Cheers for Peers

Sera Davidow
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286

In my blog, ‘False Arguments, Part 1: Don’t call Me Consumer,’ I had said I would come back to the word ‘peer,’  and… Well, here we go.

Every morning as I drop off my 20-month old daughter to her daycare, I walk by a bulletin board that says, “Cheers for Peers!” in big, bold letters.  It offers such ‘cheers’ (each written carefully on a piece of colorful construction paper) as, “Thank you, Sally, for always being willing to stay late!”  and “Debbie, Thanks so much for spring cleaning with me!”

Isn’t it funny how none of them reference mental health?  No, not a one.  Shockingly, their definition of ‘peer’ has nothing at all to do with people who have psychiatric diagnoses, have been hospitalized, or who see themselves as in ‘recovery.’  Instead, they are merely early childhood teachers ‘cheer’ing for fellow early childhood teachers and thanking them for their (peer) support.  The key point:  Their ‘peer’ness is founded in their shared profession and day-to-day work, not in some singular identity.

Consider briefly this short piece I wrote some time ago for the Western Massachusetts Recovery Learning Community’s newsletter:

“According to www.dictionary.com, the word ‘peer’ is defined as follows: “a person who is equal to another in abilities, qualifications, age, background, and social status.” By that definition and as it has boiled down in our world to its most common usage, most of us have several ‘peer’ groups. Parents, doctors, students, authors, actors, nurses, artists, politicians, baseball players… all are one another’s peers. More importantly, in order to be a ‘peer,’ by definition, one person quite literally has to be connected to another. There is no such thing as a ‘peer’ standing alone, because then, well… whose peer are they?

Strange then, that – within the mental health system and recovery movement – we should be taking on this word ‘peer,’ as if it is the next best word for patient, client, consumer, ‘person served,’ participant, and/or member. It’s strange for two reasons. The first is that no ‘peer’ should be able to stand alone. There should be no such thing as ‘a peer,’ unless there is another ‘peer’ standing next to him or her. No person should be able to talk about ‘the peers’ as some group separate from themselves because it is antithetical to the very meaning of the word. Peer does not mean ‘someone receiving services.’ It means people who exist as a part of a community of some sort and who share commonalities and relationships with one another. It’s ‘my peers’ or ‘our peers,’ if it’s ‘peer’ at all. It’s stranger still because – in this work of recovery and ‘peer work,’ – we talk so often about how healing through relationship is at the core of what we do. And yet, in essence, we have begun to refer to ourselves by a word that originally was all about relationship and now, through our very usage of it, has lost that relational focus.

And so, before we go beyond the point of no return with our usage of this word, we encourage everyone to consider the impact and to remember that, if we use the word as it is defined, no ‘peer’ can stand alone.”

I’m not sure I could say it much better at this point (except that I no longer really use the terms ‘recovery’ and ‘recovery movement’ so freely), but so many people still don’t seem to ‘get it.’  The system persists in creating ‘peer’ roles that are all about someone who identifies as ‘a peer,’ and yet those so-called peers are often set out to do atrocious things that hardly do more than replicate what has been done over and over throughout the years.  People I otherwise have great respect for in this work continue to refer to themselves as ‘a peer,’ and to buy into the definition that the term refers to anyone with a ‘psychiatric diagnosis,’ or similar.

The sad reality is any time you create a word that only has meaning in a very specific context and then you start quite literally referring to people as if they were that word, you create more barriers to them moving beyond that context and on with their own life.  Sure, it might feel good for a while.  It might feel like you finally ‘belong’ somewhere.  But if your identity is carefully shaped so that you only feel like you belong within the mental health system or the various constructs that have resulted from its existence, what does that mean for your future?  What do you want it to mean?

In truth, in the mental health system, ‘peer’ is supposed to mean exactly what it means for the rest of the world.  It’s not intended to be an identity or a badge (literal or figurative).  It’s meant to speak to how you relate to one another based on your common experiences.  And, by the way, those common experiences in this particular context go beyond simple diagnosis, emotional distress and so on.  Those are just the ones that the mental health system happens to be most comfortable discussing.  In truth, common experiences between people who have been diagnosed and treated within the mental health system also generally include oppression, discrimination, loss of power, loss of sense of self and more.  (But people sometimes start to get nervous, defensive and a little edgy when that gets recognized too loudly.)

