THE MEANINGS AND PRACTICES REGARDING SELF-MUTILATION IN THE BRAZILIAN EDUCATIONAL CONTEXT: A SYSTEMATIC REVIEW

ABSTRACT

In this article we sought to describe how self-mutilation is understood by educational institutions and what are the actions taken in the face of the phenomenon, based on a systematic literature review. Searching the BVS Portal, SciELO and the Capes Theses Catalog, using the index terms self-mutilation, self-injury, self-injurious behavior and self-destructive behavior, 20 documents were selected and submitted to content analysis. It was identified that the studies are recent, predominantly qualitative, influenced by Behavior Analysis and Psychoanalysis, and developed with adolescents from public schools. Self-mutilation was understood as resulting from physiological conditions, way of giving meaning to suffering, result of social contagion, communication attempt, manifestation of suicidal ideation and behavior of individuals with atypical development. There are few reports of intervention in the face of the problem, covering clinical, preventive and professional training practices. The need to implement interventions in schools, based on social and collective understandings of self-mutilation, is highlighted.

Keywords:
self-mutilation; schools; literature review

RESUMO

Buscou-se descrever como a automutilação é compreendida pelas instituições de ensino e quais são as ações realizadas frente ao fenômeno, a partir de uma revisão sistemática de literatura. Em busca no Portal BVS, SciELO e no Catálogo de Teses da Capes, utilizando os descritores automutilação, autolesão, comportamento autolesivo e comportamento autodestrutivo, selecionou-se 20 documentos que foram submetidos à análise de conteúdo. Identificou-se que os estudos são recentes, predominantemente qualitativos, influenciados pela Análise do Comportamento e Psicanálise, e desenvolvidos junto a adolescentes de escolas públicas. A automutilação foi compreendida como decorrente de condições fisiológicas, forma de dar sentido ao sofrimento, resultado de contágio social, tentativa de comunicação, manifestação de ideação suicida e comportamento de indivíduos com desenvolvimento atípico. Há poucos relatos de intervenção frente ao problema, abarcando práticas clínicas, preventivas e de formação profissional. Destaca-se a necessidade da ampliação de práticas nas escolas compreendendo a automutilação numa perspectiva social e coletiva.

Palavras-chave:
automutilação; escolas; revisão de literatura

RESUMEN

Se buscó describir cómo la automutilación es comprendida por las instituciones de enseñanza y cuáles las acciones realizadas frente al fenómeno, a partir de una revisión sistemática de literatura. En búsqueda en el Portal BVS, SciELO y en el Catálogo de Tesis de la Capes, utilizándose los descriptores automutilación, autolesión, comportamiento autolesivo y comportamiento autodestructivo, se seleccionó 20 documentos que se sometieron al análisis de contenido. Se identificó que los estudios son recientes, predominantemente cualitativos, influenciados por el Análisis del Comportamiento y Psicoanálisis, y desarrollados junto a adolescentes de escuelas públicas. La automutilación fue comprendida como resultante de condiciones fisiológicas, forma de dar sentido al sufrimiento, resultado de contagio social, tentativa de comunicación, manifestación de ideación suicida y comportamiento de individuos con desarrollo atípico. Hay pocos relatos de intervención frente al problema, abarcando prácticas clínicas, preventivas y de formación profesional. Se destaca la necesidad de la ampliación de prácticas en las escuelas comprendiendo la automutilación en una perspectiva social y colectiva.

Palabras clave:
automutilación; escuelas; revisión de literatura

INTRODUCTION

Self-mutilation consists of the intentional act of hurting oneself, whether superficially or not, without conscious suicidal intention. There are several ways to self-mutilate, such as: cutting, piercing, biting, pinching, beating and other self-injurious acts often driven by the search for tension relief (Cedaro & Nascimento, 2013).

In the literature, there are different terminologies to refer to self-mutilation, such as self-injury, self-harm or self-injurious behavior. Although it is not a recent practice in society (Santos, Barros, Lima, & Costa Brasileiro, 2018), it has been more explored in recent decades by researchers who want to understand its impacts on individuals’ lives (Almeida, Crispim, da Silva, & Peixoto, 2018).

