The chance of dying by suicide in a male jail in England and Wales is 3.9 occasions larger than within the normal inhabitants (Workplace for Nationwide Statistics (ONS), 2023). Incidences of non-fatal self-harm are widespread, as are assaults on different prisoners (Ministry of Justice (MoJ), 2023). Though the statistics are surprising, they don’t present any perception into what it’s prefer to expertise the jail setting. Because of this qualitative analysis on this discipline is so very important, if we’re to grasp the components that result in self-harm and violence.
Hemming et al.’s (2023) examine is a secondary evaluation of knowledge first introduced in Hemming et al. (2020). It’s based mostly on a novel participatory visible methodology, wherein contributors created drawings about their emotions.
Of explicit curiosity to me was the truth that the contributors on this examine have been chosen as a result of they’d difficulties figuring out and describing their emotions – a trait referred to as alexithymia (Taylor, 2000). Hemming et al.’s earlier work has advised that alexithymia is likely to be a consider male prisoners’ self-harm and violence, due to the lack to speak about their emotions (Hemming et al., 2020). The authors aimed to discover the emotional experiences of male prisoners main as much as acts of suicide and/or violence.
The unique examine (Hemming et al., 2020) recruited grownup male prisoners (median age 34), who had been resident in one in every of two prisons within the North West of England for every week or extra. All had engaged in violence, or had had ideas of violence, in direction of themselves or others inside the previous three months. Individuals wanted to attain above 52 on the Toronto Alexithymia Scale (TAS; Bagby et al., 1994). The present evaluation relies on interviews with the 9 (of 15) contributors who selected to participate within the drawing aspect of the examine. Individuals have been requested to speak and draw about feelings they skilled usually, and particularly previous to an act or ideas of violence or self-harm. The drawings and accompanying narratives have been analysed utilizing polytextual thematic evaluation (Gleeson, 2011).
The authors generated three themes from the evaluation of the 9 interviews and 19 photos.
The Exterior Image described outward shows of emotion, akin to behavioural or facial shows, typically contextualised to explicit conditions wherein these feelings is likely to be skilled. Usually contributors drew faces, mostly depicting unfavorable feelings akin to anger, disappointment, or anxiousness. Of their explanations, a number of contributors stated that they’d intentionally solely included themselves within the drawing to point how these feelings made them really feel lonely and separate from different folks. 5 contributors drew photos of constructive feelings (e.g., love, hope). These drawings have been related to conditions which may happen exterior jail, akin to being in daylight, spending time with their kids or going fishing.
The Inside Image, in distinction, described how feelings have been skilled by the participant. Significantly within the context of self-harm or violence, feelings may very well be skilled both as an amazing combine of various feelings or an absence of feelings. The sensation of being overwhelmed was illustrated in a single instance as a mixture of color, phrases, and textures. In distinction, the empty feeling was illustrated by one participant as an empty bottle and by one other by masking the web page in black ink.
The Complexity of the Image captured the best way wherein over half of the photographs illustrated a mixture of concurrent feelings. Comparable feelings (e.g., anger and disappointment) have been related to violence in direction of others and with self-harm. Individuals described the best way wherein feelings would possibly change inside a scenario, in order that, for instance, disappointment would possibly result in anger at the necessity to conceal the disappointment, leading to behaviour that then precipitated remorse.
Within the dialogue, the authors drew three primary inferences from their findings.
First, they highlighted the excellence between exterior shows of emotion, and internally skilled feelings, and counsel that this may increasingly mirror prisoners’ worry of unveiling their ‘true’ emotions in an unsafe setting. It is a helpful reminder of the necessity to give satisfactory weight to situational drivers of suicidal behaviour (right here the jail setting), not merely particular person components akin to alexithymia (Favril et al., 2019).
Second, the second theme seems to be per the difficulties understanding feelings inherent to alexithymia, and the way that may be skilled as an emotionally overwhelming scenario and/or as an absence of emotion (Hemming et al., 2020; Norman et al., 2023a). The literature signifies that this can be notably acute at occasions of stress, akin to previous to an act of violence or self-harm (Horne & Csipke, 2009).
