In the beginning, light was divided from darkness; day from night. How about… clinician from patient? This model formed in 19th-century medicine(1), and quickly extended into the newly germinating psychology. At first, psychological treatments were only for those in the worst circumstances (in hospitals). But starting with Charcot, and then exploding onto the stage with Freud, everything changed. Psychiatry – and, diagnosis – became something for anyone. Perhaps: everyone.
Lines blurred, and, in counterpoint, solidified. As more challenges became psychiatric, more people were designated as “ill.” Recent rates suggest 23.1% of people in the United States meet criteria for one or more diagnoses in a given year(2). Next came expanded duration. Diagnoses became recurring and lifelong, rather than faced and overcome(3).
Psychiatric diagnosis is individualistic: a diagnosis is assigned to one person, and one person alone. Therefore, if a diagnosis is lifelong, it seems characteristic of the person. Like the illness identifies me.
We all have times when we question the vibes we feel from someone. If this becomes a go-to style, we might get called paranoid. If diagnosed, we might be labeled with paranoid
personality disorder, which is seen as stable and lifelong. Identity labels kick in. Someone regularly responding out of misplaced fear becomes “a paranoid.” People may even say it about themselves, especially with the backing of diagnosis. No one calls themselves a “cold-etic” because of getting a few colds a year. Nor a “diabetic” after binging on Thanksgiving; but people do, when that diagnosis comes from a physician.
Meanwhile, many people being diagnosed were not used to being labeled or told how to live their lives. People recognized that the identity of “mental illness” made a power differential that removed some of their self-determination. This led to the Recovery Movement(4).
What does this have to do with whether I am a Peer or not? To answer, we need to define Peer. The Peer model started in the substance-use world. Peers were people who have been through it and offer perspective on their recovery. The Recovery Movement, however, created a different form of Peer: attuned to power dynamics.
We have arrived at the fork in the road. Is being a Peer just about the skills of sharing mental health experiences, or is it also about dealing with psychiatric systems of power? For some, it remains the former: e.g., I’ve been in a similar place, too. Here are mistakes I’ve made. Here’s what helped me to understand it didn’t have to be like that. True, these are words you might hear from any Peer Specialist. But from some, you’ll also hear: I’m concerned about my medication, too. And, getting hospitalized was the worst experience of my life. And, it took two painful years before any therapist finally got what I was going through.
Trauma may be part of how we define Peer. People who receive mental health diagnoses are more likely to have experienced one, multiple, or chronic traumas(5). But traumas are not just initial triggers. For some, the experiences that get triggered, such as hearing voices, dissociating, or having panic attacks, can be similarly destabilizing. And for some, interactions with mental health systems can be destabilizing. Such as, having an expert tell you your life isn’t what you understood it to be. Or taking a medicine that makes you feel different . Or, pretty much everything connected with getting hospitalized.
I’ve had diagnosable lived experiences. I’ve experienced chronic bullying, and changes in beliefs about myself and behaviors that went with that. I’ve experienced sudden, identity-altering loss.
I’ve gone through periods of depression that included suicidal thoughts. I’ve fought through social fears. I could have met with a mental health clinician and been given a diagnosis and treatment. But that’s not what happened. I had non-clinical support: family and friends who helped me to see myself more fully. I had education: training in neuroscience and psychology, that I used to put myself in context. I avoided mental health system stigmas.
I have not gone through the power imbalance or trauma of dealing with the mental health system. I have witnessed it through people I care about. Even for the many who have been supported by the system to find recovery and meaning, there is still the othering of diagnosis. For better and worse, I have evaded these issues. My experiences are similar in some ways, but categorically different in others.
So: am I a Peer? What’s your take?
What I do know is that the distinction we have come to make in the mental health world between “healthy” and “ill” is not real. These fake lines create a real power imbalance. Instead, when in spaces meant to foster well-being, we need to find a way to interact as equal partners.
1. Foucault, M. (1963). The Birth of the Clinic: An archaeology of medical perception.
Vintage Books: New York.
2. https://www.nimh.nih.gov/health/statistics/mental-illness, accessed 2/20/25
3. von Peter, S. (2013). “Chronic” Identities in Mental Illness , Anthropology and Medicine ,
20 , 48-58.
4. https://www.madinamerica.com/2012/08/the-history-and-future-of-our-psychiatric-
survivor-movement/, accessed 2/20/25
5. Houston, Shevlin, Adamson, & Murphy (2011). A Person-centered approach to modelling
population experiences of trauma and mental illness, Social Psychiatry and Psychiatric
Epidemiology , 46 , 149-157.
The NYS TINRC Newsletter is produced by CCSI. The views, opinions, and content expressed in this article do not necessarily reflect the views, opinions, or policies of the New York State Office of Mental Health (NYS OMH).