The reports of self-harm have increased among adolescents in the school context, highlighting the need for them to be understood as a complex and multi-determined phenomenon that generates a public health problem (Almeida et al., 2018) and to be addressed through intersectoral and interdisciplinarity, involving different professionals and civil society (Quesada, Aragão Neto, Oliveira, & Garcia, 2020).

In Brazil, we identified aggregate data relating to self-harmed/self-inflicted violence, which includes suicidal ideation, self-mutilation, suicide attempts and suicides. In the period from 2011 to 2018, 339,730 cases of such violence were reported, of which 154,279 (45.4%) occurred in the age group of 15 to 29 years. Of these notifications, the most prevalent means of self-harm were: poisoning (50.4%), followed by sharp objects (17.8%) (Ministry of Health, 2019).

In 2019, Law No. 13,819 was created, which established the National Policy for the Prevention of Self-Mutilation and Suicide and began to consider self-harm as preventable public health problems. Therefore, health services are obliged to report cases in which there is the presence of suicidal ideation, suicide attempts and self-harm to health authorities. Likewise, public and private educational establishments are considered essential services to combat these problems, and must notify the guardianship council of cases.

The inclusion of educational institutions in combating and preventing self-harm is important, given that the school context has a significant impact on the lives of children and adolescents, as it is in this space that they interact with peers and spend most of their days in the year.

Therefore, studies are needed to help professionals, students and the community think of ways to confront the situation and support the development of public policies to address this issue. Previous literature reviews on the topic (Sant’Ana, 2019; Vaz, & Vaz, 2019) were restricted to students or school psychologists, not including the Brazilian educational context and all the actors within it, as well as not focusing on self-mutilation. In view of the above, the present study aimed to describe, based on a systematic review of the literature, how self-mutilation is understood in Brazilian educational institutions and what actions were taken to address this phenomenon.

METHOD

The present work was based on the procedures proposed by Aveyard (2007) for carrying out a literature review with a systematic approach. In this sense, the following procedures were undertaken: elaboration of the guiding question, location, selection, evaluation, organization and analysis of the texts that made up the corpus. Thus, we sought to answer the guiding question: “How has self-mutilation been understood by Brazilian educational institutions and what are the main actions and strategies developed in response to this phenomenon?”. To this end, electronic searches were carried out, between September 9th and 22nd, 2020, in the databases Regional Portal BVS, SciELO and the Catalog of Theses and Dissertations Capes - the purpose of which was to prioritize academic bases that contained national publications; a combination of descriptors was used: self-mutilation OR self-injury OR self-injurious behavior OR self-destructive behavior. We chose not to include the descriptor “school”, as it excessively limited the number of relevant texts found. Furthermore, we did not define a time frame in which publications should fit.

In this ways, 227 references were located: 112 on the BVS Regional Portal; 43 in SciELO; and 72 in the Capes Theses and Dissertations Directory. Of the total texts, 118 works were excluded because they did not answer the research question. Of these, 41 were suppressed for not addressing self-harm and 77 for addressing self-harm in contexts other than the educational setting, the clinical context being the most frequent. Other works were also excluded: 49 works for repetition; 17 because they were secondary studies; 13 for being developed in other countries; six (06) for being incomplete; and four (04) by the type of material (videos, letter to the editor, reports). Thus, the 20 references that made up the analysis corpus of the present study were selected, comprising 12 dissertations, six scientific articles and two theses.

Regarding the selection, it should be noted that the titles and abstracts of all publications were read by at least two of the researchers, thus carrying out a double check of the references to verify whether they would make up the corpus of the review. Furthermore, all authors read the texts in full which, even after this first contact, raised doubts regarding their relevance to the study. In order to select the references, the following inclusion criteria were used: articles, dissertations, theses and/or monographs with full texts available online, published in Portuguese (Brazilian), referring to primary research, which discussed, directly or indirectly, about the way in which the different actors that make up Brazilian educational institutions understand self-mutilation and/or about actions and strategies developed in these institutions in the face of self-mutilation.