Thusly, people who work in ‘peer’ roles are in those roles not just because they’ve ‘been there.’  Lots of people have ‘been there’ in some way – far more than are willing to admit it.   No,  people who work in ‘peer’ roles are pledging (or, at least, should be) to offer peer-to-peer support that is informed by their personal experiences, is based on mutuality, and assumes shared growth and learning.  Calling a role ‘peer’ says (or should say), “I am here to walk this path with you, but only if you want me to.”  The person in a genuine ‘peer’ role acknowledges that they don’t have any answers – that there may be no one right answer – but believes in each person’s expertise about and knowledge of themselves if given the support and/or time to uncover it.     The person in the true ‘peer’ role may be agreeing to walk with you in the mental health system, but their allegiance is not to the system’s systems.  Rather, it is to co-creating the space with you where exploration may happen and your voice may once again be found or strengthened.  When they sit in team and administrative meetings in traditional settings, people in ‘peer’ roles are there to challenge the status quo (or help people figure out what and why it even is), and encourage growth all around, not to blend in as a part of the team.  Yes, a person working in a peer role can also serve as an excellent example that healing is possible and there is hope, but treating them as if they’re little more than a walking-talking-hope-bearing-story is demeaning and devaluing their true worth.  In actuality, they bring hope and belief in human potential not just by sharing their story but by supporting people (both those working in and those receiving services from the system!) on their path toward their own self-discovery.

In short, calling a role ‘peer’ should say less about the identity of the person in it, and more about the way in which they have committed to and been trained to work with another human being.

The state of our system, our language and of so-called ‘peer roles’ is not in a good place.  (I talk about this a little more in an interview on Madness Radio that you can listen to here, if you’re interested.)  The very misunderstanding and misuse of the definition of ‘peer’ is a part of what is driving this work into the ground.  If all so many of us have been advocating for all these years was simply to develop a new title in the mental health system where someone would openly acknowledge their psychiatric history but still do the same old things, what would really be the point?  Is this the change that people like Judi Chamberlain, David Oaks and so many others have dedicated their lives to?    Where has all our fight gone?  Is this a civil rights movement that has been lost?

So many questions with so few answers.  Honestly, at times, I grapple with the urge to just walk away from the whole mess.  However, in the meantime, in an effort to support movement in the right direction… or to prevent further backsliding… or perhaps just for your own amusement (or horror)…  I offer you the following ten signs (I’ve actually heard or witnessed) that you might be missing the point of ‘peer’ roles:

  1. You are ‘court mandated’ to work with someone, and don’t think that’s a problem.
  2. You have a ‘caseload,’ and don’t think it’s bad to refer to them as ‘cases.’
  3. When you hear a provider say something akin to, “Peers are great, because they’re in the best position to convince someone they really need to take their meds,” you agree with them.
  4. You are responsible for administering medication and writing treatment plans,  and think it’s a sign of how far you’ve come.
  5. You leave all the tough conversations about difficult topics like suicide and medication to the ‘professionals,’  because you’re just there to ‘inspire’ people.
  6. You really like your name badge and keys to all the locked doors and wear them prominently.
  7. You not only know what words like ‘decompensate’ and ‘baseline’ refer to (even though one of them doesn’t even appear in your average dictionary), you also use them frequently.
  8. You’re proud to be a ‘high functioning’ peer.
  9. You refer to yourself (or anyone else) as ‘SMI,’ ‘SMPI’ or any other system acronym.
  10. And finally, you think ‘Nothing about us without us’ is probably just some new pop song.

 

I am a part of the Western Massachusetts Recovery Learning Community and I am proud of that.  Our history is based in this idea of peer-to-peer support, and yet we just made a decision to drop ‘peer’ from any and all job titles for many of the reasons described above.  In the end, we are all human beings with powerful stories and powerful abilities to impact the world around us.

We are committed to connecting with one another and creating space for learning and growth.

We believe in our own potential and in yours, whatever role you may find yourself in.

We are going to change the world.

It will not be because we are ‘peers.’

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30 COMMENTS

  1. Thank you, Sera, for saying this so clearly and emphatically! The absurd use of the word “peer” as a euphemism for “mental patient” has driven me straight up the wall for years and I’m tired of people rolling their eyes at me when I raise the issue. From now on, I will just hand people a copy of this blog post and move on.

    • Thank you, Sera, for your considered and thoughtful address of this topic. Spot on, I think. And thank you, Darby, for sharing it with me. I’ve spent considerable time up the same wall.

