A political approach to thinking about self-harm

This is a post by Dr. Guy Aitchison and Dr. Ryan Essex introducing their recent paper, ‘Self-harm in immigration detention: political, not (just) medical’. It appears on the Journal of Medical Ethics blog.

In April 2016, the Iranian refugee, Omid Masoumali, set himself on fire in front of UN inspectors at the Nauru island detention centre run by Australia. He later died of his injuries after delays in his treatment. Before carrying out his act, he shouted “This is how tired we are”. Omar’s case is extreme but not unusual. A great many people in immigration detention harm themselves. Things are especially bad in offshore facilities of the kind Australia runs in the Pacific and the UK has recently introduced in Rwanda. Indeed, one study found that rates of self-harm in an Australian offshore centre were 216 times higher than in the general community. Across the world immigration detention is known to produce anxiety, depression and PTSD, as well as high rates of self-harm and even suicide.

A number of media outlets – especially the Guardian Australia – have done important work in bringing the individual stories behind such acts to light. But for the most part, the world has turned a blind eye, dismissed or demonised these acts. Authorities dismiss self-harm by detainees as an attempt at ‘manipulation’ or as a purely medical problem. A medical approach brings with it certain assumptions. Self-harm is usually treated as something maladaptive that stems from personal (rather than collective) factors. Diagnosis and treatment by medical professionals is the preferred ‘solution’. For the most part, advocates for detainees have endorsed a medical approach. When we began the project that produced our recent paper in the Journal of Medical Ethics we wanted to uncover the political side of self-harm. We felt it was important to situate it within a broader context of resistance to punitive border controls. Self-harm is a difficult, complex topic and it inevitably brings one into contact with a great deal of human misery. We admit to a certain amount of unease at the prospect of writing about this issue. At the same time, government across the world benefit from keeping the topic taboo.

Keep reading at the Journal of Medical Ethics blog.

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