The 20 selected references were organized in Excel tables to identify the analysis dimensions that answered the guiding question, namely: year and source of publication; linking university; study area of the journal or postgraduate program; the authors’ characteristics; theoretical perspective of research; methodology; type of educational institution and participants researched; main results; meanings and meanings attributed to self-mutilation; the intervention characteristics. In Box 1we explain the general characterization of the selected texts:The analysis of the results took place both through a description of the more objective data, as well as through a thematic categorization carried out according to content analysis (Bardin, 2016), through the steps of: 1) pre-analysis - floating and exhaustive reading was carried out the texts; 2) exploration of the material - the contents were grouped by similarity, giving rise to thematic categories; 3) treatment and interpretation of results - the categories were described, exemplified and analyzed, relating them to the theory. It is noteworthy that the contradictory and disparate findings of the texts were discussed throughout the results and discussion section.

Box 1
General Characterization of Selected Texts.

Box 1
Continuation

The assumptions adopted in the analysis and discussion of the results were those of the critical perspective of School/Educational Psychology. According to her, the role of educational institutions in the face of the phenomenon of self-mutilation must be based on a democratic and socially committed conception and with actions that involve students, families and educators (Sant’Ana, 2019). In this sense, situations involving self-mutilation should not be analyzed solely from a pathological and individualizing perspective (Almeida et al., 2018).

We highlight that the literature review met the criteria established by the Brazilian adaptation of the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool developed by Costa, Zoltowski, Koller and Teixeira (2015).

RESULTS AND DISCUSSION

The results will be addressed through the following categories: 1) General characterization of the selected references; 2) Senses of self-harm; and 3) Interventions developed to combat self-harm.

General Characterization

The references were published from 2010 onwards, being distributed as follows: the years 2010, 2013 and 2014 with one publication each; 2015 with two; 2016 with one; 2017 with three; 2018 with three; 2019 with six; and 2020 with two. There is a low number of publications about the topic researched over the years. Only in 2019 was it possible to notice a jump in the number of productions, indicating how current the topic studied is. This increase may have been influenced by the creation of laws (such as Law 13,819/2019) and materials produced by the government and health bodies about the subject in recent years (Quesada et al., 2020; Ministry of Health, 2019) and/or for the responsibility of schools to report cases of self-harm and suicide attempts.

Regarding the sources of the publications, the articles were published in six scientific journals. Of these, three are in the field of Psychology and two in Nursing. In respect the dissertations and theses, eight are in the field of Psychology, three in Education, two in Nursing and one in Theology. It is concluded that Psychology is the area that has been most concerned with the topic, with contributions also from Nursing and Education.

In relation to the institutions of origin of the work developed, the University of the Postgraduate Program was considered in the case of dissertations and the University of affiliation of the first author regarding the articles. It was possible to observe that the studies are distributed across several universities in Brazil: seven in São Paulo; four in Minas Gerais; the states of Ceará, Pernambuco and Goiás with two studies each; and Paraná, Piauí and Sergipe with one work each. According to data about self-inflicted/self-inflicted violence in Brazil, the states of São Paulo, Minas Gerais and Paraná are among those that reported the most cases of this violence among young people aged 15 to 29 in the period from 2011 to 2018 (Ministério da Saúde, 2019), data that is consistent with the greater number of publications about the subject in São Paulo and Minas Gerais. Furthermore, it is worth highlighting that the Southeast region has the highest concentration of universities and stricto sensu postgraduate courses in the country, while the northern region has a low concentration (Barros, 2015), which may also contribute to the understanding of this result, mainly due to the lack of work linked to universities in the North of the country.

