Problem with the DSM: It highlights or exaggerates differences between the diagnosed and the undiagnosed A possible alternative to the DSM would be a system that simply defined when normal human problems become severe enough to justify formal treatment. The problems in this case would not be defined as categorically different.

What research says teaching the biological model does to perceived stigma around mental illness: Mental health workers who believe it think less of consumers Consumers feel more helpless The general public sees consumers as more unpredictable and dangerous

More problems with the DSM: It fails to tell us anything unique about cause, or about what will be an effective treatment. It gives people the illusion they know what is causing the problems. (It’s the bipolar disorder, or the intermittent explosive disorder, that caused your troubles!) It makes people imagine that they know the outcome, frequently leading to negative expectations.

Contrasting the Peer Perspective with the Traditional Mental Health Approach

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Psychiatrist Mark Ragins MD summed up the traditional beliefs about serious mental illness in which he was trained as follows: “People with chronic mental illness are permanently disabled. Medicate them and forget them. They are weak and need to be taken care of. They can’t hold down jobs. They have no significant role to play in society. The possibility of them having a meaningful life is slight. Their prognosis is essentially hopeless.”

Peer Approach: You can recover, just like I did, or am. Traditional Approach: You have a neurobiological disease. We don’t have any model for how you could possibly recover from it.

Peer Approach: Normalizes symptoms, sees “symptoms” as understandable reactions to life events. Traditional Approach: “Abnormalizes” people, frames symptoms as part of brain disease rather than being understandable.

Peer Approach: Is person centered. “Diseases don’t recover, people do.” - Pat Deegan, psychiatric survivor. Traditional Approach: Is disease centered. “We have here a case of schizophrenia.”

Peer Approach: Life story, including experience of trauma, is seen as key to understanding people. Traditional Approach: Trauma, and life story in general, is seen as irrelevant to major mental illness.

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Peer Approach: Interventions should address a person’s needs, usually as defined by that person. Housing & jobs for example may be a priority. Traditional Approach: Interventions should be aimed at the illness.

Peer Approach: People who are being helped by peers can also use those peers as a role model. Traditional Approach: Consumers are expected to learn their role as consumers, rather than to model themselves after the “experts” who help them.

Peer Approach: Self disclosure, of both personal problems and of recovery stories, is considered fundamental. Traditional Approach: Don’t do self disclosure: it is inconsistent with the role as “expert.”

Peer Approach: Focuses on alliance, not compliance. Much more “trauma informed,” better trust, non- hierarchical. Traditional Approach: “Experts know best” so treatment should be forced if people don’t accept it.

Peer Approach: Boundaries only when/as really necessary to prevent exploitation of those being helped (or if needed to prevent exploitation of the helper.) Traditional Approach: Really into “boundaries” even when they get in the way of authentic human connection. More boundaries = more professional!

Peer Approach: Technical language which highlights differences is avoided: common humanity is highlighted instead. Traditional Approach: Lots of medical or technical language so you can tell how expert the “expert” is.

Peer Approach: Formal education is seen as frequently interfering with connecting one on one with another human being. Traditional Approach: Higher education is required, all the better to identify who is hopeless and “non- understandable.”

Peer Approach: Unusual experiences or beliefs are seen as offering some mix of value and trouble. Willing to discuss this with a person. Traditional Approach: Unusual experiences or beliefs are typically seen as purely pathological: increase the medication!

Peer Approach: Peer experiences are expected to be at least somewhat mutual, even when one peer may be doing better and is officially the “helper.” Traditional Approach: Roles are clearly defined: everyone knows who is the “expert” helper & who has nothing to offer and will just be the “patient.”

Peer Approach: Is organized around “how is your life?” Traditional Approach: Is organized around, “how are your symptoms?”

Peer Approach: Peer support for mental health consumers is on a continuum with the natural human support required by all community members. Traditional Approach: Support for Mental health consumers is very different from that provided for community members in general.

As we get better in helping people recover, mental disorders will just be seen as temporary states that we can all help each other through and learn something from, rather than as something that replaces the identity of certain people.