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Volume 51 Number 2
The Changing Shape of Self-help/Mutual Aid
Written by Tehseen Noorani
The key concepts our interest group revolves around - for instance, 'self-help', 'mutual support' and 'peer-assisted' - can be understood in broad-brush terms. In doing so, the phenomena they refer to might be said to appear everywhere - in the workplace, social gatherings, big institutions, community spaces, on the internet, or at home. This raises a challenge for those of us interested in studying and/or promoting self-help and mutual support (SHMS) practices: how can we draw boundaries that allow us to distinguish where it is from where it is not? If we cannot any longer, perhaps the distinctive study of SHMA risks fading into a sort of generalized irrelevance.
In her acceptance speech for the Association for Research on Nonprofit Organizations and Voluntary Action (ARNOVA) award for Distinguished Achievement and Leadership in Nonprofit and Voluntary Action Research in November 2016, Professor Thomasina Borkman explained that the study of self-help and mutual aid originally focused upon clearly-bounded in-person meetings centered around the technology of a sharing circle that endures over time, building up a collective 'experiential knowledge'. The study of such groups sought to highlight the problem-solving capacities they cultivate and apply. Borkman's early research (1976; 1999) has been seminal in the sociological and psychological research into SHMS groups. However today it could be argued that these social formations are giving way to activities of listening, sharing and problem-solving that are more ephemeral, online, contested and unreciprocated, communicated through open networks that have come a long way from the notion of pre-digital bounded sharing circles.
At the same time (and arguably part of the same larger story), the health and social care sectors have been reconfiguring themselves around experiential knowledge since at least the 1980s. Today it is rare to find a hospital or a service provider that does not seek to represent users, clients and patients in some form. This may be couched in a more consumerist discourse of seeking feedback in order to provide the best 'customer service', or a more democratic or social justice discourse of 'giving voice' and promoting patient-driven research and service provision. Also, in many political contexts (for example, more evident in the UK and Germany than the US), there have been attempts to incorporate users, clients and patients into government and governance structures, with the goals in mind of feeding back and - or so the rhetoric goes, at least - 'driving' both government policy and legislative change in modern democratic societies.
In all these cases, the co-optation of existing SHMS groups into private, public or third sector institutions, or the development of new groups within existing institutions, often leads to different kinds of social formations than those which have been studied under the phenomenon Borkman has helped to define. These newer groups tend to be led by professionals. Group processes and ground rules are more likely to be applied from the outside rather than to emerge organically as part of the group's self-experimentation. One consequence is that communication between group members tends to echo official discourses, frameworks and claims, less generative of new or alternative ways of seeing, experiencing and understanding.
All of this is of course important to document. For instance, we might trace the changing (in)capacity of groups brought into institutional structures to invent, resist and contest bureaucratized procedures, rules and norms. Alternatively, in following the language of 'self-help', 'mutual support' and 'peer', we can end up connecting important dots, for instance in highlighting hitherto hidden histories, as Deidra Somerville showed us in the last issue. However, following the language can also take us far from the qualities we value within SHMA groups. The label 'peer' is increasingly applied to paid and professional roles where those with experiential knowledge of a problem work on behalf of larger organizations and institutions to provide client services. In our interest group's Fall phone call last year, we shared examples from Canada of how 'peer support' is being replaced by 'lived experience' in order to allow those with no relationship to service users to be hired as support workers, while in Los Angeles, 'peer' is being used to designate those who are of the same ethnic group as clients. In both these examples the underlying conception of 'community' undergirding the peer role gets reconfigured.
Meanwhile, the term 'self-help' is applicable in a far wider range of practices than that of the sharing circle alone, such as in books written by self-help gurus and treatment programs and online courses with predetermined content. Academic literature searches on "self-help" bring up more references to self-help manuals and programs than to groups, yet none of this embodies the ethos of mutual assistance and collective problem-solving found within SHMA groups. One response is to wrestle the meaning of these terms back from how they have been taken up in these disparate practices, but arguably the horse has already bolted.
Another tack for SHMA researchers is to look for the qualities one finds in SHMA groups, if not exactly the same group formats. During an interview for my PhD research, the Hearing Voices Network1 group facilitator Don Swift described the 'co-emergence of truth and trust' as a precious and powerful healing force in group meetings. In the contemporary moment, as scientific knowledge is increasingly met with skepticism, generalized concerns about living in 'post-truth' societies have arisen alongside new populisms that reject scientific truth-claims. In this context, knowing who and/or what to trust may be becoming more important. SHMA groups are protected spaces and as such make it possible to discuss experiences in vulnerable ways. Members build relations of intimacy and trust around problems that cannot be shared with outsiders without a degree of shame or discomfort.
If mutual aid is about building up relations of trust and solidarity, alongside shared understandings of both individual and shared predicaments, we may find them in the proliferation of new commons that are emerging. With experiments in sustainable commoning centered upon agricultural practices such as permaculture, derelict and unused spaces and community gardens, the solidarity is often staked upon a shared relationship with the land. Here the myriad practices we find - of working the land, strategizing resource use and living together - may not be centered around regular group meetings or sharing circles but the ethos, goals and attention to process may warrant including them in our study of SHMA practices.
Including such spaces invites also looking at online fora, some of which lay claim to being 'digital commons'. We should be wary of romanticizing MAGs as spaces for slowness and face-to-face interconnectedness, as pitted against speed, easy-access information, and algorithmically-mediated forms of experiencing that are increasingly familiar in digital life. In many instances, surfing the web does not produce closed circuits of sustained reciprocation, as we move incessantly from website to forum searching for information that one can use. However, in other cases, particular sites are returned to time and again, and online communities of truth and trust to emerge. It is exciting to ask how the distributions of affectation, care and trust are altered by the abilities of the online platforms with their partially-anonymized visitors to produce linkages, communication and knowledge resources in new ways.
But what of the bounded, 'outsider' self-help/mutual aid groups as originally conceived in the research tradition inaugurated by Borkman and others - should we accept that these models are simply dying out in our globalizing, digitizing world? Perhaps not. One driver behind the formation of new groups are issues or practices that are illegal, stigmatized or perceived as threatening within their social and cultural milieus. They cannot therefore be transparently institutionalized like so many patient, client, and user voices, nor perhaps even openly discussed in accessible collective spaces. Changing laws, regulations and norms around drug use offer good clues for where new SHMA groups might spring up. Consider groups for those seeking to better understand and integrate powerful and sometimes traumatizing experiences occasioned by the use of psychedelic drugs, or groups of mothers working in newly-legalized marijuana dispensaries who are concerned that their actions will condone marijuana use amongst their children.
By tracking the shifting and oft-conflicted designations of legality and acceptability, SHMA research can identify and study groups that require enduring boundaries in a world of ephemerality and porosity, in part for the very reason of the protection from legal, political or social judgment that this affords. Far from becoming an antiquated or fringe social formation, the study of such bounded groups to ascertain how members build relations of intimacy, trust and truth-seeking around problems that cannot be easily shared with outsiders lends an important task for self-help researchers in the contemporary world. Perhaps with a twist - more than in the research tradition's early years, such research takes us into the fecund shadows behind the visible social world, where secrecy, boundaries and protection remain vital for the slow, careful construction of alternative and inventive ways of living together.
1 See http://www.hearingvoicesusa.org/ for the US website.
Borkman, T. (1976) 'Experiential Knowledge: A New Concept for the Analysis of Self‑Help Group', Social Service Review, vol. 50, pp. 445‑456.
Borkman, T. (1999) Understanding Self-Help/Mutual Aid: Experiential Learning in the Commons, New Brunswick, NJ: Rutgers University Press.