As a firm believer in peer-support, I often wonder why it is so stigmatized. It seems to be one of those things that people think can be immensely helpful for other people, but then say it’s ‘just not for me’. I think the ‘just not for me’ attitude stems from misconceptions surrounding just what peer-support is, and isn’t. But where did these misconceptions come from? Wanting to know more, I decided to look into the history of peer-support. To my surprise, it wasn’t a movement that was started in the 1960s, or even in the 1900s, at all… The earliest known examples of peer-support date back to the 1780s.
The following series of posts will summarize some of what we believe to be the most important, or simply most interesting exemplifications of peer-support over the last two and a quarter centuries.
Arguably the first use of peer-support in an institutionalized space dates back to the 1780s with the induction of Jean Baptiste Pussin as the governor (i.e. superintendent) of the Bicêtre Hospital in Paris- the very same institution in which he had once been treated. Pussin, along with a partner, Philippe Pinel, strongly believed in the benefits of hiring staff members with lived-experience, noting that they had a tendency to be “more gentle, honest, and humane”.
Appalled by the standard of care of the day, the duo formulated a series of guidelines that would later come to be known as ‘Moral Treatment’. The practice of Moral Treatment advised, amongst other things: the infrequency with which physical restraint should be used; the idea that insanity is a curable ailment; the idea that people recover best when there is structure, routine and socialization in a family-like environment; the idea that patients are normal and rational; the idea that patients respond better to reward than they do to punishment; and that the staff should consist of amiable individuals.
By the turn of the century, the movement of moral treatment had spread quickly to other countries throughout the west, and had amassed success rates of up to 91.3% in some institutions.
As the mental-health world began to integrate aspects of peer-support as we know it today, the concept was being further fleshed out in other sectors. Arguably the most interesting use of peer-support is the program surrounding Leslie Keeley’s ‘Double Chloride of Gold Cure’ for drug addiction, alcoholism, and ‘tobacco habit’. What makes the program so fascinating is the fact that in many ways, Leslie Keeley was a fraud.
While touting the efficacy of his implied active ingredient, gold (which was not actually an ingredient following a near-fatal mishap with the first iteration of the cure), the success of the ‘cure’, which some speculate contained ingredients such as: alcohol, atropine, strychnia, and apomorphine likely did actually aid in the detoxification of patients. It was, however, the social-infrastructure and peer-support that was likely the cause for sustained rehabilitation.
A stay in the Keeley Institute generally consisted of the following: Upon entering the rehabilitation center, the patient, if intoxicated during admittance, would have an attendant (usually with lived-experience) assigned specifically to them for the duration of the ‘come down’. Each patient was required at a specific location four times a day for injections of the Keeley remedy. During the rest of the day, patients were permitted to socialize as they wished, with little staff supervision.
Both during, and following treatment at the facility, an elaborate set of ‘rituals’ amongst patients and former patients helped individuals pass the time and strengthen their practice of recovery. According to Emeritus Sr. Research Consultant at Chestnut Health Systems, William White, “[while] the daily injections may have served to alleviate the discomfort of withdrawal, the elaborate rituals may also have constituted a psychological sleight-of-hand, designed to keep the addict engaged while Keeley’s other admonitions —daily rest, nutrition, mutual sharing, and alternative diversions worked to improve the patient’s physical and psychological health.”
With stronger health-related foundations firmly established, Keeley patients were also strongly encouraged to participate in the Keeley League: an institution of peer-support and shared experience for which meetings were held daily.
Upon ‘graduating’ from the rehabilitation centre, individuals were asked to deliver speeches to fellow patients and write back regularly to the institute to encourage new members. During meetings, these letters of encouragement were often read. In addition to this, club meetings often consisted of greeting new members at the local train station, and delivering religious services.
By the 1940s, a relatively new organization called Alcoholics Anonymous was integrated into the program. The institute strongly encouraged former patients to attend A.A. meetings in their own home communities to help maintain their sobriety.
The practice of peer-support was enabled by two very distinct individuals in the 18th and 19th centuries, Jean Baptiste Pussin and Leslie Keeley. While both men were likely motivated by the idea of helping the community at large deal with situations of intense mental anguish, ironically, it is the profit-driven, and somewhat morally-questionable actions of Mr. Keeley that most helped shape the peer-support landscape into an iteration remarkably similar to what it is today.