Listening with your eyes: Using pictures and words to explore self-harm

Background: Why do people harm themselves intentionally and sometimes painfully and repeatedly even when they do not wish to die? This thesis explores that question using traditional and non-traditional research approaches.

Methods: Firstly, a systematic review was undertaken to identify and undertake a qualitative synthesis of the existing empirical evidence on functions of self-harm, and explore whether particular research approaches concentrate on and identify particular functions of self-harm. Based on those findings, a second study employed a qualitative approach using photo elicitation, a method in which photographs were used as a stimulus and guide within the interview. An adapted polytextual thematic analysis was employed to identify themes within eight participants’ narratives, which consisted of text and images. Finally, a third study also employed a qualitative visual methods approach to explore the content of images posted on blogs tagged as self-harm from two blog management sites, over a five month period. A polytextual analysis of 230 images was conducted.

Results: In addition to empirical evidence to support existing functional models of self-harm, the systematic review also found evidence of other functions which have received less attention in the theoretical literature. Findings suggested particular research approaches might be restricting our knowledge of some of the different and nuanced functions self-harm, and might account for the apparent gap between the empirical evidence and extant theoretical models of self-harm. A visual methods approach in the second study also confirmed evidence of some functions which have received less attention in the literature. For example, how people used self-harm positively, as a way of protection and as a language. Similarly, the visual content from the third study portrayed a trajectory of self-harm which was largely experienced by females who used it as a means of escape, self-expression, and as a language to communicate with noncorporeal others. Strengths and limitations of using a visual methods approach are also presented.

Conclusions: Employing a novel research approach based on visual methods to access the complex and sometimes ineffable experiences of self-harm proved useful in broadening our understanding of some of the reasons why people self-harm.