The Double Standard at the Heart of Peer Services

Max E. Guttman, LCSW
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There is an unspoken, covert, and arbitrary double standard for working in the mental health community as a peer. In this land, discrimination goes without question sometimes. The double standard exists in mental health agencies everywhere. The insidiousness of this double standard runs deeps.

As a professional in mental health, I have seen the depth of this discrimination at various levels and intersections of “agency.” From Human Resources (HR) to Operations, Clinical work to Peer-run departments, there is a misinformed set of expectations and beliefs involving peer work looming over the entire mental health “agency” setting.

The double standard exists because of a culture of mental health medicalization. The DSM-5 has codified the symptoms of mental illness for clinicians. However, all of these symptoms are subjective. If someone who has not disclosed a diagnosis reports having trouble sleeping, or feeling down that day, no one would think twice about it. But for peers, who are labeled with an illness, these same experiences become seen as “symptoms” and force the other agency members to question the peer’s competency

Think about it. Peers, through the act of self-disclosure, reveal their lived experience at work in the agency all the time. Through the act of self-disclosure, these peers are revealing their lived experience to other peers, but also clinicians, psychiatrists, social workers who are very much bound up in a narrow-focused idea of good mental health.

For most clinicians, peer work not only continues to be misunderstood; it is viewed with the lens of the prescriber or therapist as work by people who are still disordered or sick. Despite the supposed egalitarian non-hierarchal landscape of interdisciplinary teams (e.g., ACT, or Assertive Community Treatment) in mental health, peers are certainly not understood as being as healthy as their fellow clinical counterparts in the mental health agency or when working on the same team.

I have worked in several mental health agencies and settings. Each experience was invariably similar, especially concerning the informal set of questions and comments circulating about the peers’ job performance and health. As far back as I can remember, the peers at my agency were under constant evaluation since they were hired.

Even more troubling, after working there for some time, the peer still seemed to be under continuous and informal assessment from colleagues without a disclosed diagnosis. For everyone else at the agency, the assumption was that they could do their jobs, that their health would not get in the way. But for us peers, the assumption was that our quality of work was always questionable, our health always on the verge of interfering with our jobs

While the level of “functioning” is now generally accepted as a dated clinical term, it has sadly found new meaning, traction, and use against the peer community. The peer’s work readiness and ability to perform at work given his or her preexisting mental health issues are always under question. Even worse, the lingering questions around health, in my own experience, have risen to more than just conversation around the water cooler. I have observed these questions rise to HR and even result in unfounded termination from employment.

In every agency I have worked for in New York state existed a secret conversation, an informal meeting, and ongoing dialogue about a particular peer’s mental health status when an incident or unexpected event occurred. For example, if a peer called out sick, or there was a new and unusual behavior in the peer’s day-to-day disposition, all of a sudden, that peer’s competency was under question.

I knew plenty of professionals (e.g., therapists, social workers, psychiatrists) that would talk about “fucked-up marriages” or “explosive” behaviors at private social functions or work. Somehow, someway, these professionals are not considered sick or in need of treatment. These behaviors are widespread. What is not so common is the license for peers to mimic this behavior.

Peers who want to feel comfortable in their shoes being themselves without fear of losing their jobs or respect from their colleagues cannot behave like this without fear of being called “sick.” The etiology of this discrimination runs deep. Therapists and psychologists without any lived experience are somehow above reproach. The same behaviors that are viewed as normal and understandable when exhibited by therapists and psychologists are considered symptoms of an illness when peers exhibit them.

This disparity was so visible and yet so brazenly discriminatory in the jobs I have held. I’ve suffered trauma from the entire experience of working as a peer with lived experience.

As a peer, my education, disposition, presentation, focus, and ability to do a job are under scrutiny. Given that we live in a world of stereotypes, discrimination, and labels, peers are always judged by other team members when working in mental health or interdisciplinary teams. We are considered not quite healed yet, or in need of further recovery to be successful or ready to use.

After openly disclosing my lived experience while working as a clinician, I heard colleagues’ comments, the smirks, the language thrown around the watercooler. These were comments about my ability and calculated as a general summary of perceived progress and recovery status from a diagnosis. My colleagues would talk about how recovered I was, or how healed I was from my illness. Even worse, my recovery was taken out of a more human context and discussed only in clinical language. I felt like a textbook example on the agency’s list of “recovered” peers.

My point is that peers’ worth and abilities seem to be summarized by their so-called functioning level. A peer’s ability is determined—by clinicians and their colleagues in the system—to be only as good as their ability to come across as healthy to their fellow team members. The standard is as absurd as it is arbitrary. Since there is no clinical determination or assessment of seeming healthy, the peer’s health status is bound up in a world illusion and discrimination.

The double standard requires peers to demonstrate their skills and talents to help people heal, be publicly comfortable with their problems, and work alongside social workers and others in the helping profession. In doing so, peers handle the same or even more severe issues but are deemed less able to compartmentalize problems and engage in self-care.

