Desperate times

I just read this paper by Shery Mead, describing what’s become of alternative support systems in the age of accreditation. It resonates totally with my own experience, for which I’m grateful, as I’m still trying to get my bearings in understanding how mental health took such a bad turn, and why the old models, which do exist and to put it mildly, have not been officially discredited, are, nevertheless ignored in making policy.

In the past 25 years I’ve been a client, paraprofessional, support group member, paid direct care staffer and worked in all types of mental health agencies and settings. The difference in how things were 20 years ago compared to today are stupifying, more so because the blatant devolution is touted as progress.

The origins of peer support is humanistic theory. I was treated by humanists and made them my model. I was taught that peers help one another mentally by entering their narrative, by assimilating their “field of representation” and going with it in empathy, a willingness to be uncomfortable, and suspension of judgment. This was bottom line qualification, what you start with and build on, or you really have no business dealing with people in distress.

Once trust is established you can begin to share your own experience with psychosis and extreme mental states, delusions, cutting, self-destructive and suicide urges, and if the person is scaring you, you tell them what you need them to do to make you feel safe with them. The point of mutuality is genuine connection, and the sharing is to de-intensify the so-called “bizarre,” and make it part of the conversation, which is between two open and honest equals, and out of that conversation you create new meaning, acceptance and strategies for coping with the cards you’ve been dealt. Neither person is considered defective, neither one is acted on by the other, both of us come out of it with more than we had going in. What happened to this model?

We now live in an age of accreditation, peer support is devalued if not outright suspect. DBT groups have replaced the old way, though DBT is lauded as peer support, making it more evil than the usual authoritarian horseshit because it pretends to be something it’s not.

I lasted 2 months at the group I joined, and night after night the indignity of the power dynamics left me speechless. I didn’t want to leave the others in the DBT group, my peers, and they liked me too, but I hated the paid facilitators and the harm they did to people in pain. As if how they treated people was okay because they were following the manual and the manual was the thing.

After the DBT group ended the headcases would hang out in the parking lot, helping each other recover from the disrespect we’d just paid 35 dollars to subject ourselves to, at the urging of our psychiatrists. I couldn’t stand it anymore, and years later I still wonder how this became the norm, about the waste of our human resources, and what could have been had the members not been in subordinated social positions. DBT is not an act of god or inevitability, it is however marketed as a treatment of choice and lobbied to “people in the know” who casually direct us to these invalidating environments because the evidence base shows misfits come out of them conforming and well-behaved.

It’s easy and obvious to lambaste programs like DBT, what’s not so easy is to recognize the influence of the paradigmatic shift in a person’s own way of thinking and relating. The shift from entering the other’s narrative to diagnosing them is complete. It is now seen as perfectly normal and unproblematic for an alternative, uncredentialed supportive peer to inwardly make a diagnosis and proceed from that, without realizing the completely fucked up dynamic s/he’s creating. If you have any doubts about that, call a peer-run psychiatric warm-line next time you’re in crises and see what happens.

Every model they shove at us is de-politicized, as if there is no context anywhere in the whole wide world and *you* are the problem. Trauma-informed peer support has been confiscated. We have a long way to go to begin taking it back, what we can do is live our lives as if we should. And that we do, whether in recovery or screaming batshit through the streets.

Mead, on Peer Support and a Socio-Political Response to Trauma and Abuse (pdf.)

The trauma agenda (or our attempt to build more trauma- informed mental health services), once again has been put on the back burner.

Treatment outcomes are based on acceptance of psychiatric diagnoses/labels given by others, on compliance to what others think is “good for us,” and adherence to medication regimes that once again require our bodies to be in the power of others. Even if we are given a “trauma” diagnosis (PTSD, Borderline Personality Disorder, Dissociative Identity Disorder) we are considered manipulative, hard to work with and needy. We are mandated to rigid and controlling therapy programs such as DBT and lose treatment resources if we don’t go. We are considered inappropriately angry and unsuccessful at relationships, and we are banned from calling hotlines. Further, as managed behavioral healthcare has developed a stronger voice across all mental health treatment, we are losing many resources that might help us to work through the abuse, to build healing relationships and to move through the anger that has kept us bound to our cycles of pain.

In fact, rather than helping people truly to heal from the effects of past abuses and
offering them the opportunity to break the cycle of violence, we are creating lifelong “mental patients” – people who are firmly embedded in the notion that they have something permanently and organically wrong with them.

Peer support programs must challenge the current system’s approach to how people with histories of abuse are treated. The devastating impact of abuse must be recognized for what it is and not viewed as psychiatric pathology or biological brain disorders. Through peer support services we can offer each other relationships that are respectful of our experiences, our ways of communicating, and how we have learned to tell our story. We can challenge each other to both face and to move beyond these stories and patterns. We
can build new community norms that replace the illness environments that have kept us trapped. Finally, we can conscientiously name and expose the cultural violence that caused us to end up in these institutions. If we can learn to tell our stories in new ways, we can create communities where the sanctioned outcomes include non-compliance to “mental patient” identities or expectations, rejection of unhelpful treatment regimens, the questioning of overuse of medication, and speaking out about the prevalence of trauma and abuse.

Finally, we can to call into question whose “problem” it really is.