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Self-harm in Adolescence

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Álvaro Jiménez

on 10 March 2015

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Transcript of Self-harm in Adolescence

A comparative study on the psychological suffering and social malaise in Chile and France
Globally 10% of adolescents in the general population have reported committing acts of self-harm (suicide attempts or self-cutting). Self-cutting affects 18% of the teenage population.

Self-harm in adolescents is a common problem in the emergency health services. Over 50% of hospitalizations of children and adolescents in psychiatric units are due to suicide attempts. In France, self-cutting affects between 30-60% of the hospitalized adolescent in Psychiatry, and is a contagious behavior in hospital settings.

Self-harm is associated with difficult and high risk cases, and present many questions about the efficacy of therapeutics settings.

For many years, self-cutting was confused with suicide attempts (“parasuicide”). Why? On the one hand, there is a clear statistical association between self-cutting, suicide attempts and suicide, and empirically there is a considerable comorbidity and common risk factors shared by different forms of self-injurious behavior. On the other hand, clinically they are two distinct phenomena, each with a specific etiology and course.

• Do the different forms of self-injurious behavior represent different degrees of lethality? Is self-cutting the first step in a potential escalation to more severe forms of self-harm? (continuity hypothesis)
• Can self-cutting and suicide attempts be considered as only partially overlapping phenomena, and therefore do not necessarily represent different degrees of suicidality? (discontinuity hypothesis)

In this context, today new categories have emerged to describe and classify self-harm (for example: “Non suicidal self-injury” and “Suicidal behavior disorder” in the DSM-5).

Epidemiology is not able to explain, on its own, the change in rates or the higher prevalence of self-harm, and Psychiatry or Psychopathology fail to consider self-harm as a social phenomenon.

While new discourses on psychological suffering and social malaise are emerging,
the phenomena related to self-harm are articulated with the transformations of individualism in contemporary societies
(i.e. the promotion of the capacity to act by oneself without being overwhelmed by emotions, the acquisition of discipline during the age of generalized autonomy, etc.). In a context where the norms and values of autonomy have become our condition, not only have the forms of action changed, but the manners in which we suffer too, which redefines the status and expression of symptoms and malaise. Indeed, the language of mental health has made mental disorders a form of suffering that not only relieves the particular dominion of the disease, but also of social life in general (processes of individualization and socialization in the family, school, work, etc.).

Adolescents in Chile and France represent a privileged population to account for said changes:

• Adolescents have become a new focus of “social issues” and appear to lie at the intersection of different social representations of our time;

Adolescents - both in Chile and France - have become the object of new mental health policies that go beyond the space usually allotted to Psychiatry
, redefining the boundaries between the social and sanitary spheres.

Chile and France are two singular kinds of individualistic societies that respond to different socio-political traditions
(French “corporatism” v/s Chilean “neoliberalism”), which is reflected in its institutions and policies, and their collective representations.

The present research aims to describe the experiences,
representations and practices of individuals (adolescents
and mental health professionals), the mental health policies
and methods of treating self-harm (self-cutting and suicide
attempts) in mental health institutions in Chile (Santiago)
and France (Paris) from a sociological and comparative point
of view. Thereafter, symptoms and culture will be compared
and linked to one another (cross-cultural differences and
similarities, relationships between sociocultural factors
and syndromes) in order to bring the facts to
light by contrast.
In recent decades there has been a significant worldwide increase in the prevalence of mental disorders in the adolescent population.

Risk behaviors, “
passages à l’acte
” and self-harm in adolescents (suicide, suicide attempts, self-cutting) have acquired great social visibility.

Self-harm has not only become a great problem for psychiatric classifications, but is also an increasingly common phenomenon and has become a major epidemiological and clinical problem for public health institutions and professionals in the mental health field
Álvaro Jiménez Molina
PhD. Student in Sociology,
Centre de Recherche Médecine, Sciences, Santé, Santé Mentale, Société
(CERMES3) Université Paris 5 Descartes. CNRS, INSERM. Advisor: Alain Ehrenberg, PhD.

Today, suicide is the second most common cause of death in adolescents.

In the last 10 years, Chile has doubled its rate of teenage suicide, representing the second largest increase among the OECD countries. Currently, Chile has made it a priority, in terms of their objectives in healthcare, to lower the mortality rates related to suicide among adolescents.

In contrast, the suicide rates have slightly decreased in France.

… but this is only the tip of the iceberg.

The rate of self-injury is almost 40 times higher than that for completed suicide.

This research uses a mixed methodology:

• A qualitative approach:
(observation and description of practices and interactions in mental health institutions) and
semi-structured interviews
(to show the representations of individuals).
• A historic approach (description of the evolution of the psychiatric categories and taxonomies associated with self-harm).
• A
sociological comparative perspective
(Chile and France, as two different ways of “making society”).

We expect to obtain
a comprehensive analysis of adolescent self-harm
and a descriptive analysis of psychiatry and mental health knowledge (categories and taxonomies, representations and practices), policies and institutions (regulations, instruments used and everyday uses and practices).

Four axes of study are proposed:

(1) Describe the transformations in discourse of contemporary Psychopathology
(from the middle of the 20th century until the beginning of the 21st century)
pertaining to self-harm phenomena.

How has self-harm been conceptualized and defined by contemporary Psychiatry (from 1960 until the DSM-5 and
the biomarkers)? Which nosologic categories and etiologic explanations have been associated with this
phenomenon? How has the specificity of adolescents been conceptualized?

(2) Describe the policies and programs in mental health orientated towards adolescents in Chile and France (prevention policies, intervention programs, clinical guidelines, etc.) and characterize the methods of treating phenomena associated with self-harm in adolescents within mental health institutions.

Where is the emphasis of mental health policies placed and how do they conceptualize adolescence? What specific programs are orientated towards self-harm phenomena? What type of practices do mental health institutions that work with adolescents offer?

(3) Describe the self-harm phenomena (suicide attempts and self-cutting) in Chilean and French adolescents.

Who are the adolescents who frequent the Psychiatry services due to self-harm phenomena and what is their trajectory in the institution? What makes self-harm an effective resource for individuals? What is its meaning and how is it experienced by individuals? What is the relationship between self-mutilation and suicide attempt?

(4) Analyze and extract the sociological meanings from a body of testimonies of mental health professionals in Chile and France.

How do the actors and professionals of the mental health field (psychiatrists, pediatricians, psychologists,
nurses, social workers, etc.) represent, for themselves, the phenomena of self-harm in adolescents?
What are their diagnostic criteria and arguments? How do these actors define their
methods of action?
Suicide rates among teenagers (15-19 years old) in OECD countries
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