Another relevant fact is the predominance of research carried out exclusively by women, responsible for the authorship of 14 works, three studies carried out by men and another three works, with men and women as authors. The significant number of research carried out by women may be related to the fact that historically courses in the areas of health and education are more sought after by the female public, due to the division of labor that assigned women roles related to care, assistance and tasks domestic and family situations (Barros & Mourão, 2018).

Regarding the theoretical perspective, six studies used Behavior Analysis, five Psychoanalysis, two Social Psychology, two Pedagogy/Education; and School and Developmental Psychology, Analytical/Jungian Psychology and Symbolic Interactionism were present in one reference each. Two studies did not make the theoretical perspective adopted explicit. It is known that Psychoanalysis and Behavior analysis are the two theoretical lines most present in the choices among Psychology students and professionals in Brazil (Silva, Cardoso, Franco, & Moscon, 2018), thus, it is expected that studies from this area will use these approaches more in their researches. In view of this, it was found that most of the works analyzed had the perspective of Clinical and/or Health Psychology, contradicting the expectations that, due to the topic researched, works would be found that dialogue with School and Educational Psychology. This situation leads us to question what space Psychology has actually occupied in schools, seeming to individualize the phenomenon instead of collectivizing it - something characteristic of the way it began to be inserted in schools (Sant’Ana, 2019).

It is also noteworthy that of the four works published in the area of Nursing, two used Psychoanalysis and one Social Psychology, and of the three works developed in the area of Education, one of them used Behavior Analysis, thus using approaches typically linked to Psychology.

The most used research methodology was qualitative, present in 13 references. Four studies were also developed with quantitative methodology, two with a qualitative-quantitative approach and one with an experimental design. This can be explained by the high number of works carried out by Psychology authors, since this area concentrates a lot of qualitative research. Among the texts analyzed, there is a predominance of studies that aim to understand the meanings attributed to self-mutilation, which is consistent with the use of a qualitative methodology.

Regarding the educational institutions researched, 13 studies were developed in Elementary and/or Secondary schools, three in Higher Education institutions, three in institutions focused on Specialized Educational Assistance and one carried out an exploratory study about social networks to then suggest interventions in the educational setting. It is noted that self-mutilation has been treated as a problem typically associated with adolescence, considering the predominance of research carried out in elementary and/or high school. This may be due to the greater number of cases among people in this population, as highlighted by Sant’Ana (2019). In relation to institutions, 14 works were developed in public institutions, two in private institutions, one in public and private at the same time and two studies did not specify. Conducting research predominantly in public educational institutions may be due to the social researchers’ commitment, as well as greater ease of access to them.

Regarding research participants, 13 studies were developed with students and six with teachers. Of these, nine studies were with elementary and/or high school students, two with higher education students and two with students with atypical development, in addition to four studies carried out with Elementary and/or High School educators, one with Higher Education teachers and one with teachers from Specialized Educational Services. Thus, it is observed that the focus of research on self-harm has been students, especially adolescents. In contrast, six studies were developed with teachers and no research with parents or other professionals from educational institutions, who are important actors in combating self-harm (Quesada et al., 2020). In this sense, considering the critical perspective of School and Educational Psychology, it is important to reflect on the need for involvement of different actors to produce more complex analyzes of this phenomenon, avoiding concepts that focus only on adolescents.

Meanings of self-harm

The works analyzed brought different meanings to the phenomenon of self-mutilation, which were categorized into the following themes: Practice arising from physiological conditions; way of giving meaning to suffering; result of social contagion; attempt to communicate with others; manifestation associated with suicidal ideation; recurrent behavior in individuals with “atypical development”.

The first theme comprises self-mutilation as a practice resulting from physiological conditions. Santos (2017) states that bodily biochemical changes play a relevant role in self-injury, which may result from some specific action (ingestion of psychoactive substances, for example) or even medical conditions such as insomnia, fatigue, thyroid or hormonal diseases or anomalies, pre- -menstrual and other factors that may increase vulnerability to psychological stress and, consequently, the risk of engaging in self-injurious behaviors to deal with these sensations. For the author, the physiological arousal typical of stressful events seems to be more exacerbated in individuals who self-mutilate.

