- Turning Mad Knowledge into Affective Labor:The Case of the Peer Support Worker
As advancements are made through processes of social inclusion, disability justice frameworks have emerged to query the limits of rights-based and incorporation strategies by revealing how such practices sustain systems of oppression.1 Indeed, disability justice has shown how inclusion models position "exclusion" as the problem in need of redress, leaving larger structural issues of inequity unchallenged. Positioned within the larger field of critical disability studies, mad studies scholars and activists are beginning to reevaluate the consequences of what it means to participate in regimes of power, as we now must deal with what results from being included and recognized by the political apparatuses and technologies that not only manage disability but also produce and sustain it.2 Here I show how the inclusion of peer support workers within dominant mental health service systems is an emerging form of affective labor, which can help orient service users toward feelings and emotions that actually cooperate with psy regimes of governance.
Affect theory that engages "negative states" of being, when put in conversation with mad studies, holds potential to think in new ways about how distress is produced, intervened on, and made sense of. While current scholarship attends to the relations between emotion, affect, feelings and thus both the politics of affect and madness, Lisa Blackman's work in particular holds promise for mad theorists and activists, as it unfolds through a serious engagement with the Hearing Voices Network.3 Critical of psycho-social-biological approaches to voice hearing, which reify "a normative conception of the singularly bounded psychological subject as a focus," Blackman's work asks for "ways of theorizing subjectivity and mind-matter relations that exceed such a normative and individualized conception of personhood."4 Affect theory that moves madness beyond individually confined deficit models thus offers new promises for mad futurities. [End Page 333]
Currently, principles including patient-centered care, cultural competency and diversity models, community engagement and consultation, and service user involvement are reorganizing the ways in which health and social service care are delivered. In mental health service deliveries, incorporating "people with lived experience" as workers within the systems that affect us has become accepted as a "best practice." In the last two decades, Western countries (especially Canada, the United States, the UK, Australia, and New Zealand) have prioritized and mandated such inclusionary practices in mental health and social care policy.5 Informed by community-based participatory research and practice, the formalization of specific roles in research and services for people with lived experience of distress is called "peer work." The peer worker has thus become a key paraprofessional figure in the assemblage of professionals within health and social care interventions.6
Efforts to include service users as peer workers in mental health research, evaluation, and service provision is ever increasing.7 As care models move toward the more "progressive" (and cost-efficient) practices of harm reduction, recovery, and resilience models, peer workers as "experts by experience" are understood to be uniquely positioned to provide such services and support.8 In this way, madness as an experience and mad as a marginal identity has suddenly become harnessed as a commodity for exchange in neoliberal care and service markets.
By far the most recognized, formalized, and professionalized type of this peer labor is peer support work. Peer support workers are hired to use their own experiences of distress, difference, and/or contact with the mental health system to work relationally with and on service users in a variety of settings. Peer support rests on the premise that we use our experiences to connect and relate with service users in ways that other professionals cannot. The roots of current recovery models emerged in the 1980s with the recovery movement, which together with consumer/survivor/ex-patient and mad activism demanded a radical reconfiguration of biomedical approaches to madness confined under the domain of the psy disciplines. With the recovery movement, informal peer support as mutual aid emerged as a way to offer advocacy and support outside the remit of medical authority.
However, the meaning and practice of recovery and peer support are...