with each individual to explore the meaning and purpose of the self-injury and its underlying issues and to develop alternative coping mechanisms and create positive change (Clarke & Whittaker, 1998; Shaw & Shaw, 2009; Spandler, 1996).

There is growing recognition of the multifaceted functions of self-injury as a means of coping with and expressing traumatic issues and experiences. The individual experiences connected with self-injury (including neglect; physical, emotional, and/or sexual abuse; grief; loss; displacement; and chronic illness) alongside the broader social context (poverty, racism, homophobia, ableism, and gender prejudice) and the immediate life situations in which they are experienced intersect and compound one another in deeply wounding ways. Self-injury becomes the embodiment of and the coping response to these experiences (Babiker & Arnold, 1997; Inckle, 2007; Spandler & Warner, 2007).

As such, responses to self-injury need to be equally multifaceted and developed in collaboration with the individual in his or her particular circumstances. In this article, I explore a range of meaning-making practices that have supported my research participants in understanding their self-injury and the issues that underlie it and in moving toward less harmful coping mechanisms and positive change.


This article draws on the experiences of four research participants-Amanda, Emma, Clare, and Colm-from a larger 2-year postdoctoral research project in which I used creative and qualitative research methods to explore a holistic and harm reduction approach to self-injury (Inckle, 2010). All names are pseudonyms except Clare, who works and publishes in this area and specifi cally requested that I use her real name.

Qualitative and creative methods were appropriate not only in mirroring the creative ethos of helpful responses to self-injury but also because "the goal of qualitative inquiry is not the mere accumulation of information, but rather the transformation of understanding. Qualitative fi ndings contribute to thoughtful practice by creating more perspectives from which to know" (Sandelowski, 1997, p.128).

I used unstructured, in-depth qualitative interviews to facilitate individuals sharing their experiences in a way that felt safe and meaningful for them. …

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