In the second theme “way of giving meaning to suffering”, the practice of self-harm among young people is understood as: a) a representation of conflicts (Fonseca et al., 2018); b) a way of expressing in the body the feelings that adolescents are unable to elaborate, such as anxiety, tension and anger (Lopes, 2017; Lopes & Teixeira, 2019); c) a painful attempt to ritualize the transition to adulthood (Navarro-Vasconcellos, 2019); d) a form of symbolic death (Rodriguez, 2010); e) a possibility of overcoming, escaping and escaping pain (Gonçalves, 2016). According to Barbosa et al. (2019), externalizing this pain generates relief from the stress and pressures experienced, making them want to repeat this action, however, Fonseca (2019)indicates that the subject feels, at the same time, relief and regret for the act, creating a relief dichotomy-fault. Thus, the works understand self-mutilation as a way of giving meaning to suffering through resignification or escape.

In contrast to the second theme, the third discusses self-mutilation as arising from potential social contagion. In this sense, according to the texts analyzed, self-injury: a) is a link of identification and emotional closeness among a group of friends (Lopes, 2017); b) it can be copied by adolescents who witness other people doing it and gaining attention (Gabriel et al., 2020); c) it can be encouraged in virtual spaces, as the practice is widely shared among adolescents on social networks (Gonçalves, 2016; Rigo, 2015).

The fourth theme brings self-mutilation as an attempt at communication, since, among adolescents, this practice can be an attempt to draw other people’s attention to themselves and/or to the cuts made (Lopes, 2017), as a request for help, for love and affection and/or an appeal to nearby adults (Araújo, 2018). According to Fonseca (2019), young people who self-harm have difficulty asking adults for help directly, for fear of disapproval and judgment. Thus, they face barriers in communicating with family members due to conflicts (Tardivo et al., 2019) and with teachers due to a lack of trust, for fear of exposing the cases to management and other teachers (Araújo, 2018). According to Rigo (2015), the teenager finds himself emotionally helpless and, without places to listen, uses the virtual space to share his pains with young people who are going through the same situation. In line with this, Costa, Silva and Vedana (2019) identified that, given the denial of pain that exists in the contemporary world, self-mutilation is an indirect cry for help.

In the fifth theme, about self-mutilation associated with suicidal ideation, the texts discuss that self-injury can express both a desire for death and a substitute for suicide, as it is a way of getting around pain and maintaining life (Barbosa et al., 2019). For teachers, self-harm is the main suicidal attitude in the school context, perceived through isolation, sadness and conflictual family relationships (Brito et al., 2020). According to Brito et al. (2020), distinguishing which behaviors are or are not associated with suicidal ideation is a challenge faced by schools in identifying warning signs.

The sixth theme is the one that differs most from the previous ones, as it addresses self-injury as a common practice among individuals who present “atypical development”. Congruently with the selected works, Abreu (2006) considers that individuals with “atypical development” are those who have some behavior outside the normal or typical patterns of development and who may have different origins such as intellectual disabilities and learning disorders. In this aspect, Cordeiro (2018), Souza (2014) and Ausec (2013) understand self-mutilation as a class of specific responses that can be configured as problem behaviors, resulting from learning processes and reinforced through social attention and/or sensory consequences (Santos, 2017), which may contribute to the social stigmatization of people with intellectual disabilities (Cordeiro, 2018). Santos (2017), states that self-injurious behavior is common in people with autism, functioning as a way of expressing themselves and communicating. Finally, Garcia (2015) understands self-injurious behavior as an escape mechanism maintained by negative reinforcement.

Despite presenting different possibilities for understanding self-mutilation, the references analyzed express a concern with the causality of this phenomenon, typically focusing on individual aspects (organic or psychological). Thus, it is observed that the perspectives present in the studies barely discuss the socio-historical aspects that are important for understanding self-mutilation. We emphasize that such understandings from a single aspect individualize the phenomenon, considering that the problems are only in the individual and can only be resolved through them. In this sense, the role of society, educational institutions, and public and social policies that could contribute to a more complete understanding of these situations is lost sight of. Given this, Quesada et al. (2020) highlight the importance of looking at self-harm as a complex, multifaceted and multidimensional phenomenon.