Third, the proof that comparable feelings are skilled earlier than each self-harm and violence in direction of others is supportive of fashions of ‘twin hurt’, which posits that each behaviours might have comparable emotional and cognitive antecedents (Shafti et al., 2021).
The examine exhibits how an analogous and sophisticated vary of feelings are skilled by male prisoners earlier than ideas and acts of violence in direction of themselves or others. Importantly, the examine used a novel methodology which allowed contributors who would possibly in any other case wrestle to verbalise their emotional expertise as an example it via drawings.
Strengths and limitations
This examine has two notable strengths. The primary is using a visible methodology and polytextual thematic evaluation. As talked about above, permitting contributors to speak their expertise utilizing one thing apart from phrases is a wonderful means of overcoming the inherent problem of conducting qualitative analysis with sure teams. In my very own analysis I’ve inspired contributors with excessive alexithymia to make use of pictures as a part of the interview (Norman et al., 2022, 2023a). The opposite power of this examine is the involvement of individuals with lived expertise in any respect levels of design and evaluation, together with co-authorship.
Because the authors acknowledge, the context and dimension of the pattern imply that warning must be utilized to the transferability of the findings. As well as, I’d argue that two elements of the strategy restrict the conclusions that may be drawn. First, contributors have been requested about feelings usually as effectively about feelings previous to violence and self-harm. The evaluation doesn’t distinguish between these situations, though the authors remark that the confusion captured within the theme The Inside Image tended to be related to violent or suicidal ideas or behaviours. The authors reference the Card Type Activity (Townsend et al., 2016) as a way which may extra systematically monitor the chronology of feelings previous and following completely different conditions. Introducing drawings to the conventionally word-based Card Type Activity is likely to be a means of mixing one of the best from each strategies.
Second, the contributors have been comparatively heterogeneous of their experiences. Two of the 9 contributors had made suicide makes an attempt and two had tried violence towards one other prisoner. The others had had ideas of suicide or violence. We all know that the chance components for suicidal ideation could also be completely different to these for suicidal behaviour (O’Connor & Kirtley, 2018). You will need to take into account whether or not the feelings, and the cognitions, that precede suicidal or violent ideas in jail are completely different to people who precede actions.
Implications for follow
The authors counsel that psychoeducation might assist prisoners recognise and establish feelings, as a precursor to speaking them to others. Drawing on the findings from this examine specifically, experiencing both a turmoil of combined feelings or an emotional void could also be an indicator of a danger of subsequent violence to themselves or others. Lastly, the drawing activity helps different analysis indicating that artwork remedy may very well be useful for prisoners (Gussak, 2009).
I welcome this analysis as an vital contribution to understanding the lived expertise of alexithymia in several contexts. Once I volunteered as a Samaritan listener I grew to become very conscious of the difficulties some callers had in answering the query, ‘how are you feeling?’. This motivated me to discover alexithymia within the context of suicide and self-harm. The qualitative analysis that I undertook as a part of my PhD dropped at life for me the best way wherein not having the ability to establish and describe feelings made folks really feel misunderstood and disconnected from others, typically exacerbating their misery (Norman et al., 2023a). Serving to folks to search out different methods of expressing themselves, as Hemming et al. have finished on this examine, feels to me to be an vital contribution to analysis and follow.
Importantly, nonetheless, the programme of labor by Hemming et al. means that environmental danger components, such because the jail tradition, could also be as vital as particular person components, akin to alexithymia. Regardless of scoring extremely on the TAS20 a few of the contributors have been in a position to give fairly detailed accounts of their feelings, distinguishing between, for instance, worry, anger, disappointment, and anxiousness. These accounts seem to vary from revealed case research of alexithymia, which spotlight people’ tendency to give attention to bodily signs and exterior reasonably than interior experiences (Lumley et al., 2007; Smith et al., 2019). This examine due to this fact is one other reminder of the necessity to give attention to the context, in addition to the person, when designing interventions to enhance psychological well being.
Assertion of pursuits
I’ve had no involvement within the preparation or publication of this examine. I’ve no monetary pursuits to declare. My very own analysis pursuits embrace alexithymia and self-harm and I’ve revealed critiques (Norman et al., 2020; Norman & Borrill, 2015) and empirical work (Norman et al., 2022, 2023a, 2023b) on this topic.
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