The question of the human biological body and technology has been of major concern within posthumanist theories emphasising the co-constituting relationship between materiality and social discourse for the productions of subjectivity. Online space cannot be thought of as liberating the mind from the materiality of the body, but instead seen as effected by the body and affecting the body in return. The philosophy of Gilles Deleuze and Félix Guattari has been used to argue that the body is implicated in online practices for the productions of subjectivity within posthumanist discourses. In this theoretical master thesis, the aim is to investigate the productions and transformations of the subjectivity of self harm between the biological body of the subject and practices of written text in an online message board forum for self harm support. Methodologically, a functional hermeneutics is constructed from Deleuze and Guattari’s concept of the assemblage in order to engage empirical material generated from observations of the message board. The empirical material is interwoven with a theoretical exposition of Deleuze’s philosophy. By the concepts of force and affect, it is concluded that texts on the forum are constituted as bodies. However, the practices leading up to such constitution of bodies would not be considered corporeal. This is further theorised in the concept of the assemblage with particular emphasis on a proposed distinction in Deleuze’s philosophy between bodies and language. These bodies of texts function to create new forms of expressions and enunciations on the forum, and may theoretically be said to transform the biological body of the subject. The concept of expression functions to form the ethical backdrop to transformations of the body in the online space of enunciation. By the relations between bodies in the assemblage of self harm support, expression envelops these bodies in a supportive world. It is through the relations with other bodies in the assemblage that words form the expressive world that envelops all bodies in that world, thereby transforming them. This is further deepened by considering Deleuze’s ontology of the actual and the virtual, where it is proposed that online space is actual in that enunciations are materialised in bodies of texts which in turn create virtual ideas and new possibilities for expression and enunciation. It is argued both with and against posthumanist readings of Deleuze in regards to information technology that bodies and materiality are constituting factors of subjectivity along with language, insofar as the body is theorised as transformed incorporeally.

Att skapa en god vårdrelation mellan sjuksköterska och patient är en förutsättning för att patienten ska kunna delta och vara motiverad till att förbättra sin psykiska hälsa. Patienter med borderline personlighetsstörning (BPD) och självskadebeteende är patientgrupper som omnämns med en negativ attityd inom psykiatrisk omvårdnad. Vårt syfte med studien är sjuksköterskors beskrivning av faktorer som kan påverka vårdrelationen med patienter med BPD och självskadebeteende. Metoden är systematik litteraturstudie där sökning av vetenskapliga studier har gjort i databaserna OneSearch beta, Medline , Cinahl och PSYC-info. Studierna granskades utifrån modifierade kvalitetbedömningsprotokoll. Data analyserades, granskades och bygger på ramen för innehållsanalys. Resultatet visade att patienter med BPD och patienter med självskadebeteende skapade känslor av bl.a. frustration och hopplöshet hos sjuksköterskor. Känslorna skapades av att inte kunna ge adekvat vård pga. resursbrist, kompetensbrist och brist på tillit från patienterna. Att inte vara överens i arbetsgruppen skapade känslor som påverkade patienternas vård negativt. Vår förhoppning är att fler studier kan göras, och resultaten tydliggöras för att få ökad kvalité på arbetet inom psykiatrisk omvårdnad för främst dessa patientgrupper.

