Since this is my first post on MIA, a quick word about my style/intention: I’m basically going to write about my own processing of my work as a peer support coordinator in a mental health agency. My intention is not to teach or advise but to “learn out loud” and hope that others join me in that process. Also, I’m coming from a starting place of believing that there is value in having *some kind* of system for helping people who aren’t able to find support elsewhere.
I find it to be a really difficult decision—some days more so than others—to do peer support in the traditional mental health system. I need to remind myself pretty often why I am doing this because it’s really, really hard!
Here are the reasons I go to most often:
If Not Me Then Who?
This job exists—for better or for worse, there is a demand for peer support in all kinds of settings. If I didn’t take this job, who else would? Would it be someone who continued the message of illness and disability? Would it be someone who was comfortable with the status quo? If someone is going to be in this role and talk about people without them there, write notes about them, restrict access to some items, and do other things that can feel a little icky to me at times, maybe it’s better that the people doing this be critical and questioning of those practices rather than comfortable with them?
There Are People in the System Being Harmed
Building alternatives is something I value a lot and I hope that someday we get to the point where people have access to other types of support besides what the traditional system has offered. In the meantime, there are many people every day being told devastating messages about themselves and their future, people being shamed, people being coerced, people being over-drugged or unnecessarily drugged, and people being written about, talked about, thought about in disrespectful and degrading ways. Maybe my presence will lead to a bit less of this.
I Don’t Want to be Sheltered or Shielded
Similar to the point above, horrible things are happening in the mental health system on a regular basis (in my opinion). It’s happening in the world. I’ve decided I can co-exist with that reality and, at least for now, I would rather be right there to see it and feel it so I can try to understand it better and perhaps change it. (There’s no implied judgment here towards people who decide that it’s better for them to have some space from consistently seeing this kind of harm up close and personal on a regular basis—very reasonable!)
There are also some really tough situations and questions to be dealt with, particularly issues around public safety and social control. I used to have a bit more black-and-white thinking about things like heavy medications, restraint, force, intervention and secretive notes/conversations. It was easier to simply think of all of that stuff as bad and not really engage with the more complex questions. For me, when I really wanted to work somewhere that I considered a “pure alternative,” I think it was in part because I didn’t want to deal with those tough, uncomfortable things that felt scary and horrible and bring up my own experiences of systemic trauma and oppression. (For the record, I still OFTEN feel that way and there are so many questions/issues I’m just not ready to tackle.) I appreciate that working in the system really compels me to consider these tough issues from multiple points of view and I’ve found that it is (occasionally, slowly) softening some beliefs or attitudes that were a bit rigid. I find this process painful and frightening but so far I’m valuing my aspiration to not be dogmatic over my desire to be comfortable.
I’m Gaining Some Useful Skills
I feel so very, very lucky in my job (and in the world in general) because I’m really challenged in all the ways that I want and need to be!
I get a lot of practice with things that I want to become better at. On a daily basis I feel compelled to rethink pretty much all my opinions and automatic reactions. I definitely get to work on a lot of diplomacy skills; I have to give people feedback and speak up about what I think (I wouldn’t be doing my job if I didn’t) and it has to be in a compassionate, tactful way in the context of genuine respect. I want to have consistency and integrity in what I believe and how I would like people to be treated. If I think that people are worthy of positive regard and not being reduced to anything less than a dynamic, lovable, understandable, equal human being then I need to work on cultivating that kind of attitude towards people whose actions I consider harmful or oppressive. In my opinion if I do anything less than that then I’m just handing out diagnoses and prescriptions as well.
I get to practice hope a lot. And having joy and peace despite being around a lot of very unjoyful and unpeaceful things. I’m beginning to learn a little bit about what’s mine to worry about and what isn’t. I’m learning a lot about myself, of course, and I’m (tentatively?) discovering and trying out my potential to be influential in the world around me.
I get to practice sharing difficult or unwanted information with people (like “No, I’m not going to bring you home” or “if you did that my response would be to call the police” or “I am going to call crisis now” or “in order to see your chart you have to fill out this form and wait 30 days” or “I don’t feel comfortable sharing that information with you”) in a way that, as much as possible, sends a positive message about their worth, autonomy, and capability.
