Asylum Magazine (Volume 20 No 2) Summer 2013

Self-Harm: Minimising Harm, Maximising Hope… This special issue on self-harm came out of a conference in September 2012 that Asylum co-hosted with the University of Central Lancashire in Preston, alongside harm-ed and Manchester Metropolitan University. The conference highlighted some of the tensions between the perspectives of people who self-harm and those who care for them.

For example, some participants felt the conference was “biased towards service users’ own opinions” and some workers felt “unheard” and “criticised”. Others felt that workers could be “overly defensive”; “applauded the speakers for talking so openly and honestly about their experiences”; and went away feeling “inspired” and “enlightened”.

In this special issue we have tried to honour our diverse perspectives and illuminate issues facing workers and carers, as well as users and survivors. We have included presentations from this event, with some other related submissions, alongside our regular features. We bring together survivors/service users, workers/ professionals, carers, performers and poets.

It is no coincidence that most of the contributors are women. The majority of the pioneering work in this area has been developed by women, often in women’s organisations, and out of feminist activism, for example, against sexual violence. The way we see self-harm has changed considerably over the years and this shift would not have been possible without feminist, as well as user/survivor, activism.

Some contributors heavily criticise therapies (especially dialectical behaviour therapy, DBT) and diagnostic labels (such as borderline personality disorder, BPD). We appreciate that others fnd them helpful. Marsha Linehan, the originator of DBT, has recently ‘come out’ as a person with a BPD diagnosis. Does this make DBT a ‘user-led’ therapy? Does this make it any more acceptable? In addition, most contributors endorse the idea of harm minimisation.

Although proponents of harm minimisation have been clear that it should be an overall approach to practice, not a simple technique, it is often misunderstood and even misused. This is especially the case in the current context, where services are under increasing pressure. Harm minimisation has never been about simply giving people things to hurt themselves with. However, the tabloid press love to sensationalise and blame (and are especially keen to scapegoat public sector workers).

For example, the Daily Mail recently covered a story of a special school in Surrey “handing out razor blades” so that a pupil could self-harm. Another story we heard concerned a nurse who fatally left a young woman patient with a ligature because she thought it was giving her comfort. The reporting of these instances illustrates the real anxiety the general public feels about the dangers of self-harm. On the surface, these stories appear to be about neglectful, or even harmful, professionals.

However, they can also be read as being about caring professionals who are genuinely trying to support individual choice and autonomy, albeit having misjudged issues around enabling safety. Balancing the tension between preserving individual freedom and managing risk is never easy. These are complex situations that require greater understanding and reasoned debate because they acutely illustrate the life-and-death issues at stake.

We hope this special issue will contribute to a wider discussion about these issues. Asylum magazine has never been an easy read and this issue may be especially difficult. The subject matter is, by definition, distressing. Asylum rarely provides ‘good news stories’ nor easy answers. However, we have tried to include some positive experiences and examples of good practice. We simply ask that you read with an open heart and mind.

Helen Spandler, Clare Shaw & Sam Warn


Download Volume 20 No 2



  • Special Issue: Self-harm: Minimising harm, maximising hope
  • Guest Editorial – Helen Spandler, Clare Shaw and Sam Warner p.3
  • Living with scars by Clare Shaw p.4
  • Performing our experience by Clare Summerskill p.6
  • Beacon of Hope: Working with self-harm in a survivor led crisis service by Fiona Venner p.8
  • Bristol crisis service for women p.10
  • The naughty child by Fiona Jones p.11
  • From state control to state support Sam Warner p.13
  • Making friends with self-harm by Vicky Hudson p.15
  • Some thoughts from a support worker by Tracey Greaves p.17
  • Being Human? My struggle with self-harm by Nicki Evans p.19
  • The impact of caring by Terri Shaw and Karen Wright p.20
  • Comic strip – Asylum Squad Side Story: The Psychosis Diaries by Sarafin p.22
  • Poetry: Jackie Hagan; Michelle Brown; Dean Smith
  • News and Comments
  • In the Writers Chair: Clare Summerskill
  • Help! I’ve Lost my Diagnosis! Barbara Riddell
  • Asylum Quiz: What is Democratic Psychiatry?
  • What the hell is wrong with everybody? Alan Jennings
  • Reviews: Crooked Beauty and the Embodiment of ‘Madness’
  • Wolf the Artist: from Apocalypse Back