Interventions Developed in the Face of Self-Harm

The present work also sought to understand which interventions are being carried out to combat self-harm in Brazilian educational institutions. Of the 20 references selected, only seven reported interventions, which can be divided into: Clinical Practices, Preventive Practices and Professional Training Practices.

Clinical practices are made up of interventions carried out with young people who presented self-injurious behaviors, being considered forms of treatment based on individual practices. Lopes (2017) and Lopes and Teixeira (2019) developed a joint intervention in school context which they named “qualified listening at school”. This action consisted of individual sessions with adolescents who self-harmed, carried out by the psychologist/researcher in the school Psychology sector, normally after school activities had concluded. Young people were referred by teachers, coordinators, parents or of their own accord and during the meetings they could speak freely about their anxieties and discomforts.

Garcia (2015) used Experimental Functional Analysis to identify and act on situations that could encourage self-harm in young people who present “atypical behaviors” in the context of Special Education. Firstly, an Experimental Functional Analysis was carried out, exposing the participant to conditions that could encourage the occurrence of self-injury. After this assessment, changes in environmental contingencies were planned to control the participant’s behavior. In the end, it was possible to observe a decrease in the frequency of self-injurious practices.

Similarly, Souza (2014) based his intervention on the evaluation of several treatments to reduce self-injurious behavior in people with “atypical development”. Initially, interviews were carried out with the participant’s mother and teacher, direct observation sessions and functional assessment to identify the reinforcers of self-injurious behaviors. Then, non-contingent reinforcement and differential reinforcement strategies were applied to stimulate the occurrence of appropriate behaviors and the reduction of self-injury.

Of the references analyzed, only one developed interventions focused on preventing self-harm. Navarro-Vasconcellos (2019) held two workshops lasting 40 minutes each and with 29 High School students from a public school. The meetings were held during regular class periods, in a room without desks for the group to form a circle. Expressive/symbolic resources and conversation circles were used about different themes related to adolescence. The topic of self-harm came up during the discussion about “self-destructive behaviors and feelings.” According to the author, the workshops were important, as they provided a space for conversation and reflection about the students’ experiences.

In relation to Professional Training Practices, interventions were carried out with teachers in the context of Specialized Educational Assistance, aimed at students with “atypical development”. Cordeiro (2018) used Trial-Based Functional Analysis (TFBA) to reduce problem behaviors by altering environmental events. The training took place for two months with six teachers and two students were assigned to each. Initially, each teacher carried out with one of the students, without prior training, the procedures that appeared on a form. Then, they underwent one of the training sessions: 1) Video feedback - feedback regarding the implementation of TBFA; 2) Model video - demonstration recorded on video. Then, the teachers applied the TBFA with a second student to check whether the skills learned would be transferred to new situations. Although five educators did not reach the learning level, they reported changes in their attitudes in the classroom, and there was an improvement in the TBFA application repertoire.

Ausec (2013) sought to evaluate the effectiveness of the ENSINO Software, which provides concepts and problem situations that simulate behaviors that may occur in students’ daily lives, to enable teachers to deal with university students who presented behavioral problems, such as self-injury, indiscipline and aggression in the school environment. The training was carried out with four teachers and took place during four meetings with an average duration of 70 minutes. Teachers received basic instructions on how to use the computer for training during their first contact with the software. In the end, it was observed that teachers became able to identify appropriate and inappropriate behaviors.