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SAMMANFATTNING BAKGRUND: Suicidalt beteende och självskadebeteende kan förekomma hos personer med emotionell instabil personlighetsstörning (EIPS). Det kan finnas en negativ attityd till patienter med EIPS och liknande ohälsa hos personal som vårdar denna patientgrupp. Tidigare studier beskrev att sjuksköterskor upplevde att de hade för lite kunskap och utbildning i hur självskadebeteende ska bemötas i vården. SYFTE: Syftet med litteraturstudien var att analysera och sammanställa relevant vetenskaplig litteratur som utifrån vårdpersonalens och patientens perspektiv belyser bemötande och vård av patienter med emotionell instabil personlighetsstörning och liknande ohälsa. METOD: Systematisk litteraturstudie. Litteratursökningarna utfördes i databaserna, CHINAL, PubMed och SCOPUS. RESULTAT: Resultatet består av 21 inkluderade studier. Data genererade fyra teman vilka var vårdpersonalens attityder, vårdrelationens betydelse, behov av kunskap i vårdandet och vårdlidande. Personer med EIPS och liknande ohälsa kunde uppleva att de fick ett icke respektfullt bemötande och en negativ attityd från personalen. Vad som även kunde påverka vårdandet var ifall vårdpersonalen hade bristande kunskap, förståelse och verktyg för att behandla och vårda denna patientgrupp. Personer med EIPS och liknande ohälsa ansåg att viktiga aspekter för att lindra lidande kunde vara respekt, stöd, tillit, förståelse och omsorg. Att känna sig hörd av vårdpersonalen och delaktig i såväl sin behandling som beslutsfattande kring medicinering ansågs vara av stor betydelse. SLUTSATS: Negativa attityder och bristande kunskap hos vårdpersonal bekräftades av både vårdpersonal och patienter. Dessa aspekter kunde leda till stort vårdlidande hos patienten. Att minska lidandet hos patienten kunde göras genom att få patienten att känna sig delaktig i sin vård, känna sig hörd samt att ha ett respektfullt sätt gentemot patienten. Nyckelord: Emotionell instabil personlighetsstörning, självskadebeteende, vård / BACKGROUND: Suicidal and self-harming behaviour can present itself in people with borderline personality disorder. There can be a negative attitude towards patients with borderline and similar disorders among staff caring for these patients. Previous studies highlights that nurses feel they have too little knowledge and training in how to adress self-harming behaviour. AIM: The aim with this literature review was to analyse and compile relevant literature highlighting treatment and care of patients with borderline personality disorder and other similar disorders from the viewpoint of healthcare professionals and the patient’s perspective. METHOD: Systematic literature review. Literature search was made in the databases CHINAL, PubMed and SCOPUS. RESULTS: The result consists of 21 included studies. Data generated four themes which were attitudes of health care professionals, the importance of the nursing relationship, the need for knowledge for caring and care suffering. Patients with borderline and other similar disorders may experience that they are treated with non-respectful behaviour and a negative attitude. Another aspect that may influence the care is whether or not the nursing staff had the adequate knowledge, understanding and tools to care for these patients. Patients with borderline and other similar disorders considered respect, support, trust, understanding and care important aspects of alleviating suffering. To feel heard and to feel involved in their treatment as well as decisions regarding medication was considered of great importance. CONCLUSION: Negative attitudes and lack of adequate knowledge among health care professionals could be confirmed from both the health care professionals themselves and the patients. These aspects can result in suffering for the patient. This suffering can be alleviated by getting the patient to feel involved in their care, to feel heard as well as approaching the patient with a respectful manner.

Deliberate self-harm are a growing problem among young people in Sweden. It's not only the child that suffers from the behaviour, even the whole family. Parent´s need the right support from the healthcare staff for their own wellbeing, but also to be able to give good support for their child. Par-ent´s experiences are of importance for the nurse in the healthcare of the child and their families. The aim of this study was to describe parent´s experiences of living with a child with a deliberate self-harm behavior. In this literature study ten qualitative articles were analyzed using the method of Friberg (2012). Eight articles were found by a systematic search and two articles were found in an unsystematic search. This study showed four main themes and ten subthemes. Main themes were parent´s experience of support, parent´s experience of different feelings, parent´s experience of fam-ily relations and parent´s experience of parenting. Subthemes were to experience lack of support from healthcare staff, to need support from the environment, to feel guilt and shame, to feel concern and fear, to experience chock, to communicate with their child, to experience a different relation-ship in the family, to maintain trust in the relationship between parent and child, wanting to protect their child, to feel unsecure in their parenting. Conclusion were that parent´s need better support from the healthcare staff and from others in their environment. Nurses need more knowledge about parent´s experiences to be able to understand their needs and to be able to support them.