This is clear evidence of a double standard and attitude that favors and privileges one side of the binary—the clinicians—over peers. This discrimination must be made visible and revealed to mental health advocates and changemakers. Readers of this article must take this information and begin to explore this discrimination at various levels of the mental health sector, including advisory boards and other apparatuses above the agency’s level. Only in the larger arena, above the agency’s auspices, will we be able to put a stop to this double standard once and for all.

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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.

29 COMMENTS

  1. A person cannot be a “peer” in a mental health system. Peers are common people in everyday life. It’s ludicrous to think that people who shrinks have labelled themselves are now to be “peers” to other people they have or will soon label, especially under the guidance of those very people. I’ve noticed this tendency over and over again. Many people who were former patients just end up becoming a part of the system themselves to have some leverage in their freedom. But they are never truly free.

    One has to leave the system completely. If one wants to help, it has to be as a free agent. Else, “peers” are simply adding more parts to the mouse trap they are trapped in themselves. The cheese is never yours.

    This is not being a peer. It is being a Kapo.

  2. With this experience of being under constant suspicion by professional fault finders and never being able to redeem yourself as normal, you can offer real peer support to people who have been sucked into the mental health industry as patients. I’ve never had a mental health professional treat me as an equal. This is a huge part of lived experience for many of us. I hope that, in a spirit of understanding, you will help to undo the damage that has been done to many of your peers by the very industry that is supposed to help people.

  3. Hi Max, thank you for your story.
    Isn’t it psychiatry that promotes the “STIGMA” problem? Those signs they got the mediocre folks to tack on the walls? The signs that tells “the public” not to have Stigma, so as to smokescreen the VERY Stigma and discrimination that they unleash in every area of a human’s life?

    I am thinking that to save a piece of yourself, perhaps don’t work for the devious and cunning. I know you need the money most likely, so easier said than done.
    It is after all their misery that they leave at your feet. I hope you understand what it means to be around miserable people. The MH people call it “toxic people”. The clients might be taxing, but the psych industry is nothing less than toxic.

    I hope you are able to build up a shield against their useless chatter. They are sounds with no meaning.
    There is only power behind their sound, which is completely separate from meaning.

  4. That being said, I hope you’re able to provide true help to people to get out of psychiatry, and out of the patient role. Whatever you problems were, they are the individuals who labeled you with that god-forsaken “schizophrenia” label. That is as great or greater a burden to take than your original suffering. I see this as inexcusable but I know most don’t.

    Help people live ordinary lives. Not psychiatrised ones. Else, this discrimination you talk of in this article will forever dominate them. Those “behind your back” gossip-mongers will do the same to others.

  5. Thank you, Max, for pointing out this hypocrisy and discrimination. I took a peer training class, passed it, but decided not to work in the industry because I saw the double standard during training.

    For goodness sakes, they were still pushing the chemical imbalance theory in these peer training classes in 2016 or so, when I participated in the training. Despite the chemical imbalance theory being debunked long ago.

    I knew I wanted no part of working within such a scientific fraud based, discriminatory, disrespectful – to the point it would likely feel hostile -environment.

  6. Maturity, adulthood, all that it’s supposed to mean, just plain thrown away with behavior like this. We are animals, children, brats, etc. The best of us are the ones who know it and the dangers of not curtailing it. Humility is what is needed. Humble those colleagues. They should have to start each day with the announcement that their science is a sham and they’re just playing dress-up.

  7. Honestly, as a humane being I have to confess that I look at the Mental Programming System and he people who work for it like lower than pond scum, drain the lake, dig under the sediment type people. monsters and idiots.
    That being said , I have been blessed enough to have some really excellent Psychiatrists in my life Were it not for them ESPECIALLY in Wisconhell, I’m sure I would be physically and mentally disabled to the point of a life long funding stream asset for the state.
    The word “peer” reminds me of Elan.
    http://www.thelaststopfilm.com
    I was always a natural healer
    I always had a heart
    I have more mental health experience than most. (Not around MIA)
    I got certified and it’s a Joke.
    I never bothered to get re-certified.
    In general it’s not a paid living wage.
    More BS lets underpay you to play Uber.
    If they did pay I can’t imagine having to constantly re-educate EVERYONE I work with. (I know I would and I’m no diplomatic type so I’m sure I have intermittent snapping on mental health workers disorder with run on sentence features)
    There is not enough weed on Earth to cope with that ugly scenario.
    Peerbot AI ? Mental Health Apps?

  8. Peer services are a double standard and a deception at the same time. I didn’t sign on to be a “sick fuck”, nor a “sick fuck helper”, and I especially didn’t sign on for a life term of doing such. Suspend “the age of consent” as much as you wish to, there is a problem with doing so. For one, it is preferable simply to grow up. Suspending weaning is indicative of attachment issues. This eternal ward of the state business is not to my liking one iota. Peerless services, there you go, only you’re not going to get nannie state services for non-wusses. Toughen up, and you’ve got everybody thinking, why didn’t I think of that.

