I am an extremely disillusioned peer. I have spoken up about issues in the peer community, on several platforms, and face-to-face with other peers. Regardless of the medium, no one I have spoken with or has read my previous articles (here or elsewhere) can say the message has changed or wavered. Since I first began identifying as someone with lived experience, what I am about to talk about has bothered me to the very core of my ethics and what I believe means to have good upstanding values practising as a peer in mental health.
These are problems that require urgent attention. Even corrective action, if our peer community is to raise in status among the other mental health discourses.
I have held my tongue far too long, honestly. I am not just throwing about statements here because time is sometimes essential when people object to insidiousness.
The issue at hand is the taboo unresolved question surrounding relapse when living and practising as a peer. I am not just suggesting, but signalling with a spotlight that when a peer relapses, other peers turn their back. To be even more precise and without idiom, by ‘turn their back,’ I mean to support their peer going through a new or crisis or relapse from a pre-existing condition.
If all this isn’t clear enough, when peers get sick or decompensate, I am saying. I am only using this term because I think its archaic nature calls upon readers to truly understand how viscerally disgusting these behaviours are to observe and have been for me to watch. I suppose it isn’t clear because no one seems willing to speak openly about them in any mental health forum.
With this all said, let’s talk about the issues complicating peers speaking about all of this openly.
Peers, by definition, in the mental health community have experienced the impact of a mental health disorder, and sometimes, mental severe ‘illness’ in their life. While there is no rule or prescribed limits written down in the Academy of Peer Services (APS) around how long a person should be in recovery or healed from their illness. There is a generally understood notion that this peer should be active in the recovery process if not fully ‘recovered.’
Here is where the issue of recovery, healing, and diagnosis all confuse and complicate things. Depending on what you consider ‘healed’ or ‘recovered’ and how you conceptualise diagnosis will impact, unequivocally, the level of rigour and how you can perform and carry out your job as a peer. I am saying, in no uncertain terms, if you are only just embarking on your recovery journey, you might experience a few more blips or issues while working as a peer as s direct result of not being fully recovered.
Think about it if you are still experiencing some ‘symptoms’ of a ‘disorder’ or haven’t learned how to enact the best possible self-care. The more likely you may need more time off or might be triggered more (as a result of being less familiar with your disorder and how your ‘symptoms’ re-activate). The more a peer might need additional time to heal and recover as you continue on your healing journey.
Either way, there is undoubtedly a vast spectrum to healing, recovery, and the level of rigour and resultant performance of peers in the workplace. I’ll be brutally honest when I first encountered another peer; introduced to her and a few others at my local mental health agency. My heart dropped, and I was highly concerned.
I was worried and sullen because I was shaking hands with glassy-eyed people who looked highly medicated. In some cases, tired-looking, again, perhaps because of medication, or overmedication, and a general attitude I picked up from them as being overly grateful and happy just to be working in the same environment as their ‘professional’ counterparts. Seeing this was difficult for me, even merely on the level of observation, because I was one of them. I was a peer myself.
I wondered, do other folks see me in this light? Do others see me as healed or still ‘disordered? The answer to this question preoccupied me because if people still saw me as disordered, even just a little, they would be more likely to turn their back on me when they believe I was relapsing. That’s right, I have been marked as relapsing, even when I was quite well. I had supervisors who wanted me out without justification that they suggested I was sick when I was quite well. I recall one instance when I was up for a promotion and competing for the position with a co-worker. I emailed her, but I inadvertently had a typo, or god forbid, two of them. When my co-worker responded with: ‘Max, are you OK?’ my heart dropped. Because at that point, I knew this co-worker wanted to mobilize her knowledge of my lived experience to make a case I was unwell or unfit and therefore not a good candidate for this position we were both competing.
My first peer supervisor, years before this betrayal, taught me how I was more powerful. My lived experience would be a model to others to be agents of change and a testament to the upper limits of success and career growth that a peer was truly capable of during their career. My supervisor also reminded me, reinforcing at every intersection of practice, how important it was that I came out and stayed out as a peer and someone with lived experience. In concise declarative terms, she also told me that my resolve and health would be under scrutiny from everyone around me in the agency. As I discussed earlier, and would sadly find out, again and again, this would be the case in the future too.
I have made bold and declarative statements about peers betraying other peers they think are relapsing or getting ‘sick’ again. I’ve seen it repeatedly, for so many yet complex, and ultimately, petty, cowardly, and distasteful reasons.
The reasons are so multifaceted and nuanced, flagrant, and most assuredly ‘unpeer’ like, that I could do a full-length presentation about it at the next peer conference and probably should. But like most double standards that are taboo and not talked about, the expression would likely be terminated, cut off, and go terminal before I even got to speak. Heck, I am confident my proposal wouldn’t even get selected as a speaker at this hypothetical conference.
Why you might wonder, should such a courageous and essential proposal be shot down? I could speculate. I could imagine some folks are uncomfortable when they look in the mirror. When they hear about their behavior from others, they become resistant to being challenged and quite defensive. Again, this idea is hypothetical and speculation, but quite probable, wouldn’t you say?
Think about it and think back on your experiences. Have you observed or heard stories about other peers who had relapsed and got fired when accommodations or other measures were not put in place to avoid their termination?
I fully believe that in a profession based on living out and healing from a disorder, we should not just expect but be prepared for our fellow peers to relapse. There should be active protocols in place in every agency when this happens. From HR to agency-wide discussions and conversations around this very natural part of living with a mental health disorder. Now, back to that piece that makes this conversation ever more complex. What does ‘relapse’ really mean? What exactly is the correct term or way of speaking about this behavior?
Maybe, or maybe not. In my book, the most important item here is that we begin to fully prepare the ongoing conversation in agencies and the larger peer community around relapse and what it might mean for a program or a community of peers. I have often seen the taboo treatment of ‘relapse’ mean withdrawal or removal of support between the person relapsing and their fellow peers. This phenomenon is the very converse of what should happen between peers. We need to augment support in a crisis, not remove it, folks.
Maxwell Guttman, LCSW teaches social work at Fordham University. He is also a mental health correspondent for Psychreg.
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