PEER SUPPORT SPECIALISTS, DEMORALIZATION & HEALTHY SUFFERING

Illness is common. About 60 percent of adults have at least one chronic illness. Mental illness is also common, affecting about 25 percent of adults in any given year. As Dr. Jerome Frank notes in his landmark book Persuasion and Healing (1993), the key challenge to having a chronic illness is not the illness itself but the demoralization that commonly accompanies illness and undermines the person and their ability to cope.

Demoralization is rooted in several causes, including (1) feelings of loss of control; (2) feeling bewildered and confused by what is happening and what will happen; (3) feeling loss of courage in the face of a health issue; and (4) feeling overwhelmed by loss. These are common feelings that can accompany any chronic illness and mental illness.

Effective Peer Support Specialists are perfectly positioned to help reduce demoralization in several key ways:

1.      They serve as a concrete model of someone who has experienced what the client is experiencing and who is not demoralized.

2.      They educate clients and family members about what they are experiencing, including illness, treatment, and recovery. They normalize these experiences and embody the image of someone who has successfully responded to them.

3.      They reduce feelings of being overwhelmed or confused. They do this by listening to the client and explaining any confusing aspect of their experience from the perspective of another client. Peers provide a story about illness and recovery that reduces confusion and feelings of being overwhelmed.

4.      They model courage in the face of illness.

PEER SUPPORT SPECIALISTS MODEL A HEALTHY STANCE TOWARD SUFFERING

There is a related foundational issue that underlies illness and recovery, whether that illness is mental or medical. Suffering is part of life, and this is something that people are understandably ambivalent about. Illness may involve various forms of suffering, including physical/emotional pain, other physical/psychological symptoms, anxiety about future illness, lost functioning (e.g., lost days at work), failures caused by the illness, remorse and regret about ways we may have contributed to the illness, and subsequent unmet needs and desires.

Suffering is universal, and various forms of suffering are common for most people. We typically try to avoid suffering, and those efforts often create more problems for us. Some of the more subtle ways we do this include

1.      Denying that we are suffering.

2.      Avoiding thinking about the suffering.

3.      Avoiding talking about the experience.

4.      Distorting how we talk or think about the experience of suffering.

5.      Avoiding experiences and activities that could lead to suffering. (Because suffering is part of life, we may tend

to avoid almost any life activity, but this form of avoidance often focuses on forming relationships, taking risks,

and pursuing goals.)

 When we try to avoid suffering, we are often not being open with ourselves or others. This leads us to create forms of distance from others—we avoid talking about suffering with others, and so there is a barrier in our communication. By not talking about our suffering, though, we don’t openly process the experience, and so we lose a chance to fully learn from it. By hiding our experience, we hide part of who we are from ourselves and others. All of these steps can lead to a sense of shame and isolation, which then adds to our suffering.

A healthier stance is to accept that suffering is part of living and to accept our own suffering and learn from it.

Again, Peer Support Specialists do this in a variety of ways, including

1.      Openly acknowledging the experience to ourselves and others.

2.      Allowing ourselves to think about our experience of suffering without distortion.

3.      Building our tolerance for experiencing suffering, allowing us to accept it when we need to or choose to. Better tolerance for suffering actually improves our ability to take thoughtful steps to reduce it. Feeling more tolerant, we can lean into necessary challenges and experiences that might include a risk of suffering.

4.      Avoiding experiences and activities that could lead to needless suffering. Because suffering is accepted as part of life, we know that we can’t avoid it, and in some situations, we should not avoid it. We accept that some activities come with a risk of suffering, and we choose to participate in them knowing that there is a risk and knowing that we can tolerate the resulting suffering.

REFERENCES

Frank, J. D. & Frank, J. B. (1993). Persuasion and healing: A comparative study of psychotherapy. JHU Press.