Concluding comments; Towards an integrated approach to self-injury and summary of implications for practice

Andrew Lovell, Pauline Heslop

    Research output: Chapter in Book/Report/Conference proceedingChapter in a book

    Abstract

    Exclusionary practices dominated the lives of many people with learning disabilities over the course of the twentieth century, literally through institutional incarceration and educational segregation, but also in many other subtle, and not so subtle ways. The legacy of marginalisation to the fringes of society runs deep, however, and it is now more than fifty years since initial ideas about normalisation (later social role valorisation), self-advocacy, empowerment and self-determination began to be formulated. The current century has witnessed many improvements in the lives of people with learning disabilities, particularly increased visibility and attempts to address previously unmet or non-identified health needs. Impetus for further improvement to the lives of people with learning disabilities came with the Valuing People White Paper (Department of Health 2001), but people with learning disabilities are not, nor ever have been, an homogeneous group, so progress remains slow and sometimes uncertain. The institutions are closed, though institutional practices have not disappeared; people with learning disabilities are no longer shunned, although many are still denied basic human dignity; integration and inclusion have become increasingly significant, but many people with learning disabilities live lives characterised by isolation and of being ‘in’ instead of ‘a part of’ the communities in which they live.

    The language around learning disabilities continues to evolve, if evolve is the right word, with multiple terms employed, both nationally and internationally, a consensus only emerging in relation to the need for terms to be less insulting. Learning disabilities has been the term of choice in assembling this book, although intellectual disability is preferred by many, and others prefer developmental or cognitive disability as more accurate descriptive terms. Terms which dominated most of the twentieth century, such as mental retardation, deficiency, sub-normality and handicap have been largely consigned to history. Language in relation to self-injury, as we saw in Chapter Two, in the context of defining the phenomenon, is similarly complicated. A variety of terms have been employed (such as self-harm, self-destructive behaviour, self-inflicted behaviour, and self-damage), yet the consensus settled on the term ‘self-injurious behaviour’ in relation to people with learning disabilities, and ‘self-harm’ in relation to those without learning disabilities. This, unfortunately has served to reinforce the continued identification of people with learning disabilities (particularly when spoken language is absent or extremely limited) as a discrete group. The consequence, since if we define things as real then they are real in their consequences (Thomas and Znaniecki, 1919), has been to justify a range of treatments, behavioural interventions and other therapeutic responses based on a supposition of difference between people with learning disabilities and the rest of humanity. The contention of this book has been that this argument is flawed.
    Original languageEnglish
    Title of host publicationUnderstanding and working with people with learning disabilities who self-injure
    EditorsPauline Heslop, Andrew Lovell
    Place of PublicationLondon
    PublisherJessica Kingsley Publishers
    Pages129-141
    ISBN (Electronic)9780857004437
    ISBN (Print)9781849052085
    Publication statusPublished - 2013

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