Emmy Noether Group - Situated Care: Subjectivity, Knowledge, and Labor
Situated Care: Subjectivity, Knowledge, and Labor
How does the valuation of lived experience as a form of expertise in psychiatric care challenge hegemonic discourses around subjectivity, knowledge production, and forms of work? How does the formation of a new kind of care worker shape concerns regarding the burden of global mental health and the labor conditions of the advanced liberal state? To address these questions, the DFG Emmy Noether Research Group, Situated Care: Subjectivity, Knowledge, and Labor, led by Dr. Lauren Cubellis, seeks to reposition anthropological understandings of the relationship between the psyche and society, the contingency of knowledge production, and work and the self in innovative spaces of mental health care. The research group focuses on the training and employment of peer support workers (PSWs) across the German-speaking countries. PSWs are individuals with lived experiences as mental health service users who have been trained to offer support to others experiencing psychiatric crises. The training and employment of PSWs offer a critical site at which to examine the effects of collective mobilisation around previously marginalised identity categories, the changing terms of psychiatric care in the face of an increasing mental health burden and the financial limits of the welfare state, and the reconfiguration of psychiatric crisis from a pathologised illness and disability category to one at the fore of utopian and recovery-oriented mental health movements. The research group will advance disciplinary discussions of subjectivities in formation, the terms of situated and local knowledge production, and the intersection of disability and labor as evolving forms of social participation, care, and control.
Peer support in the German-speaking countries
The role of PSWs is an increasingly important one in public mental health in Europe and the United States, as well as in sites across the Global South (WHO 2013). The international literature on peer support work has shown that in both giving and receiving support from others, a new sense of self can develop, and individuals are able to move out of the “devalued and oppressed mental patient role” and find a meaningful and worthwhile way to assume control over their own lives (Adame and Leitner 2008: 148). Peer relationships can help mediate feelings of stigma on both personal and systemic levels, for both service users and peer support workers themselves (Verhaeghe et al. 2008). At the same time, scholarly discussions of peer support highlight the ways poorly defined job structures and a lack of support from non-peer colleagues can undermine integration, as can the confusion between clinical and co-worker roles. Institutional challenges, like confidentiality in disclosing peer identities, access to client records and information, inequalities in pay, inadequate or unrecognised training, and poorly defined tasks all contribute to the actual everyday experience of peer support work being far more complicated than the ideal presentation of mutual presence and resonant experience (Jacobson et al. 2012). With the increase in attention from traditional psychiatric institutions, peer support has been recognised as a potential complement to treatment-as-usual but has simultaneously surfaced new questions about the role, responsibilities, and repercussions of having lived experience positioned as a form of professional expertise (Vandewalle et al. 2016).
The research group examines the frictions this mutual aid movement encounters as it transforms to meet the demands of professional development. There is a fundamental tension between the political orientations of the original peer support movement and its anti-psychiatry commitments and the professionalisation of the PSW role. Thus, the practical integration of PSWs into mental health programs encounters numerous conflicts around imagined capacities, expectations, and responsibilities that must be negotiated in everyday encounters (Schmid 2019). This tension is being worked out in the minor gestures (Manning 2016) and micro-exchanges of everyday life. Whether PSWs become more like their clinical colleagues, or whether clinical colleagues slowly change because of working with a PSW, there are subtle shifts at stake in the professionalisation of this movement as these and other outcomes remain uncertain. The history of abuse and discrimination in the psychiatric system infuses at all levels the negotiation of power in these spaces, with PSWs expected to simultaneously embody a gesture of accountability for past abuses and usher in a new form of psychiatric care. In order to account for this variability, the research group asks (1): how does the history of psychiatry across the German-speaking countries shape perceptions of mental health and political subjectivities in the present?
