International Journal of Mental Health Nursing (2005) 14, 172–180 Feature Article Cutting across boundaries: A case study using feminist praxis to understand the meanings of self-harm Sue McAndrew 1 and Tony Warne 2 1 School of Healthcare, University of Leeds, Leeds and 2 Department of Health Care Studies, Manchester Metropolitan University, Manchester, UK ABSTRACT: Deliberate self-harm predominantly occurs in women under the age of 30 years. This qualitative case study using feminist methods explored the experiences of three women who each had a long history of self-harming behaviour. Psychoanalytical concepts are used to explore the meaning of the conflicts that these women experience. Emergent themes include: great expectations, I speak but no one hears, sexual naivety meets sexual violence, and redrawing the sexual map. This thematic analysis helps facilitate an insight into what these women are trying to communicate, and provides guidance for mental health professionals to more effectively respond to the challenges of working with women who self-harm. KEY WORDS: mental health, psychoanalysis, self-harm, women. Blackwell Science, LtdOxford, UKINMInternational Journal of Mental Health Nursing1445-83302005 Blackwell Publishing Asia Pty Ltd143172180Feature Article CUTTING ACROSS BOUNDARIES: SELF-HARMS. MCANDREW AND T. WARNE Correspondence: Sue McAndrew, School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9UT, UK. Email: s.l.mcandrew@leeds.ac.uk Sue McAndrew, RMN, CPN Cert, BSc (Hons), MSc, PhD Cand. Tony Warne, RMN, MBA, PhD. Accepted March 2005. INTRODUCTION Deliberate self-harm is an expression of extreme distress, which can consume an individual’s very existence. Self- harm is predominantly a female behaviour (Clark & Whittaker 1998; Suyemoto 1998) and encompasses a vari- ety of behaviours, which pervade destructiveness of the self. Globally, deliberate self-harm is the most common reason for female medical admission to hospital (Bennet et al. 2002; Hawton 2000). The most common self- harming behaviours are self-poisoning (predominately by drugs and alcohol misuse), misuse of food and/or self- mutilation. The average age of women who self-harm ranges from 22 to 28 years (Hawton 2000; Langbehn & Pfohl 1993; Schmidtke et al. 1996), while the mean reported age for the onset of this behaviour is 13–24 years (Hawton 2000). Reports of women self-harming have been documented in medical literature since the mid- 19th century. The earliest relates to a 48-year-old woman described as a ‘psychiatrically depressed guilt ridden widow who enucleated her eyes’ (Bergman, 1846, cited in Favazza & Conterio 1989). This paper seeks to explore how mental health practi- tioners can move beyond the pathologizing of such expe- riences resulting from the sometimes reductionist use of psychiatric diagnostic labelling. For example, the Diag- nostic and Statistical Manual 1V TR (American Psychiat- ric Association 2000) includes deliberate self-harm behaviour as an essential feature of borderline personality disorder (BPD). However, the link between self-harm and BPD has been widely debated (Crowe & Bunclark 2000; Johnstone 1997) and highlights the tendency to associate self-harm with BPD, thus ignoring traumatic experiences and the social context of a person’s life. Using a psychoanalytical approach to understand the experi- ences of three women who use self-harm, presented in case studies of the gendered nature of their experience, a more complex and complicated phenomenon is revealed.