As part of the Art in the Asylum exhibition currently underway at Lakeside, I recently attended the Ancient and Modern Mental Healthcare lecture held on 2 October 2013. Speaking at the lecture were Jules Evans with Dr Arun Chopra and Dr Ben Di Mambro. All three speakers focused on different aspects of mental healthcare treatment as depicted from Greek philosophy, films, politics and popular culture. Rather than give a summary of the evening, I would like to instead highlight the question I have been mulling over following the lecture, namely the use of peer support as a treatment for mental distress.
The ideas of peer support started off with Jules Evans giving us an overview of Cognitive Behavioral Therapy (CBT) and explained how it derives from Greek philosophy, particularly stoicism. His talk was centered on his own personal story of mental health difficulties in his early 20’s as a result of drug use and his recovery from social anxiety through the use of CBT. Interestingly, rather than the traditional CBT model of individual therapy with a mental health professional, Jules received help from a peer support group that used a computerised CBT course. There were no clinical practitioners or mental health professionals – just others who also struggled with anxiety helping each other. This raised the question for me as to whether it was the principles of CBT or the peer support that had been the most helpful in overcoming social anxiety. Furthermore, in terms of the peer support, what was it specifically that was beneficial?
The importance of peer support in a therapeutic process is not a new concept, least of all in mental health research. Many others (Lapsley et al., 2002; Corrigan and Phelan, 2004; Hogan et al., 2002; Davidson et al., 1999; Haigh, 2005; Pilgrim et al., 2009) have done an admirable job of highlighting the use and benefits of peer support. But it does raise some important questions when exploring the use of peer support as a form treatment, either on its own, or in conjunction with another form of therapy. What mechanisms are actually at work that make it ‘effective’? What happens when it goes wrong? What about the role of power, social control, peer pressure and marginalising? We (and I definitely include myself in this!) often use sweeping statements, such as relationships are central within mental health treatment. But as I unpack that I am constantly asking myself – what does that actually mean? What are we saying matters most? Contact with people? Contact with certain types of people? What types? And so on and so forth…
My point is that as a form of treatment, peer support is not a routinised model of care in the same way as CBT. Thank goodness! Yet it does mean that as a mechanism of change, it receives far less scrutiny. In addition, much of the social support research focuses on the outcomes of support and does not explore the processes at work within these interactions. For instance Corrigan and Phelan (2004:519) in their study of individuals with a diagnosis of mental illness found that whilst social support seemed to reduce distress symptoms, it is unclear ‘how social support promotes symptom remission’.
As a form of mental healthcare treatment, peer support can play a vital role in recovery. After all, the old adage carries a lot of truth: it is people who hurt us and people who heal us. Yet as Haigh (2005) notes, our question should not be so much do the relationships work and is personal change achieved, but rather what do these relationships and interactions actually mean, how are these meanings constructed and how do they play a role in transformative change. Questioning, challenging and extending our knowledge of peer support is necessary as, for many people, it forms such an important part of personal change.
Jenelle Clarke, ESRC PhD student, School of Sociology and Social Policy, firstname.lastname@example.org
Corrigan, P.W. and Phelan, S.M. (2004) Social Support and Recovery in People with Serious Mental Illnesses. Community Mental Health Journal 40(6): pp.513-523.
Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D. and Kraemer Tebes, J. (1999) Peer Support Among Individuals With Severe Mental Illness: a review of the evidence. Clinical Psychology: Science and Practice 6(2): pp.165-187.
Haigh, R. (2005) The Trouble with Modernisation: we need better relationships, not policies and procedures. Mental Health Review Journal 10(3): pp.3-7.
Lapsley, H., Nikora, L.W. and Black, R. (2002) “Kia Mauri Tau!” Narratives of Recovery from Disabling Mental Health Problems. Report of the University of Waikato Mental Health Narratives Project. Wellington: Mental Health Commission.
Pilgrim, D., Rogers, A. and Bentall, R. (2009) The Centrality of Personal Relationships in the Creation and Amelioration Mental Health Problems: the current interdisciplinary case. Health: an interdisciplinary journal for the social study of health, illness and medicine13(2): pp.235-254.