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 self-harm. 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.
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Notes
In Table 1, those classed as ‘urban’ incorporates 1–3 (large urban areas to accessible small towns) of the sixfold classification; and those classed ‘rural’ incorporates 4–6 (remote small towns to remote rural). For deprivation, we used deciles, and 'more deprived’ incorporates SIMD deciles 1–5, ‘more affluent' refers to SIMD deciles 6–10.
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Acknowledgements
The authors would like to thank two anonymous reviewers, and the editors of this special issue, for encouraging and helping us to refine this paper. The project was funded by the Chief Scientists’ Office, Scotland (Grant Ref: CZH-4-783). Heartfelt thanks to all of the GPs who shared their time and stories with us, and to the Primary Care Research Network for supporting recruitment.
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Chandler, A., King, C., Burton, C.D. et al. The social life of self-harm in general practice. Soc Theory Health 18, 240–256 (2020). https://doi.org/10.1057/s41285-020-00139-9
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DOI: https://doi.org/10.1057/s41285-020-00139-9