    • Thanks Frank !!You are allowed to say “Fuck” on MIA? Holy shit! This is news to me because what I really wanted to say is: I certainly never signed up to be a sick pathetic waste of a fuckin life and brain but I always helped others because I give a flyin fuck. Fuck peer support that word is straight out of Synanon cult speak. What a fuckin joke!
      *I discontinued commenting on MIA for about a year because I kept getting censored for my use of language. (I’ll be really shocked if this comment makes it past the moderator?)

          • Posting as moderator: It is possible that past moderators handle things differently. The Posting Guidelines do mention profanity, but in the context of being respectful to others. It could be interpreted that all profanity is banned, but I’ve read it as meaning profanity in reference to someone’s person or ideas would be out of bounds.

        • I was censored for using an 8 letter word to describe a person with a methamphetamine addiction. In my mind the addiction alone does not properly describe the behavior. It was one word in a very long (for me) heartfelt reply. It’s cool my videos are getting taken down from YouTube also.
          I don’t write often. I would not personally attack anyone here certainly not an Editor. There is a difference between someone who is dependent on a substance but functions as if they did not have an addiction and a ********. I can not properly express myself without freedom of expression and it’s not my fuckin fault that everyone is a fuckin snowflake. Oh no! Another bad word! Fuck! I expect that type of crap from The Mental Health System. “Be appropriate” I certainly never expected it here and I’m absolutely shocked that my comments are not censored.

          • Posting as moderator:

            Don’t sweat it! As long as you’re not calling someone names or telling them off, swear words will generally fly without attention, at least at this moment in MIA history.

    • OK I’ll join this “speaking bitterness” session!

      My addition will be: It recently occurred to me that the “peer” concept, with its implications of equality (for a price) is a reflection of the psychiatric caste system — with “peers” at the bottom.

      So fuck with that. 🙂

      • That is my observation also. “Peers” are rarely considered equal partners, but more someone who can “talk at the client’s level” and thereby explain why the system is “right.” I’ve seen plenty of “peers” who intentionally and consistently buck that trend (Stephen Gilbert/Boren, for instance), and they can sometimes get some stuff done, but they are never considered actual peers to the professionals. As long as that condition pertains, “peer support” remains mostly coopted and lacking in significant influence beyond the level of an individual person’s situation.

        • Yes Steve,
          And I think that there is no reason to be a peer who constantly seeks the
          “approval” of shrinks, because that “approval” is basically an insult.
          Peers will be looked down upon no matter what, so why not do one’s own thing to the best of our ability. No need for “approval”.

          It is like any other forms of communication, like “open dialogue”. It is not OD if it exists as an add on, with an authority. Peers, OD or any other voices will only be as successful as the honesty and humility within the practicing communicator.

        • I was going to mention that the MIA comment history of Stephen (who left us almost a year ago) is a testament to the insufferable contradictions those who take their “peer” status seriously are subjected to, and the constant assaults on one’s sense of integrity.

          If Judi Chamberlin or Howie the Harp could see what has become of the concept of “peer support” they would roll over in their graves. Old movement veterans are horrified when they realize how the term has been “professionalized.”

          (Btw way I don’t know of “many” so-called “peers” with the moral clarity of a Stephen Gilbert. I could probably count them on one hand.)

    • Well, if you delivered proper services as a peer, you’d find yourself out on the street, accused of blasphemy, or even worse, sorcery, if your proper services got your charges to improve but didn’t use standard psychiatric methods that your employers approved of.

      • I did that I was accused of Voodoo and Witchcraft also. (In a revocation hearing for my Criminal Mental Health Commitment) My Lawyer got me the transcript she was awesome! I remember David Oaks telling me I was lucky to be an American because in a lot of Countries they just kill the “Witch”.
        I remember thinking “I’m a Jew and this is nothing new.” I’m still alive.

  9. Very well said and clear truth. I’ve worked with two peer agencies and this is exactly what happens. Double standards, blatant discrimination, and the usual fare of gaslighting and double-speak to avoid any challenges to their hierarchical corporate system. Because they can get away with it, because it is the norm.

    Addressing this effectively requires breaking a deeply stubborn and self-protecting toxic system where truth-speaking against the grain is seriously frowned upon and gets one ostracized, regardless of one’s role and position. But it does bring brave hard truth one way or another, and that’s always a good thing, once the dust clears. I’ve been there, and it’s always a blessing in disguise, and I know some kind of change has occured as a result of taking that necessary leap of faith.

  10. Thank you for writing this! Also at work here is what I term ‘clinical arrogance’ — the strong tendency in clinicians to view lived knowledge (knowledge winnowed from deep lived experience) as having little or no value, and the belief that only academically-derived knowledge has validity. Having been trained both as a clinician and a peer supporter, I find very little of my clinical training real or helpful, and almost 100% of my peer support training real and helpful.

    • True. It’s very much a toxic culture that I admit even I was very keen on in my youth. People have a reverence for their conception of “science”, i.e. journal papers, imaging, stats, fanciful language instead of an actual desire to know the truth.

      It’s a common mentality you see, not just in academia, but all over the internet and it’s still going strong. Only when things happen to people in their own life, do those experiences bring them down to earth and out of scientistic mental masturbation. It isn’t something that can be adequately conveyed via language. It has to be felt. In your bones.

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