I get to practice teaching people a new way of thinking and relating to others who are in distress or whose experiences they don’t understand.
I so don’t have any of this figured out—and probably won’t—but it’s really enjoyable/rewarding/not-boring to be actively in this process. There are some perks to regularly being in difficult conversations and situations.
There’s Actually Hope
I hear some people say that there’s no hope for the mental health system and we need to throw it away and start over. I don’t disagree with the “throw it away and start over” approach but guess how that happens? I think it happens from within the system. I’m seeing it happening! It’s painfully slow but—at least where I am—a clear shift is underway. Many people are at least aware of things like Open Dialogue, the Hearing Voices Network, Mad In America, etc. AND there is buy-in from a lot of people in leadership positions. All the awesome young leaders I see (and many of the older ones too) are open-minded and rights-conscious.
Also, it’s just not cool to use very pathologizing, disease-based language anymore. It totally happens all the time but you don’t see it happening without a bunch of people bristling at least.
I’d really like to include a few anecdotes here but I think I might get myself in trouble with some small-state politics so I won’t.
I’m Making a Difference
I just am.
I feel uncomfortable rambling off a list of things that I’ve done or been involved in but it’s clear to me—unless I’m feeling really discouraged—that things would be different if I weren’t here. I think my presence (like the presence of every member of our community) makes a difference in the individual experience of people receiving services, in the activities and atmosphere we provide, in treatment decisions, in program policies, in staff perspectives, and in what kind of information and ideas people are exposed to.
I Happen to Work With Great People
I’m not sure if I could work in the system if I didn’t have support from my supervisor, coworkers, and senior leadership. There’s openness and interest towards approaches outside the disease model and a strong push to be “recovery-oriented” (but actually, not just as a cool phrase to put on a brochure). I realize it’s not like this everywhere.
If you work in the mental health system, why do you do it? If you tried and decided it wasn’t for you, why? If you’re thinking about working in the system, what factors are you weighing?
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.
Hi Malaika, I appreciate your having personal reasons for doing this work and learning as you go. As someone who has been through all the peer stuff, and having ‘graduated’ from this dubious status (I am no longer connected with the system in any way, for reasons having to do with maintaining my sanity and well-being), I found it terribly toxic and crazy-making. I also appreciate those, like you, with the intention of creating change from within.
However, this statement from your article stood out to me:
“I’d really like to include a few anecdotes here but I think I might get myself in trouble with some small-state politics so I won’t.”
Creating change would mean challenging such control. For me, one of the main issues I noticed in the system, and in working in ‘peer’ settings, is the fear and intimidation which fuels the client/’peer’ culture. Playing it safe keep the status quo alive. Taking risks is what produces change.
All the best,
Thanks for your reply! I can relate to the “toxic and crazy-making” experience for sure.
I think you’re right that taking risks and challenging that kind of “playing it safe” is important. I totally agree with you. That’s one of the main struggles that I have– that balance between challenging the status quo and keeping my efforts sustainable and effective. The main reason for me not sharing those anecdotes that were coming to mind is that I want to maintain a collaborative relationship with those individuals and organizations. I am up for challenging them (and I think I do, though not always) but broadcasting them on the internet is not the way that I want to do that. The program I work at is pretty progressive compared to a lot of the other service providers we interact with and this already creates difficulty without me publicly critiquing them 🙂
Thank you for the reminder and encouragement to take risks!!!!
No need to broadcast anything, but if they are doing something that is troubling, unethical, or perhaps even illegal (I’ve used ADA to successfully challenge agencies) that is doing harm to clients, then I do hope you are sharing the specifics with someone, somewhere. I know reactions can be defensive, and the system has many rocks and hard spots, and also that it’s hard to find anyone who really knows how to take action against the system. But silence has equaled death.
I do understand the balancing act this all is. Personal growth is just that.
Thanks, Alex, for your accurate and restrained reply.
Maybe there is change in the horizon but I can’t really see it. At least where I live now – there is a lot of “change” on paper and none of it in reality and the system is just as stupid and harmful and arrogant as ever.