The prevalence of sexual harassment among college women has been reported to range from 33% to 97% (Klein, Apple, & Khan, 2011; Yoon, Funk, & Kropf, 2010) across the lifespan. In any one year of college, the prevalence of sexual harassment reported by women ranges from 33% to 57% (Crown & Roberts, 2007; Huerta, Cortina, Pang, Torges, & Magley, 2006). The severity and frequency of sexual harassment has been found to be related to reports of psychological distress (Nielsen & Einarsen, 2012), feelings of shame (Yoon et al., 2010), anxiety and depression symptoms (Murdoch, Pryor, Polusny, & Gackstetter, 2007), and social isolation (Pershing, 2003). These consequences of sexual harassment are concerning given the association between depression, isolation, and suicidality (Boardman, Grimbaldeston, Handley, Jones, & Willmott, 1999; DeWall, Gilman, Sharif, Carboni, & Rice, 2012). While there are numerous studies documenting the negative consequences experienced by women who are sexually harassed, little is known about the relationship of sexual harassment to the more severe negative outcomes of suicidal ideation and self-harm behaviors and what variables might facilitate this hypothesized relationship. Thus, the purpose of this study is to explore whether the experience of sexual harassment is related to increased suicidality and if this hypothesized relationship is mediated or moderated by other factors such as an individual’s response style and/or degree of connection to or isolation from others.

The widespread practice of non-suicidal self-injury suggests that it might no longer be reasonable to frame such behaviours as individual pathologies and highlights the need to understand such acts as sociological phenomena instead. This dissertation therefore explored the core elements of self-injury such as the self, the body, and meanings ascribed to acts of injuring the self/body, in relation to forms of sociation. Focusing on intent and aetiology, this qualitative enquiry used an interpretive mode of explanation, and collected data via indepth face-to-face interviews from a characteristically diverse community sample of fifteen participants. Findings indicated that respondents' aetiologies of self-injury were located in social interactions characterised by abuse, neglect, bullying, and invalidation. Individuals who perceived themselves as worthless and unlovable objects punished themselves, or branded themselves as failures. Paradoxically, sufficient castigation averted the complete annihilation of the existential self. Findings concur with previous studies which reported that, at its deepest level, self-injury is antithetical to suicide. This study also highlighted the body's communicative role in the symbolic expression of traumatic experiences, and emphasised its physiological role in (a) emotion regulation and (b) self-injury's propensity to become addictive. From a sociological perspective, instant emotion regulation via self-injury allowed individuals to avoid social stigma; well managed social performances in turn protected social bonds. Although self-injury constitutes a maladaptive coping mechanism, its reported physiological, psychological and social gains are significant and need to be considered in intervention programmes and policy. This dissertation therefore makes two recommendations: firstly, restorative practices should be reinstituted, particularly in schools; secondly, the growing and alarming trend of copycat behaviours reported in children and young teens needs to be researched further in relation to the mediation, ideation and imitation of self-injurious behaviours.

Mental health screening is frequently recommended to facilitate earlier detection of mental illness in prisons. For this goal to be achieved: (1) the screening process must be accurate; (2) appropriate follow-up treatment must be provided; (3) the treatment must lead to improved outcomes. The current thesis aimed to evaluate mental health screening in relation to these three criteria by studying 13, 281 prisoners admitted to Correctional Service of Canada. Screening achieved comparable accuracy to tools that have been studied internationally and many inmates received at least some treatment. However, interruptions in treatment were frequent and long-term treatment was rare. There was weak evidence that treatment led to reduced rates of institutional incidents of suicide, self-harm, victimization and violence. While screening remains widely endorsed, further study of its impacts is needed to maximize its value. This could include considering alternatives to screening itself, or as follow-up for those who screen positive.

