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:
- You are ‘court mandated’ to work with someone, and don’t think that’s a problem.
- You have a ‘caseload,’ and don’t think it’s bad to refer to them as ‘cases.’
- 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.
- You are responsible for administering medication and writing treatment plans, and think it’s a sign of how far you’ve come.
- You leave all the tough conversations about difficult topics like suicide and medication to the ‘professionals,’ because you’re just there to ‘inspire’ people.
- You really like your name badge and keys to all the locked doors and wear them prominently.
- 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.
- You’re proud to be a ‘high functioning’ peer.
- You refer to yourself (or anyone else) as ‘SMI,’ ‘SMPI’ or any other system acronym.
- 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.’
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.