I do not disparage people who want to work within the system, do whatever helps. I just know that working within the system makes you valuable to start thinking like the system. People on MIA have written quite a bit about “othering” as this evil thing but in my opinion a bit of “othering” may help you put things in right perspective. There is a real danger that when you work with and around people who do things that are bad you’ll slowly absorb the attitude of not speaking out, not making your colleagues upset, making excuses for them (since I’m sure they’re all “good people”). I’ve seen that happening so maybe it’s good to remember and be careful on where your values and objectives truly are now and 1, 5, 10 yrs from now.
Yeah this is something I’m really scared of, actually. Thanks for sharing!!!
Welcome to MIA. I have worked for 21 years as a therapist/counselor in community mental and I can identify with many of your thoughts about working on the inside. Being on the inside certainly does challenge us to learn how to struggle with people in a way that might have a chance of winning them away from being swallowed up by Biological Psychiatry’s oppressive paradigm of so-called treatment.
“Black and white” or “Up against the wall” approaches will not educate people, but only alienate others or ultimately isolate us. This DOES NOT mean, however, we do not call out and expose those things that are clearly wrong; we just have to find the best ways to conduct that struggle.
To stay true to our beliefs and defend potential victims from this system does require risk taking. I once wanted to write a blog titled “How to Do Revolutionary Work in the Community Mental Health System Without Getting Fired or Going Crazy.” The truth is some of us have been and will be fired (and some may even have gone “crazy”), and if that happens it will (if organized around) provide opportunities to educate people more about this oppressive system.
You did say said something I definitely disagree with:
“I hear some people say that there’s no hope for the mental health system and we need to throw it away and start over. I don’t disagree with the “throw it away and start over” approach but guess how that happens? I THINK IT HAPPENS FROM WITHIN THE SYSTEM.” (my emphasis added)
I believe revolutionary change will most likely occur with people on the inside uniting with activists on the OUTSIDE of the system. In fact it much more likely that the impetus for change will be initiated from the outside, especially led by survivors and other outside dissidents who have left the system.
You said : “I’m not sure if I could work in the system if I didn’t have support from my supervisor, coworkers, and senior leadership.”
I find my greatest support and inspiration has been from those activists and survivors outside the system who add strength to my convictions and a sense of moral responsibility to do what is right and just.
I hope you write that blog post called “How to Do Revolutionary Work in the Community Mental Health System Without Getting Fired or Going Crazy”!!!
I love how you articulated this: “This DOES NOT mean, however, we do not call out and expose those things that are clearly wrong; we just have to find the best ways to conduct that struggle.” Well said and I agree 100%.
In terms of change coming from inside or outside of the system, it seems clear to me that it’s both. I certainly didn’t mean to imply that it only comes from within the system because that would be obviously wrong. I think you’re probably right that the impetus or the spark is outside (survivors, dissidents) but the actually internal transformation and restructuring involves a lot from the inside.
Thanks for your thoughtful response!
There is not going to be internally motivated tranformation. The need for it and the dimension to which its needed are not even visible to those who start going along with things. It is plain that there is a danger in becoming an apologist for mental healthcare providers. It is obvioulsy tempting to start wanting to join the fun of not having to suffer detentions and restraints, chemical lobotomies and absence of interest in your suspicion that something is very wrong with how treatment is doled out.
I think that you have passed beyond the point of getting through to you about these things, M. It is not so simple as that the medical model has to be “transcended” and that we put smiley faces over the frowns and stares.
It is rather more true that it is the coercion model that hurts. If doctors kept at their biomedical interpretations but could not take over the courts with insanity defense ideas or abrogate the liberties of persons who have as yet not gotten tried for creating distrubances, then it wouldn’t matter the way it does now that they insist that you “get insight into your illness”.
You’re spot on. The ability of psychiatry to act as judge, jury and executioner absolves them from any practical liability for their “treatments” and causes no pressure for them to change.
Thanks for writing such an insightful blog. The issue of whether or not to challenge things is always there and I know how important it is to choose your battles. My stance on this is I want to see change happen and that if I go about it the wrong way then it just becomes a battle of us and them. I have worked “in the system” for over 20 years and then the last 3 years as coordinator of peer support services so totally relate to what you are saying.
