‘I Get You’
Peer counseling, as a form of care and support located within collectives and communities formed around the locus of stigmatized identities, has a long history. It is a model that resists, even challenges, the hold of “experts” over such matters, while foregrounding the needs and concerns of lives lived on the margins. Creating a ‘Peer Support Practice’ (PSP) course for queer-trans collectives and organizations was an attempt not just to support ongoing efforts within these communities, but to help these efforts grow and reach more queer-trans people.
Political foundation
While the purpose of this article is not to spell out the history of peer counseling within queer communities in India, it is worth noting that much has happened in this area over several decades – largely carried out with scant resources, and deserving of its proper place in the archives of queer activism in the country.
This piece aims briefly to discuss the process of developing a PSP course and its content, in the process challenging the clinical hold over counseling while seeking accountability from informal modes of offering support.
Even if one reason why peer counseling came about is an absence of mental health support that was affirming, the political implications of such counseling go beyond simply “filling gaps”. It is not so much individual experiences of discrimination that form the basis of peer counseling, but the shared experience of marginalization created by the predominant body-gender binary and heterosexuality.(1) Being pathologized and medicalized by the “Psy” disciplines (2) (those related to the study of mind and behavior – including psychology, psychoanalysis, psychiatry, psychiatric social work, psychiatric nursing) has meant that when both the mental health establishment and traditional kinship systems have been unaccepting or violent, peer counselors have been a precious alternative resource.
Furthermore, in creating this course, we are saying that the marginalized, in this case the historically pathologized, might take from the discipline not just skills and values, but also the subversive possibilities its knowledge and perspectives offer.
Envisioning a Peer Support Practice (PSP) course
In 2019 Sappho For Equality (SFE), a Kolkata-based organization working with LBT persons reached out to Dr K Ranade, seeking help in building peer counseling capacity. A team of four queer-/trans-identified Mental Health Practitioners (MHPs) and trainers – Dr Ranade, Shruti Chakravarty, Pooja Nair and Gauri Shringarpure – worked together to devise a PSP course for interested queer-trans community persons. Partnering with the Mariwala Health Initiative was a foregone conclusion, given their recent partnership success with the QACP (Queer Affirmative Counselling Practice) project.
With PSP, the attempt was to develop and deliver a curriculum with inputs from both, MH and the specificities of queer-trans life experiences. The four trainers each brought their political perspectives, queer-trans lived experiences, and training in therapy to the course design.
PSP brought together intention (of peer counseling as a conscious choice and not simply as a consequence of community “membership”), knowledge (with the lived experiences of queer-trans persons as its source), and skills and values (as acquired through formal systems of training in counseling).(3)
Experience as resource
Peer counseling is about lending hope and strength through empathy that comes from shared experience, and providing role-modeling and possibilities for living non-normative lives.
PSP is built on the premise that our shared experience is our resource. The “Self” is the most important “tool of the trade”. This is very different from claiming to draw the necessary know-how and credibility solely from one’s training; it is experience, rather than discipline-based expertise, as knowledge. Deconstructing discipline-based expertise may eventually lead us to recognize its embedded values and hidden agendas – its instinct to make individuals conform to normative ideas of what is normal-abnormal. For instance, queer people continuing to see ex-partners as support systems, or having close bonds with them could, within a normative framework, be seen as “enmeshment” or as difficulty in “moving on”, without perceiving how shared marginalization, as well as the scarcity of validation in other spaces, might make an ex-partner a valuable support person.
“When both the mental health establishment and traditional kinship systems have been unaccepting or violent, peer counselors have been a precious alternative resource.”
Relationship with clinical knowledge
The mainstream systems have not just pathologized queer-trans identities but have also medicalized the costs of living these stigmatized identities. Against the given backdrop of scarce MH resources and oppressive mental health systems, it is abundantly clear that there is an ever-present need for peer counseling for queer-trans persons.
The PSP course uses content from queer realities to teach the skills and values components from Psy disciplines.
Another advantage of teaching skills and values in peer work is that this acts as a moderating factor against the essentializing – the homogenizing and, thereby, the reduction, oversimplification, even distortion – of experience, which is a point of controversy in user-survivor movements across the world.
Ethics also forms a vital component of the course, allowing us to address the critical areas of boundaries and of power dynamics that exist in any relationship where one is a seeker of support that another provides. It is important to raise ethical issues, and engage in dialogue to find our way through them, because the various unique challenges faced by queer-trans persons suggest that peer counseling in these communities will endure, by default if not through training.
And finally, a note of caution
Before concluding, it is imperative to acknowledge that this form of “affective labour”(4) is a contentious issue. Besides the fear of essentialization, apprehensions have been raised regarding inclusion, citizenship, and co-option. These are valid concerns that deserve more discussion and debate.
In the shift from “movement” to “model”, we also worry that peer support/counseling should not become an auxiliary service – a route for bringing persons with MH challenges into the realm of the mainstream MH establishment. We have seen this happen in the case of western countries with peer counseling for those who were formerly institutionalized because of various psychiatric diagnoses (ibid).
How, then, will queer communities in India engage with these questions of co-option? I think about this every time a peer counselor asks, ‘How will I know when to send a community member to a trained/qualified psychologist or psychiatrist?’
In what ways can we stay in our locations and engage with MH systems on our own terms as subjects that anyway carry the weight of the history of pathologization within these disciplines? Can we keep MH support out of the hegemonic MH establishment? Even though the axes of marginalization are different, what are the lessons we can learn from critical disability studies and mad studies in their journeys of challenging the ‘Psy-complex’?(5) Peer counseling carries the risk of becoming a project involved in the “governance of ‘similar others’”.(6) How, finally, do we continue to preserve and promote the subversive potential of peer counseling in queer-trans communities?
I believe these questions may, again, best be answered by the communities in question that routinely experience erasure, discrimination, and more overt forms of violence.
To me, the theme of ‘Beyond the Clinic’ speaks not just about loosening the grip of social institutions over lives, but simultaneously reimagining spaces as those where possibilities for healing exist in plenty. As peer support in the queer-trans communities has repeatedly shown, healing and growth is not the monopoly of Psy disciplines; it never was.
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References
[1] Ranade, K. (2019, Feb-March). Peer support practice: Some introductory ideas. [Paper presentation]. Peer Support Practice Course, Mumbai.
[2] Ranade, K. (2019, Feb-March). History of medicalisation of sexuality and gender. [Paper presentation]. Certificate Course in Queer Affirmative Counseling Practice, Mumbai.
[3] Chakravarty, S. (2019, Feb-March). Model of peer support. [Paper presentation]. Peer Support Practice Course, Mumbai.
[4] Voronka, J. (2017). Turning mad knowledge into affective labor: The case of the peer support worker. American Quarterly 69(2), 333-338. doi:10.1353/ aq.2017.0029
[5] Rimke H. (2018). Sickening institutions: A feminist sociological analysis and critique of religion, medicine, and psychiatry. In J. Kilty & E. Dej (Eds.), Containing Madness. Palgrave Macmillan, Cham.
[6] Voronka, J. (2015). Troubling inclusion: The politics of peer work and ‘people with lived experience’ in mental health interventions. (PhD. Thesis). University of Toronto.