The analysis of the interventions studied shows the predominance of clinical practices focused on the individual, disconnected from the school context, holding young people responsible for the act of self-harm. Martins (2003) defends the use of clinical listening by psychologists, as long as it allows the creation of collective situations and spaces for reflection. However, as we saw, there was only one group practice, of a preventive nature, carried out through workshops. Furthermore, it is important that schools promote actions that also integrate health sectors and families in combating self-harm and invest in training their staff and developing intervention protocols in crisis situations (Quesada et al, 2020). In this sense, only two interventions aimed at teachers were found, however, in the context of self-injurious behavior associated with “atypical development”. There was a lack of work aimed at training regular education teachers and/or joint actions with school teams and families.

In addition to these few reports of interventions carried out, the selected studies discussed possible actions against self-mutilation, which covered: a) diagnostic practices, involving the mapping of self-injurious behaviors (Santos, 2017), identification of signs and symptoms of self-mutilation (Barbosa, 2017) and recognition of adolescents in risk groups(Rigo, 2015); b) dialogical and collective practices that allow listening, welcoming and supporting students (Gabriel et al., 2020; Gonçalves, 2016) through different strategies and with partnerships among family members, education and health professionals (Barbosa, 2017); c) training practices to raise awareness and assist teachers in proposing dialogues, promoting interventions and welcoming students, as well as discussions of cases of educators and students mobilized by the occurrence of deaths at school (Araújo, 2018; Rodriguez, 2010 ); and d) pedagogical (re)structuring practices that promote the insertion of dialogical actions in the institution political-pedagogical project (Araújo, 2018; Lacerda, 2019) and the production and/or use of pedagogical materials aimed at discussing self-mutilation, death and suicide (Rigo, 2015; Rodriguez, 2010).

Regarding the proposed actions, the references emphasized the role of educational institutions in the face of self-mutilation as training spaces responsible for the physical and mental well-being of their students, and must provide actions for development, strengthening, protection, reflection, appreciation of life and solution of problems. However, it is observed that few instruments are made available to school actors and the actions are very individualized and focused on them.

It is important to highlight the importance of school institutions seeking broad strategies to combat this phenomenon, not individualizing it. Therefore, actions must focus on both the psychoeducational and psychosocial dimensions, going beyond the clinical model and taking into account the Brazilian reality, its complexity and challenges (Martinez, 2009; Sant’Ana, 2019). It is clear that the possible actions in the face of self-mutilation are not those that are actually being taken, raising the following questions: What are the difficulties encountered in putting the possible actions into practice? What are the contexts, public policies and public investments in Health and Education that influence the feasibility or not of these practices?

FINAL CONSIDERATIONS

The present study aimed to analyze how self-harm is understood in the context of Brazilian educational institutions and what actions are taken to combat this phenomenon. There is a small number of studies that sought to explore the interface of self-harm with Education and, even these, demonstrated that research about this phenomenon in the educational context has been carried out predominantly in the health area. It is noteworthy that the studies had only students (mostly teenagers) and teachers as participants, signaling the need for new work to be carried out with other actors that make up educational institutions, such as coordinators and family members.

It was also possible to realize that self-harm takes on different meanings in the educational context, and should be treated as a complex and multi-determined phenomenon. Regarding interventions, few actions have been carried out in Brazilian educational institutions and those carried out are, for the most part, individual and clinical in nature. Even so, studies point to several possibilities for actions, bringing a broad and social vision of coping with self-mutilation, which signals a contradiction between the interventions carried out and those suggested. In view of this, the need for other work to be developed in school institutions, especially in Regular Education, stands out, understanding self-mutilation from a social and collective perspective. Furthermore, it is necessary to question the role of public and social policies in relation to the phenomenon of self-mutilation.

Among the possible limitations of the research were: not incorporating works whose texts were not available online; analyze a low number of studies, due to the scarcity of publications and also presenting some unidentified publication bias. Despite this, we consider that this work presents information that helps in reflecting about self-mutilation, interventions carried out and possible, and in the development of public policies that reinforce the role of educational institutions in the face of this problem.

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Publication Dates

• Publication in this collection
  08 Dec 2023
• Date of issue
  2023

History

• Received
  18 Jan 2021
• Accepted
  18 Aug 2022