Peer Support and the Complexity of Mental Health

April 06, 2020 by Independent Lens in Beyond the Films

By Lennlee Keep

The film Bedlam explores mental illness from the perspectives of physicians, politicians, parents, and patients themselves. The power of documentary film is that it generates conversations about more than what is on the screen. After I watched Bedlam the first time, I wanted to watch it again with my friend “Pete.” [We changed his name for privacy protection.] He’s a filmmaker and writer, and has been diagnosed with a mental illness.

There is a very thin line between the personal and the political when you are talking about mental health. And I learned quickly that some words and phrases that are commonly used to describe mental health issues are not only incorrect but in some situations even weaponized.

“The idea of mental illness has been highly politicized,” Pete told me. “For example, it was used against dissidents during the birth of communism in Soviet Russia. Soviets made up the diagnoses of ‘slow schizophrenia’, which meant that a person was schizophrenic but just hadn’t shown all of the symptoms yet.  Communists would use this ‘mental illness’ to put dissidents into asylums, The prevailing theory was that anyone who wasn’t on board with Communism must have a mental problem. I mean, you’d have to be crazy to not want to be a Communist, right?”

“So calling someone ‘mentally ill’ wasn’t just a way to describe them or their behavior, it was a weapon. That is a stark example, but overall, the idea of ‘mental illness’ is erroneous and not innocuous.”

Mentally ill patients with staff at St. Elizabeth Hospital, Washington, DC, ca 1910
Mentally ill patients with staff at St. Elizabeth Hospital, Washington, DC, ca 1910

In addition to Pete’s other work, he is also a Peer Support Specialist

To be a peer support specialist, you have to have diagnosed mental health issues. Then you receive training to learn how to use your experience to assist others. As a result, Pete works with people to help define what their goals are, and build skills that will help them live the life they want, rather than focusing on changing behaviors. 

Whatever their goal, he helps them create a plan which can include anything from medication to therapy to nutrition or meditation; it all depends on what they want. This model focuses more on quality of life, and also reinforces the very basic and human idea that people, regardless of their diagnosis have agency and control of their own lives.

Early in Bedlam, we meet Johanna, a girl in her 20’s. She’s handcuffed to a chair in a psychiatric ward. She’s talking very quickly, and she’s not making a lot of sense to the people around her. She seems agitated and upset, or that’s how I view it. Pete views this scene differently because he has been in Johanna’s shoes. 

“I don’t know if this is what she’s experiencing, but I have had that feeling before, an intense speed of thought,” Pete told me. “In and of itself, it’s not really a bad thing. It only becomes an issue when other people can’t effectively communicate with you. That’s when you end up where Johanna is.”

Johanna from Bedlam, with a butterfly on her shoulder
Johanna from Bedlam

We then see that the doctors are going to give Johanna medication. Pete says, “Here is one thing that can really help both patients” — he doesn’t like that word either, but we have agreed to use it here for lack of a better one — “and the people who care about them. Personally, I have an advanced directive for my mental health care. When you are in an ER for psychiatric reasons, doctors and nurses are going to take action and the first is usually medication and then it might be restraint or isolation or any other number of things.” “I encourage the people I work with to have an advance directive.”

“So when I am having speed of thought,” he continues, “I might be unable to articulate or remember that maybe a certain medication causes me to react badly, or that being restrained will cause me intense panic and make the situation worse. I encourage the people I work with to have an advance directive.”

“There is a more thorough plan called a WRAP or the Wellness Recovery Action Plan, a personalized wellness and recovery system born out of and rooted in the principle of self-determination.  WRAP® is a wellness and recovery approach that helps people realize their own patterns and articulate what they would want in case of a mental health emergency. They can share this plan with friends and loved ones before.  

“For example, I have a friend that if he suddenly starts sleeping only a few hours a night, he knows that might be a sign that something is up. Now it could be that he’s bothered by something at work, or it might also be that his medication needs adjusting. But because of his plan, his wife knows that it’s worth mentioning. It doesn’t mean she rushes him to the doctor or calls 911; it just means that something might be up, and it’s worth talking about to possibly avoid a larger problem.”  

patient in medical gown with handcuffs

So what is Pete’s diagnosis? 

“Labels are really just fishing in the dark,” Pete says. “I know from my own experience that when doctors spend time trying to assign names to and treat behaviors it complicates everything and it sometimes pathologizes behaviors that may just be who the person is. But mental health is complicated. Most psychiatrists I know are really good people, they really want to help. They are in this for all the right reasons. I use medication, and, for the most part, it does make my life a little bit better. 

“But in general, following only a medication model will not only fail many people, but the wrong medications can also make a person’s life much much worse.”  

NOTE: **Pete and I have spent many hours digging deeper into other terminology that isn’t entirely correct. Ultimately, we agreed that, for the purposes of this article, I would use the term mental health. We only settled on phrasing because we lack the language to come up with a more suitable term. He spends a lot of time learning about and thinking about these issues, and I could spend years writing a thesis on it. We realized that I couldn’t fit all of his knowledge about this into this piece, but if you want to know more, he said to “start with reading Foucault.” [Further reading:  Mental Illness and Psychology; Madness and Civilization


Extra scene from Bedlam in which Richard Friedman, MD, director of psychopharmacology, Weill Cornell Medical Center, talks about the failings of drug treatment in our society, including how most studies are funded by pharmaceutical companies.

Lennlee Keep is a nonfiction writer, filmmaker, storyteller and reticent D&D player. Her writing has appeared in The Rumpus, The Southeast Review, and ESME (and here, including this piece). Her films have been shown on PBS, A&E and the BBC. The ex-wife of a dead guy, she talks about death more than most people are comfortable with. She is working on a memoir about addiction, grief and a literally broken heart. She lives in Austin, Texas with her son and their guinea pig, Chuck Norris. She is much funnier than all of this might lead you to believe.

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