Situated knowledges
A critical focus of this project is on the development, recognition, and deployment of alternative forms of knowledge and knowledge production. Training to be a peer support worker involves a fundamental reconceptualisation of the trauma and stigmatisation one has previously experienced as a psychiatric service user and newly positions that experience as a valuable counter-knowledge to the structures of mental health and illness as imagined and enacted by traditional psychiatric approaches. Critical to Situated Care will be an exploration of self-reflexive apprenticeship work that is necessary to transform difficult lived experience into a professional skillset. The examination of this unique ‘ecology of expertise’ will consider how the experience of PSWs is converted into knowledge in social contexts (Beck 2015; Ong 2005). To do this, the emergence and particular deployment of peer support knowledge must be considered as a situated one: it is bound to the particularities of one’s lived experience, which must subsequently be engaged in relationship to others, and it is fundamentally political in its attachments and challenges to established forms of knowing (Haraway 1998; Martin et al. 2015).
Thinking in terms of situated knowledges allows for a consideration of the political ecologies in which peer support work resides and takes shape, and the ways it positions it’s own form of knowledge as counter to that of traditional psychiatric science and practice. These configurations of knowledge are partial (Strathern 1998); they braid together divergent dimensions of psychic experience without reducing their complexity. Contrary to psychiatric knowledge as produced in traditional frameworks, which tends to be linear, diagnostic, and strive towards a biomedical universality (Freis 2019; Rose 2019), knowledge as produced in peer support relationships attends directly to the impacts of such partial connection. This offers an important inroad for examining the relationship between scientific knowledge production and society (Beck and Niewoehner 2006; Mol 2008). As science is currently beset on all sides by doubt, contestation, and criticism, this research into the production of an alternative way of knowing, and the way it confronts an established authoritative order from a knotty insider/outsider position, will generate new frameworks for understanding how scientific knowledge is made, disseminated, and consumed by the broader publics to which it tries to speak (Klausner et al. 2015; Stengers 2018). To this end the research group asks (2): How does the process of training as a PSW function as a mode of collective and situated knowledge production?
Disability, work, and liberalism.
The relationship between disability and work has been a focus of political, economic, and research institutions for decades, as disability is often measured in relation to its impact on work, and chronic disability is understood to have a negative impact on the welfare state and its resources (Boardman 2003). Despite broad acknowledgment of disability categories and attempts to address their long-term impacts, the majority of social services are geared towards getting people back to work (Barnes 2000; Morrow et al. 2009). The training and employment of peer support workers is a compelling intersection at which to consider these dynamics: as individuals who have experienced mental health crises in the past, many PSWs have previously struggled to find employment (Bennetts et al. 2013). The creation of the PSW role takes that experience of struggle, which was previously coded as limiting or stigmatising, and recasts it as a unique professional tool (Cubellis 2018). This marks an important moment of recognition and incorporation by state and local institutions, as well as a critical existential shift for many PSWs (Bailie et al. 2015; Vandewalle et al. 2018).
Under these conditions PSWs must hold a slippery dual identity: one in which their former “disability” status simultaneously allows them membership in the working class and that membership continues to hinge on their history of mental health struggles being available as a form of expertise (Voronka 2019). This delicate tension means that the evolution of PSW roles, and the varied expectations that PSWs encounter in everyday practice, has profound consequences for self-narratives and identity, and personal and professional relationships.
Moreover, the incorporation of PSW roles surfaces a fundamental ambiguity in the professional valuation of lived experience: to what extent do peer support movements remain counter-hegemonic, advocating for new forms of care and knowledge production, and when do they become a new means for getting people who have labeled chronically disabled back to work? When work in the late liberal state both affords a sense of social belonging and maintains the mechanisms of production that mark deserving citizens, there is a risk of cooptation, a tension between the creativity of the PSW role and the terms under which it can be enacted (Mitchell 2015). This research group will examine under what conditions peer support work remains a new form of social inclusion, what happens when new forms of knowledge/power manifest at these institutional intersections, and how disability, reframed as a professional skillset, is also stemming shortages in care in the contemporary welfare state. To this end, the research group asks (3): How is the relationship between disability and work challenged by the incorporation of peer support workers in the late liberal state?