Background: The current literature concerning self-harm and suicide has shown firstly that self-harm is a major public health problem, secondly that people who self-harm are at increased risk of suicide and thirdly, that women prisoners have a higher rate of self-harm than women in the general population and than male prisoners. Women prisoners are therefore particularly high risk of self-harm and suicide and yet to date, no specific intervention has been developed for this group. Aims: This study intends to build on an intervention found to be effective in the community and to describe a methodology of conducting a therapeutic intervention in a prison environment. Method: The research utilized both qualitative and quantitative methods conducted over four phases. In Phase 1, semi-structured interviews were completed with women prisoners who self-harm and with prison staff. Data was analysed thematically. In Phase 2, the results from the analysis were then used to inform the modification of a Psychodynamic Interpersonal skills Therapy (PIT) model originally used in the community. During the third phase of the study, prison staff were recruited and trained to deliver the therapy. Finally, the fourth phase consisted of a feasibility and acceptability study with 64 women prisoners who had recently self-harmed. Thirty-two were randomized to the treatment group which consisted of four sessions of individual PIT therapy and 32 to the control condition which consisted of four sessions with a member of staff not trained in the therapy. Rates of self-harm were measured pre- and post-treatment. Standardized measures for depression, suicide intention, hopelessness and interpersonal skills were also administered. These data were further supported by interviews conducted with participants who completed the intervention, therapists and therapy supervisors. The methods used in the study were constantly evaluated and amended when required to describe a methodology suitable for this environment. Results: There was evidence of a lack of understanding of self-harm by prison officers. The trial phase of the study did not show evidence of efficacy for the intervention. There was an overall reduction in rates of self-harm pre- and post- treatment across the sample. Comparison of scores on outcome measures, pre- and post-intervention, showed a reduction on all tests in both treatment groups but this was not significant. It was not feasible to deliver the therapy as originally envisaged and substantial changes to the methods were needed. The results showed that prison staff had the skill and capacity to deliver PIT therapy but that the prison was not able to support such a role. As a result external therapists had to be brought in to the study. Conclusions: It is acknowledged that the study was not feasible as originally designed, but due to the small sample size we cannot say it was not effective and therefore, not worthy of further study.

Background: Suicidal behaviour is increasingly widespread in South Africa and constitutes a significant burden of disease, often within resource-constrained hospital settings. Little is known about the factors associated with psychiatric admission following an act of deliberate self-harm (DSH) in South Africa. Aim: The aim of this study was to investigate the sociodemographic and clinical factors which differentiated DSH patients who were admitted to an emergency psychiatric unit compared to those who were treated in the emergency department and discharged. Setting: Data were collected for 272 consecutive patients presenting to the emergency department of a tertiary, public, urban hospital in South Africa, as a result of self harm, between 16 June 2014 and 29 March 2015, for an initial epidemiological study of DSH at the hospital. This study had a data subset of 174 of those patients (84 admitted to the emergency psychiatric unit and 90 treated in the emergency department and discharged). Methods: This study was a retrospective cross-sectional analysis, and it analysed existing data from the epidemiological study, using bivariate and multivariate logistic regression analysis. Results: Of the patients admitted to the emergency psychiatric unit, a greater proportion of patients were female (61,9%), were not in a relationship (83,3%), had no dependents (60,7%), were unemployed (73,8%), and had a low socioeconomic status (59,5%). Having dependants was associated with an increased likelihood of admission to the emergency psychiatric unit in bivariate analysis; however, when controlling for other sociodemographic variables, this was no longer significant. None of the clinical variables were significantly associated with admission to the emergency psychiatric unit. Conclusion: The lack of significant findings in the sociodemographic and clinical factors associated with an admission to the emergency psychiatric unit (compared to being treated in the emergency department and discharged) is surprising. At face value, it suggests that there are no obvious differences between the two groups. The use of a validated screening tool or more accurate measure of the clinical correlates (e.g. screening tool for substance-related 6 disorders) could have better highlighted, perhaps subtle, differences between the two groups. It is perhaps more important to question whether the perceived risk factors in DSH patients are associated with suicidal behaviour and whether emergency psychiatric unit admission, based on these factors, is more effective at treating DSH short-term, and reducing suicidal behaviour long-term, than say outpatient-based treatment interventions. Clinician-related factors that influence psychiatric admission decisions following DSH is also an important area for future research.