      While I have a range of choices for contextual self-identification I feel each is a necessary tool. However, my immediate reaction to your ‘missing-the-point’ list was the thought that it’s when we stop using the personal pronoun, ‘we.’

      I sadly witness various participants use the word peer about their supposed peers to separate themselves. It is certainly used by many service providers and policy makers to segregate themselves from ‘Peers.’

      The words we choose have power and meaning. When used thoughtfully they give us power and meaning, particularly when we use them for self-identification rather than other-identification.

  2. Great article, Sera. You were able to put into words for me why I chose to no longer see my “peer support worker.” I was horrified at some of the things he said to me, particularly when he would ask me my opinion and then correct it to realign with his organization’s mandate. Eventually, I came to understand that he wasn’t my “peer” at all and I’ve been doing much better without him.

  3. I’m relatively new here, I only read “Anatomy” several months ago. But I would like to help people harmed by the psychiatric industry, as I was. I had hypomania caused by a “safe smoking cessation med” (actual dangerous antidepressant). Then the hypomania was misdiagnosed (according to the DSM) as bipolar. And to cover up the error, a doctor caused anticholinergic intoxication with drugs that had up to six major drugs interactions simultaneously, at above FDA recommended levels. But it seems millions may have had bipolar caused in a similar way. I got away from these unethical doctors, and (long story) have been med free for six years now.

    Is it true that the only peer programs in the US are one’s that promote med compliance? Given the recent findings on the dangers of antipsychotics, and the reality that bipolar is a “partially or wholly iatrogenic illness,” it strikes me one with knowledge of how to wean others off these dangerous drugs fairly safely might have useful information. Are the US hospitals all still trying to only recommend med compliance for “lacking in validity” disorders? And, please, don’t get me wrong, my research indicates some do claim to benefit from the meds, but I know from personal experience some do not. And this is likely true for most the bipolar children.

  4. The moment that you,as a so-called “peer,” put pen to paper and write in a person’s chart, or sit on a treatment team as a regular part of the team, you are no longer a peer but someone who exercises power and privilege.

    I’ve come to believe that true “peer work” cannot be done in traditional settings found in the mental health system. The expectation is that you will be just like every other staff person. Staff in traditional settings have no idea what you mean when you say that peer workers must be in the system but not of the system. And in fact, when you state this they give you funny looks as if you’re not on the same page as everyone else, where you should be.

    The system has cooptated the peer worker idea and is using peer workers to futher the ends of the system and not the recovery of the individual “patient.” Hospitals make themselves look good, as if they’re really doing the work of recovery, by creating departments of peer workers. Psych hospitals are not into creating recovery, renewal, and restoration. Psych hospital are into warehousing, controlling, and maintaining the status quo. After all, they need people to keep coming back through the revolving door of Admissions to make sure that they have a job. Call me cynical but I’ve tried to be a peer worker in a traditioinal hospital setting for two years now and will tell you that peer workers can only function in organizations created outside of the traditional setting of the system. If, as a peer worker, you actually do address the problems with the so-called “meds” you end up being brought to HR where you will be grilled and then written up, and if you continue you will be fired. The so-called psychiatrists froth at the mouth when they find out that someone on staff has taken a stand against the so-called “meds.” You cannot contradict them or their so-called “treatment” and you cannot talk about alternative treatents, at least not in those terms. When, as a peer worker, you advocate in the morning report of the unit you work on that we quit trying to force people into accepting consensus reality but give people tools and methods to deal with their different interpretations of reality so that the interpretations don’t cause problems for them, staff loudly proclaim that this isn’t “theuraputic” and when you ask who says it’s not theuraputic anger erupts all through the group. Of course, they’ve never asked the so-called “patients” if doing this is theuraputic or not. As a peer worker, if you advocate in morning report for communicating with peoples’ voices, if their voices want to talk with staff, you’re told that this is absolutely forbidden since the voices aren’t real and trying to communicate with them just makes the “patient” sicker than they were. You are “buying” into their illness!

    Thanks for being willing to talk about this.

    • Stephen,
      I like what you’re saying but I’m not sure whose doing it this way? Can you point me to some systems/states/counties where people in the system but not of the system are helping others in the system? Are these helpers volunteering their time, energy and efforts or is someone paying them? Is this model faith based and/or affiliated with so-called Peer Centers?

