This book is aimed at students considering a career in mental healthcare. It consists of two parts.
The early chapters offer case vignettes that introduce conceptual, ethical and attitudinal issues around self-harm, attempted suicide and completed suicide. These are lively, realistic and well-worth referring to for teaching purposes. Indeed, the importance of training professionals specifically to work safely, kindly and effectively with people who self-harm is one key message of the book. The worthy Department of Health, National Institute for Health and Clinical Excellence and College reports have said it too, for over 20 years, but does it happen everywhere?
Chapters on clarifying the terminology and suicide-related behaviour are particularly dense and interesting. McLaughlin does not accept the now orthodox lumping together of all self-harm, whether it be suicide-oriented or not, under the term ‘self-harm’, preferring instead to use ‘suicide-related behaviour’ to encompass ‘any life-threatening thought or behaviour that suggests that the person intends either to harm or kill him or herself’. One problem with this is that much recurrent self-harm falls outside the proposed domain. And this is reflected in the rather brief discussion it receives in the book. McLaughlin emphasises the importance of assessing perceived lethality and suicidal intent, but the discussion of the varied psychological functions of repetitive self-harm is surprisingly brief, as is consideration of harm-minimisation strategies arising from such understanding. Self-punishment and expression of anger are mentioned, but cleansing and distraction functions are not.
The second part of the book is less enjoyable, but also less authoritative. McLaughlin attempts to introduce the numerous theoretical orientations that inform mental health practice, and covers these bio-psychosocial perspectives in chapters on stressors, responding to crisis and therapeutic responses. Unfortunately, the discussions of psychoanalytic theory and psychiatric perspectives are riddled with factual inaccuracies. To quote some examples: ‘Freud's writings extend from his first publication The Interpretation of Dreams (1900) to his final manuscript An Outline of Psychoanalysis (1940) (p. 87)’; and ‘Depression has been estimated as accounting for 75% of all psychiatric admissions… Bodily functions, sleep, appetite and sexual desire are usually disturbed as a result of morbid thoughts (p. 104)’.
The book closes with a claim that Rogerian person-centred therapy, with its attention to empathy, acceptance and genuineness, holds the best hope for a caring engagement with people who self-harm. So this review will close with a patient's experience cited in the book: ‘when Barry was assessed he felt as if he were cut open. All his past was dug up and just left there. If the practitioner did something with it, it would have been OK but nothing was done with it, it was just left there… assessments are not done [just] to provide information to the assessor (p. 165)’. McLaughlin's book is a committed contribution to preventing such experiences of ‘care’.
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