Historical Roots of Peer Practitioners

consumer/survivor/ex-patient history peer support Apr 08, 2013

Today, many people with the lived experience of recovery, are working in paid positions in traditional behavioral health settings. We work as paid peer specialists or peer practitioners on ACT teams, supported employment programs, case management programs, peer bridger programs, inpatient hospitals, etc. However, we are not the first to do so.  

Most of you are probably familiar with this painting by Robert Fleury (1795) titled "Pinel Frees the Madwomen at the Salpetrière". It depicts the famous Dr. Philippe Pinel ordering the removal of chains from patients at the Paris Asylum for insane women.  Pinel is known as the "father of modern psychiatry" and a champion of a more humane approach to the treatment of people in asylums.  However, he was not the first to remove chains or champion moral treatment. It was actually an ex-patient who pioneered the new approach.

According to historian Dora B. Weiner, Pinel was tutored in the techniques of traitement moral by Jean-Baptiste Pussin. Pussin had been an inmate/patient at the Bicêtre Hospital for years prior to working there. Eventually he was cured of scrofula but rather than leaving the hospital, he began working there, eventually becoming superintendent of the ward for the "incurably insane".  Pussin and his wife Marguerite pioneered new approaches that included forbidding cruelty, promoting kindness and emphasizing the importance of work. Here are some of the lessons he taught the famous Pinel:

"I held to the principle that in no case would I permit the insane to be beaten...The attendants tried to rebel against me...But, despite their clamors, I persisted in my resolve and, to reach my goal, I was forced to dismiss almost all of them in turn when they disobeyed."

"Work, among other things, seems to me almost necessary, not only because it provides for exercise but also because it offers distraction.  Work, in fact, belongs to the category of psychological remedies on which I especially insist."

"My experience as shown, and shows daily, that to further the cure of these unfortunates one must treat them with as much kindness as possible, dominate them without mistreatment, gain their confidence, fight the cause of their illness and make them envision a happier future."

Pussin also had success removing cruel iron shackles from the people under his care. However, at times he replaced shackles with straitjackets, "that permit freedom of movement and the enjoyment of all possible liberty without any added danger."

After 28 years as superintendent at the Bicêtre Hospital, Pussin and his wife transferred to the Salpetrière to assist Pinel in transforming that institution to more humane methods.

So we are not the first to make our recovery and return to work in the very hospitals and clinics where we once were patients.  Like Pussin, we work with a mission to transform services to be kinder and more recovery oriented.  We don't always encounter colleagues who are as open minded and willing to learn from us, as was Pinel.  Peer support has the power to transform mental health but change can be slow.  Looking across the long arc of history, it's good to know we are not the first generation of peer practitioners.  We stand on the shoulders of giants like Pussin.