Cheryl Stevens MD, R.M.P. (Real Mental Patient – thanks to Jonathan Delman for this designation

As part of a developing recovery learning community in Western Massachusetts, I want to address the whole issue of who among us are our 'peers' and who is/are not our 'peers' but 'allies' or 'partners' instead - people who might have an interest in peer-run services but who do not have a personal recovery experience.  

Mary Ellen Copeland MS, MA refers to people who have been labeled with psychiatric diagnoses as 'key stakeholders' and she designates all other interested people (family, friends, non-peer mental health staff, researchers, policy makers, citizens) as 'stakeholders'.  I appreciate that distinction and I largely agree with it. 

Except that there remains the not-too-small dilemma of those who work in traditional mental health service roles but for whom full-disclosure of our personal recovery histories would place us at risk for further victimization on the jobs (than what we already experience as underpaid and overworked staff).

Before we get too far afield on the theoretical questions of "who is a peer" in the "peer-run" and "peer services" frenzy, I believe in letting each individual decide in their heart of hearts if they have the kind of lived experience that would give them the moral authority to join in our discussions and then letting all interested individuals generate that discussion without too much fretting over who is one of 'us' ('real mental patients') and who is not (then by default, they would be one of 'them' - whomever "they" is/are - wanna be mental patients?!).

These kinds of artificially declared divisions - 'us/them' stuff - are often what happen when we use labels (like "peers") as a communication short-cut which creates categories of people instead of just dealing with people as individuals.  Also, like it or not, the designation of "peer" in front of "worker" or "staff" still carries the oppressive yoke of one who has been labeled. Not everyone who has lived experience in recovery is going to be eager to embrace the mantle "peer"; nor should they have to just to have a seat at our table - which is of course, "their" table too.

I find discussions of these sorts of "boundary issues" about who is '"us" and who is not "us" to be difficult.  

Our boundaries have been repeatedly violated by an overwhelmingly threatening cast of characters that have felt free to parade through our bodies, minds and psyche (souls) – our emotional, intellectual, spiritual, physical, sexual and social boundaries - without any fight from us or any social consequences or sanctions. 

Then in some weird attempt to create a 'safe' place for 'us' to dialogue (as if there were such a thing as a 'safe place' when the source of one's terror has become internalized), we end up creating 'new and improved' labels ("peer") that continue to (inadvertently) exclude - and perhaps oppress - members of our own group!  That is an interesting turn to the cycle of violence! 

Can you see how the violence comes full circle when we internalize the label “peer” to mean a person who experiences psychiatric symptoms?  This is just one more broken identity!  Webster defines peer as “one that is of equal standing with another: EQUAL. 2. (archaic) COMPANION, FELLOW.”   

Whether we suffered childhood traumatic stress/family dysfunction, adult re-enactments of violence ranging from distressing symptoms and addictions to the twisted relations of domestic violence, sexual assault, caregiver abuse and non-trauma-informed psychiatric treatment (psychiatric abuse) by continuing to use the word “peer” to mean someone with a psychiatric history we not only trump all our other past experiences, talents, roles and identities, but we are being (once again) insidiously silenced and co-opted. 

First, we cramp our magnificent Essence into another little label/box that parrots the “master narrative” (to quote Pat Deegan, PhD) of traditional mental health services. We let our distressing experiences (symptoms) or our psychiatric histories define who we are, failing once again to speak the truth about the violence we experienced. 

Second, although some of us have accepted these labels and then turned them around to make them work for us politically, others do not buy into the terminology at all even though they have had the same kinds of experiences as we have – and equally valuable contributions. 

It is an ironic twist that we who have experienced the particular oppression of psychiatric labeling - and all of the doors that automatically close when someone accepts and internalizes these labels - not only corrupt the original meaning of the word “peer” with another broken identity, but then are quick to throw this corrupted label around to define yet another "in" group.  

Now who is doing the excluding? 

This is exactly what happens when we fail to speak the truth about violence – it gets re-enacted as the “victims” re-victimize themselves and/or go on to perpetrate the same kind of violence against others.   