I look forward to more blogs from you that will help all of us move towards change for the better.
Thanks Pauline! I would love to hear from you sometime about what you’ve learned over the last three years!!
When reading your article i was reminded of something similar i read many years ago. It was when i looked at what you had to say about there being hope.
Viktor Frankl wrote a book called Man’s search for meaning. He was a psychiatrist working in the camps at Dachau. He did what he could for fellow prisoners given the system he found himself in.
It was hope that he identified as being the force that kept people going in such atrocious circumstances.
Share your hope about the possibility of change with those that are losing this valuable resource by being subjected to the brutality of the system. They may survive to see better times.
Thank you Boans, that’s really encouraging! I appreciate it.
“I don’t disagree” a double negative.
“I don’t disagree with the “throw it away and start over” approach but guess how that happens?”
Usually it happens with bloodshed, but being angry is called “psychotic” by psychiatry and the angry are drugged calm/stupid.
“…freedom is never voluntarily given by the oppressor; it must be demanded by the oppressed.” ― Martin Luther King, Jr.
You must take your drugs/medications, if you don’t (take medicine) who would the psychiatrist be?
I like that MLK quote. It makes me think of this one:
“Revolutions begin when people who are defined as problems achieve the power to redefine the problem” – John McKnight
In response to the “throw it away & start over” notion I say no, throw it away and bury it deep in the ground.
So I know you’re acting in good faith and with high hopes but I hope eventually you’ll decide to put your energies into exposing the system rather than trying to “improve” it. Here, I won’t comment on the reasons you listed that might help your personal growth, that’s not really any of my business. But as far as this quote goes:
“Building alternatives is something I value a lot and I hope that someday we get to the point where people have access to other types of support besides what the traditional system has offered. In the meantime, there are many people every day being told devastating messages about themselves and their future, people being shamed, people being coerced, people being over-drugged or unnecessarily drugged, and people being written about, talked about, thought about in disrespectful and degrading ways. Maybe my presence will lead to a bit less of this.”
No it won’t, and it has nothing to do with you personally or how sincere and committed you are. The simple fact is that the things you want to eliminate are working very well to serve the primary purpose of the “mental health” system, which is repression, coercion and control, and the intimidation of those who, consciously or instinctively, dare step outside the capitalist mold.
Hopefully you will keep us abreast of the struggles you go through as you attempt to do what you are setting out to, and of the obstacles you find in your path; such an account could be educational for all of us.
You might be right…but if I believe that there’s no hope then you will definitely be right 🙂
Why not expose the system while we improve it? Those don’t seem mutually exclusive to me. In fact I see some clinicians doing this.
Thanks for your message!!
Re: your question — underlying your approach, again, is the assumption that these institutions are in place to help people rather than keep them in line. But Dr. Szasz himself said that, just as with concentration camps, mental institutions cannot be “reformed,” they must be abolished. I concur. If there is some basic value in a particular practice it can be improved upon, but when the purpose is repression, “improving” it would only serve to increase that repression, correct?
There’s plenty of hope, sufficient anyway. But it won’t be found in the system. It’s ok tho, after you’ve banged your head against the wall enough we’ll still be out here waiting for you to join us in toppling this charade and creating true alternatives! Meanwhile I do wish you well.
Malaika, I hope you see how very kind your critics mean to be in the thread. Maybe you won’t think this is unjadedly true as well, but to me your position statement exhibits self-aggrandizement. Maybe it is always right to come back around to mainstream psychological worries about how your thinking too much in black and white, but when you put that in perspective, it is appropriate to see the involuntary system of care as repulsive and anti-democratic. I hope you can see what you have told yourself is going to work wonders is also based on this one-sided double standard against the “insane”.
Hey Malaika…thanks for coming and sharing some of what you thin with us here. As someone who works both “on the outside” and in the system, I agree with you that changes can certainly come from both places.
We have a need to fundamentally transform the mental health system while also creating strong and realistic alternatives to the system. That is going to take a lot of voices and I appreciate you adding yours to the conversation.
Thank you Jonathan!