Katrina Roen

Lesbian, gay, bisexual and transgender young people's experiences of distress: resilience, ambivalence and self-destructive behaviour

The research presented in this paper set out to explore the cultural context of youth suicide and more specifically any connections between sexual identity and self-destructive behaviour, in the light of international evidence about the disproportionate risk of suicidal thoughts and suicide attempts in lesbian, gay, bisexual and transgender (LGBT) young people. The empirical basis for the paper is qualitative research that was carried out in the North West of England and South Wales. Focus groups and interviews were conducted with a total of 69 young people, with a purposive sample to reflect diversity of sexual identity, social class and regional and rural-urban location. The paper presents a thematic analysis of the data specifically relating to the experiences of LGBT young people. A range of strategies that LGBT young people employ in the face of distress are described. These are categorised as resilience, ambivalence and self-destructive behaviour (including self-harm and suicide). The potential implications for health and social care of these strategies include the need for ecological approaches and for sexual cultural competence in practitioners, as well as prioritisation of LGBT risk within suicide prevention policies.

Avoiding shame: young LGBT people, homophobia and self-destructive behaviours

This paper reports on findings from qualitative research conducted in the UK that sought to explore the connections between sexual identities and self‐destructive behaviours in young people. International evidence demonstrates that there are elevated rates of suicide and alcohol abuse amongst lesbian, gay, bisexual and transgender (LGBT) youth. Rarely included in this body of research are investigations into young LGBT peoples views and experiences of self‐destructive behaviours. Data from interviews and focus groups with young LGBT participants suggest a strong link between homophobia and self‐destructive behaviours. Utilising a discourse analytic approach, we argue that homophobia works to punish at a deep individual level and requires young LGBT people to manage being positioned, because of their sexual desire or gendered ways of being, as abnormal, dirty and disgusting. At the centre of the complex and multiple ways in which young LGBT people negotiate homophobia are ‘modalities of shame‐avoidance’ such as: the routinization and minimizing of homophobia; maintaining individual ‘adult’ responsibility; and constructing ‘proud’ identities. The paper argues that these strategies of shame‐avoidance suggest young LGBT people manage homophobia individually, without expectation of support and, as such, may make them vulnerable to self‐destructive behaviours.

It might work in Oklahoma but will it work in Oakhampton? Context and implementation in the effectiveness literature on domestic smoke detectors

Objective: To explore data on factors affecting implementation processes in papers contributing to a Cochrane systematic review (SR) of smoke alarm interventions, supplemented by further papers not included in the review. Design: Screening for data on implementation on the basis of: (1) primary studies included in a Cochrane SR, (2) further papers relating to these and similar studies, and (3) approaches to authors of these and other relevant studies and reports. Results: Relatively few data were found to help people seeking to implement smoke alarm promotion interventions. Conclusions: For practitioners and policymakers to be able to build on research evidence, researchers and journal editors need to ensure that sufficient data are published, or are otherwise available to interested parties to move from understanding the evidence to using it.

Youth on the Virtual Edge: Researching Marginalized Sexualities and Genders Online

Research shows clear links between lesbian, gay, bisexual, and transgender (LGBT) youth and deliberate self-harm (DSH), but there is a lack of research investigating the social context of young LGBT people’s lives and helping to explain the higher DSH risk. In this article, we report on a small-scale methodological study intended to test the feasibility of online qualitative interviews for investigating young people, sexual and gender identity, and emotional distress. There are many methodological dilemmas arising from researching such sensitive issues with marginalized groups. The study reported here was designed to examine (a) sampling diversity in terms of sexuality, gender identities, and class; and (b) the type of data produced. We found that a virtual methodology was effective in recruiting young LGBT participants who might otherwise not take part in research. Online interviewing successfully produced in-depth, “immediate” data that potentially gave access to insights that might not emerge through face-to face interviews.

Making sense of suicide: A discourse analysis of young people's talk about suicidal subjecthood

Though there is a substantial body of literature on youth suicide, relatively few studies provide a detailed analysis of young peoples own understandings of suicidal behaviour. The present research pays particular attention to how young people make sense of suicide, in the understanding that suicide only becomes possible insofar as it is imaginable. Interviews and focus groups (including 69 participants in total) with people aged 16-24 years provide the empirical material for this study. Research participants were recruited across a range of ethnic groups and sexual orientations, and drawn from rural and urban areas in the North of England and South Wales. Four frameworks for understanding youth suicide are discussed in this paper. These frameworks of understanding variously (i) cast suicidal subjects as Other, (ii) highlight suicide as something that is accessible to young people, (iii) demonstrate the desire to rationalise suicidal behaviour, and (iv) define suicidal subjects in terms of their relationships with others. The interwoven meanings that run through these four frameworks, and their connection with existing literature, are discussed and the implications for suicide prevention are indicated.