Our boundaries have been so thoughtlessly trampled upon again and again by the very people we trusted, do we dare trust ourselves and one another without the use of a “code word” – peer – to define (limit) us??? 

In this way, the "peer/non-peer" issue becomes yet another opportunity to either re-enact the cycle of violence or to transform our past trauma by "doing it differently" - set ourselves and one another free.

Such semantic conflicts have ended up hurting (disabling) the “consumer/survivor/ex-patient (c/s/x)” movement, by co-opting us into spearheading some kind of  Psychiatric Reformation rather than keeping our original focus as a human and civil rights movement to end psychiatric violence (“treatment”). 

I belong to the Staff Survivors Network (www.staffsurvivorsnetwork.com). We are c/s/x people who work in traditional mental health services - in either peer or non-peer designated roles – to speak our truth (“until we get sick and have to quit or until we make them sick and they have to fire us” to quote Jackie McKinney).  

Having been oppressed by the effects psychiatric labeling, my “post- recovery” transformation requires me to help others who are still stuck in services (on either side of the paycheck) in addition to my social action (political transformation). I am then an “enlightened witness” raising awareness among people receiving services and speaking my truth to power – a natural role for me given my lack of social skills - I am as "reactive, confrontational, unapologetic and inconvenient" as the MPOWER T-shirt declares me to be - even inappropriate, too

My point is that there are those among us who still work in these oppressive roles in the system trying to do our part in easing the burdens of those who are still caught up in it. Some are (appropriately) not comfortable disclosing our personal experiences on the job, but might seek to have a role in a recovery learning community in off-hours....do we have room for such internal change agents without checking their R.M.P. (‘Real Mental Patient) credentials or asking them to blow their 'cover' in their day jobs?

If not, then why not? 

Our movement should not exclude c/s/x’s who work in the system nor should we insist that they “out” themselves if I they have not widely disclosed their past on the job or to supervisors.  

Although it might be a crude parallel - and I do not wish to offend anyone - I am reminded that many people worked for the resistance throughout Europe during Nazism, not just individuals of certain targeted groups.  Schindler and other righteous people were not Jewish, gay, 'mentally defectives', intellectuals, artists, activists, etc. but were 'ordinary' German or French or Italian or English citizens (at least they didn't trigger the radar of the Nazi's) who could no longer remain silent and be another complicit cog in the oppressor's machinery.  Their strategic influence depended on them NOT being on the radar!

I say that as a recovery LEARNING community, we make a decision to DO IT DIFFERENTLY. Let’s be a haven for ANYONE who feels like they are an individual - perhaps a round peg in a square hole - who can no longer participate in the cruel charade we call “treatment” (non-trauma-informed services/system) as perpetrated by a naked emperor (psychiatry).

Before we define who "we" are as a peer community of people interested in building peer-run recovery-oriented services, I suggest that we open up the tent and see/learn who comes in.  Then we can be in a better position to meet one another and learn who we are - each one of us.  

Then maybe we won't have to create another category or label that people have to fit into in order to join the discussion.  We will be able to define who "we" are and exactly what we mean when we say something like "peer-run" because we will have forged respectful and mutually responsible (trauma-informed) working relationships with one another – something that people in traditional service systems fail to take the time to do, leading to continued traumatic repetition compulsions of the cycle of violence - further disabling (silencing) clients and staff alike.  

We don’t have to be a parody of the mental health system by forcing members of our movement to adopt or to remain in oppressive little boxes (“peers, staff, clients, consumers, survivors, ex-patients, activists, service-recipients…”) which victimize one another and maintain the silence about the effects of childhood traumatic stress – growing up with neglect, physical, emotional and sexual abuse including incest; growing up in a home affected by alcoholism, “mental illness”, the loss of a parent;, someone who was incarcerated, or seeing your mother hit even just once (see www.acestudy.org for details on the effects of childhood trauma on various health indices of the U.S. adult population).

I didn't climb out of one box to be put in another one, especially one that is self-defined and self-directed.