      Thanks,
      David

      • The phrase “in the system but not of the system” comes from an article produced by Sara’s organization. Peer workers are not found in many state hospitals and of the hospitals that do have such departments my suspicion is that few probably model themselves on this idea. I can’t prove that or back it up but from what I’ve found on the internet concerning peer workers in state hospitals the peer workers seem to be very much “of the system.” Of course, I don’t know this for sure since I’ve not talked directly to any of the peer workers in state hospitals. There are only about ten state hospitals that use peer workers. Maybe a survey should be taken to see just what philosophies they do function under.

        The state I live in is setting up a certified peer specialist program for the state and I keep pushing this idea in front of them. The people responsible for creating the program do not seem to be comfortable with this idea at this point in time. What I know as of right this moment is that they want to set the program up so that they can bill Medicare for services provided by peer workers. This is an immediate red flag since making peer workers chart is a violation of the “mutual responsibility” philosophy that Sara speaks abouthere. You have power and privilege over anyone you can chart about, since they can’t chart about your behavior. Having peer workers chart is very much making them of the system. I don’t know if I’ll have any success in getting this philosophy built into the program or not. At this point I’m not very hopeful but I keep trying every time they want to consult with me. It’s the only thing that really gives a peer worker the ability to actually walk with a resident in the hospital and encourage them to seek the answers they need to their own questions concerning their own restoration in life. Institutions and organizations in the traditional system, especially state hospitals that have developed their own cultures going back many, many years, are not comfortable with allowing people to function like this. The staff in these organizations seem to interpret this as “siding with the patient” when you try to allow the so-called “patient” to open up to their own possibilities through learning to make their own decisions. Let’s face it, allowing “patients” to make their own decisions about their own treatment and lives is extremely threatening to staff who’ve always functioned in a paternalistic, “we need to make the decisions for them for their own good” mentality. Traditional institutions today may shout “recovery” all they want but in reality I don’t think that most of them mean what they’re saying. I don’t think they even understand what true recovery really is. Frankly, I don’t think that they really and truly care. They want to maintain the status quo at all costs and they see the cooptation of peer workers as a great opportunity to do this while pretending to be for recovery.

        Sorry I can’t point you to any states, counties, etc. where this is done. What you might do is contact Sara directly. She will know if such things are being done anywhere.

  5. Sera, I don’t know what ‘decompensate’ and ‘baseline’ refer to in context of mental illness. Seriously, LOL. Could you tell me? I’m completely off on lucky number 7.

    To fuss about words a bit more, here’s a quote from your article:
    “And, by the way, those common experiences in this particular context go beyond simple diagnosis, emotional distress and so on.  Those are just the ones that the mental health system happens to be most comfortable discussing.  In truth, common experiences between people who have been diagnosed and treated within the mental health system also generally include oppression, discrimination, loss of power, loss of sense of self and more.  (But people sometimes start to get nervous, defensive and a little edgy when that gets recognized too loudly.)”

    Just to point out how difficult it is to use words, the words emotional distress for example: all the things you rightly mention that people get evasively nervous, defensive and edgy about, when they are recognized too loudly, ARE actually causes for emotional distress. Which makes one wonder what they are talking about when talking about “emotional distress.”

    So maybe we can add number 11:

    11) You think emotional distress is about whether you’re “normal,” rather than wanting to be normal might have caused it.

    Or even add 12:

    12) You think emotional distress is caused by other people that aren’t “normal” enough and jar in social settings.

    And as diagnosing goes: somehow, I don’t think that “wants to be too normal,” as a symptom, if put in the DSM, would help either….

    Or

    “Is scared of the color purple”

    Or

    “Is terrified of anarchists and/or anarchy.”

    In hopes this doesn’t make too much sense,
    (Nijinsky)

  6. Sera,

    As usual, you hit the nail on the head. And no, I didn’t roll my eyes, and don’t think others will, either. Co-optation is a time-honored strategy of those in power to de-fang a protest movement, often employed when direct oppression has been unsuccessful. So perhaps attempts to co-opt should be considered a good sign, as it suggests they’ve given up on y’all going away. But giving in to co-optation is not an option. As Steven says, it’s all about POWER. What real peer support does is empowers clients to make decisions for themselves, which is exactly the concept that the MH authorities want to snuff out. So they hire “peers” and re-define the role into one of coaching their less-powerful “peers” into toeing the party line, taking their meds and “accepting their disability” like a good slave, oops, I mean patient, oops, I mean CONSUMER ought to. Kinda like the inmate prison warden who gains privileges by enforcing the prison rules on his/her “peers” in the jail. You stop being a “peer” the moment you have and are willing to exercise institutional power toward those who don’t have it.