Selling your self? The psychological impact of street sex work and factors affecting support seeking.

Previous research investigating the risks of female street sex work has tended to focus on the most tangible risks to physical health and safety. This is reflected in the provision of support services for sex workers, where these aspects are prioritised. There is little research focusing solely on the psychological risks of sex work. This qualitative study aimed to explore the perceived psychological impact of street sex work and factors that affected support seeking. Interviews were carried out with a sample of UK female street sex workers (n = 7) who attended a drop-in clinic and health professionals (n = 5) who provided input to the drop-in service. The analytic process, which drew from an interpretative phenomenological approach, revealed four main themes that work together to describe the emotional impact of selling sex. Implications for support services and future research are highlighted.

The discursive and clinical production of trans youth: gender variant youth who seek puberty suppression

This article focuses on therapeutic interventions with gender variant youth and, in particular, pubertal suppression. The aim is to address the question of which kinds of subjects are enabled, and which are made invisible, through discursive and clinical practices. The analysis demonstrates the conceptual value of drawing on discursive and queer theoretical approaches. The published work of selected clinicians is used as a way in to the complexities that various clinical understandings and approaches bring with them. A key focus is on problems inherent in the construction of gender variant youth as ‘persisting’ or ‘desisting’ in their cross-gender wishes. Psychologists working in this area have substantial challenges to face, such as the challenge of negotiating understandings about what is a ‘successful’ outcome and the complexity of reporting fluidity and uncertainty in the context of a scientific forum where ‘results’ are expected. This article addresses the challenge of engaging psychological, discursive and clinical practices in ways that enable empowered, viable, gender variant possibilities, rather than representing gender variant youth as incoherent subjects.

Psychological research and intersex/DSD: recent developments and future directions

Clinical management of intersex/DSD has been evolving, since the early 1990s, towards a goal of holistic, patient-centred care offered by specialist multidisciplinary teams (MDTs). This evolution has been championed by service users and practitioners alike. With the Consensus Statement on the Management of Intersex Disorders came clarification of MDT functioning and further recognition of psychological/psychiatric services as a key part of clinical management. In this article, we look at the intersection where academic and clinical psychologies converge with patient care in the case of the intersex/DSD individual, post-consensus statement. First, we map out conceptual advances in understanding psychosocial and psychosexual well-being, pointing to areas where psychology stands to make a significant contribution. We then discuss recent outcome research focusing on affected adults, youth, children and their parents. We address advances in service provision, focussing on the specific issues of disclosure of diagnosis and potential gender assignment. Finally, we point to trends and ideas for future research and highlight a gap in the literature bridging psychosocial and neuropsychological approaches. We recommend better engagement across research paradigms, in the interest of optimal health care approaches for people who live with intersex/DSD.

Making Sense of Neoliberal Subjectivity: A Discourse Analysis of Media Language on Self-development

Abstract The influence of neoliberalism on culture and subjectivity is well documented. This paper contributes to understanding of how neoliberal ideology enters into the production of subjectivity. While subject formation takes place in multiple and contradictory ways and across multiple social sites, we focus on the increasingly popular media discourse of self-development, and examine it as a technology of neoliberal subjectification. Drawing on Foucauldian understandings, we analyze data from two different newspapers from two different national contexts, both of which are heavily influenced by neoliberalism. Based on our analysis, we detail four interrelated discourses—rationality, autonomy and responsibility, entrepreneurship, and positivity and self-confidence—demonstrating how these discourses constitute the neoliberal subject in ways consonant with neoliberal governmentality. There is no observable resistance to subject positions offered within these discourses. Self-development discourse instills stronger individualism in society, while constraining collective identity, and thus provides social control and contributes to preserving status quo of neoliberal societies.

Surgery and Embodiment: Carving Out Subjects

This is an introduction to the Special Issue: ‘Surgery and Embodiment: Carving out Subjects’. The collection of articles in the special issue demonstrates how surgery, as a set of discourses and practices, has become central to the mediation between body and psyche in cultural understandings and individual experiences of embodied subjectivity. This is achieved by examining, from a variety of disciplinary perspectives, a range of historical and contemporary examples of surgical practice. The contributors share common concerns about embodied subjectivity, gender and sexuality, and the complex relationships between medical practice, normativity and consumerist pressures that are brought to bear on practices of body modification. We are concerned with how surgical processes are variously employed by individuals, as well as imposed upon them, in the attainment and negotiation of an embodied sense of self. Attentive also to the ways in which surgery produces and reinscribes bodies as normative and non-normative, the contributors seek to challenge the power of surgery to define the body by exploring alternative epistemologies, as well as providing possibilities for negotiating clinical practices in the construction of self and subjectivity.