    Thanks as always for an insightful and memorable piece.

    — Steve

    • Exactly. Any supposed peer worker who coerces the people she or he is supposed to be walking with isn’t any better than the Jewish kapos who enforced the Nazi concentration camp rules on their own people. It’s as plain and simple as that, period. You’ve gone over to the “dark side” the moment you start parroting the “party line” to the people you are supposed to help empower. We aren’t even supposed to talk about “helping” people since this also impllies a certain amount of power and privilege. The one getting “helped” should be grateful to the one doing the helping. We are supposed to be there to learn from the person we serve as well as them learning something from us. This is what a truly mutual relationship is.

  7. Interesting, interesting. I particularly use the word and term “peer” quite regularly and it is commonplace in my vocabulary within the context of providing services as a Certified Peer Specialist, but also within the contextual framework of living as person with the shared life experience of mental and social diversity. I am intrinsically a Peer when it comes right down to it. I have many letters that come after my birth name and more to come but at the very heart of it, I am a Peer descriptively, a psychiatric survivor, c/s/x, and the word is true and true to my work and those who I consider my comrades.

    Semantics.

    • I take nothing but blood pressure medicine. If we’re to allow the people we work with and for to make their own decisions about what they want in the line of so-called “treatment,” then we have to allow the same approach for peer workers themselves. It’s not a question of importance to me one way or the other. As long as a person can do the work, doesn’t try to coerce people, and actually promotes people being able to make decisions about their own lives as their own experts, what does it matter whether they take the drugs or not? It’s not a quesstion that I ask other peer workers; it’s none of my business unless they choose to share this with me. The crucial thing is whether they actually do the work of empowering people to think and do for themselves.

  8. I’m disgusted and so highly disappointed after reading this detailed article disregarding my position as a Peer Advocate. Forget about eyes being rolled, how about a puke response? I respect you as a writer, Sean, but it hurts me to no end that a simple word as “peer” or “peers” can create such a fuss. I understand how you feel and your views on the matter of being called a “peer” Sera, just please don’t refer to me as a “consumer” (leaching of the system) or “patient” (someone without a voice) in this sad and hopeless movement that we call, mental health.

    It’s no wonder no real accomplishment ever gets made. There’s no solidarity about anything we do or find ourselves involved in. None of us seems to understand branding and marketing. That’s truly a sad, sad, state of affairs. As a prolific writer, I would think that if there were anything that we all as people with mental, psychological, or emotional issues could agree on is would be the use of a term that seeks to empower us. Yet. Here we are. Bickering over something that needs to be settled as an objective to a particular calendar year. In this movement we are “powerless” and “hopeless.” It would stand to reason that uniting on a simple such as “peer” would show others that we stand on a solid rock, and not shifting sands.

    Therefore Sera, could you please consider writing something constructive about? Before anything else can be done, ask yourself who we are as a group and what you represent as a person!

  9. Hi Sera,
    I followed the link from your recent comment over to this blog. I’m sure you probably aren’t watching this anymore, but I thought I’d still ad my $.02.

    As much as I appreciate so much of what you say, and for that matter, so much of what you say in ALL your blogs, I still think you are missing the point of peer even though you keep stating it. In my mind the 2, and ONLY 2, key things about being a ‘peer’ is 1) equality of the power structure, 2) the perspective of BOTH people being ‘in it together.’

    I have literally, physically and emotionally, carried my wife thru the healing process. Providing her with ‘affect regulation’ and a safe haven when insiders were joining us on the outside and bringing all kinds of PTSD symptoms and so much more that is typical of people with d.i.d. I was her calm in the storm, her safe haven. That doesn’t happen from a safe distance: it happens by jumping in the maelstrom, swimming to the person that is drowning emotionally, and holding them emotionally and physically, so that the words, “It’s ok. I’ve got you now. You are safe. You aren’t alone anymore” have real meaning.

    Our ‘common experience’ is NOT the abuse: I had a nearly idyllic childhood in comparison. Our common experience is that, like the song says, I have literally ‘walked thru hell with you.’

    I never saw my wife as crazy or less than me. H3ll, I joke that I’m the family idiot compared to her and our son. I never treat her or ANY of the other girls, even the littles who present themselves as 1,2 and 3 years olds. It’s just how d.i.d. works, but I walked into her maelstrom and held her hand (or carried her as need be) as we gently, BOTH found our way out of it…together.

    Our commonality is today, not some experience in the past.
    Sam