Transcript Peers as Dignity Workers Nora Jacobson September 21, 2012 Today's Agenda A model of dignity Peer support as dignity work The dignity audit.

Peers as Dignity Workers
Nora Jacobson
September 21, 2012
Today's Agenda
A model of dignity
Peer support as dignity work
The dignity audit
Tell me about a time when
dignity was important to you...
“A coherent vocabulary and framework to characterize
dignity and different forms of dignity violations are
lacking. A taxonomy and an epidemiology of violations
of dignity may uncover an enormous field of previously
suspected, yet thus far unnamed and therefore
undocumented damage to physical, mental, and social
well-being.” (Jonathan Mann et al. 1999)
Dignity in the Literature
• Human Dignity
– The inherent and inalienable value that
belongs to every human being simply by
virtue of being human
• Social Dignity
– Dignity-of-Self
– Dignity-in-Relation
• Human Dignity
– “to be recognized for my real worth as a
human being”
– “it’s just something that should be there
regardless of who you are or where you are,
you know”
• Social Dignity/Dignity-of-self
– “dignity is the positive feelings that I have for
myself”
• Social Dignity/Dignity-in-relation
– “it’s just the way I’m treated and spoken to”
– “a sense of personal and kinda individual
control over one’s circumstances and um
respct by others of your own, um, space and
your, of who you are”
Processes of Dignity Violation
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Rudeness
Indifference
Condescension
Dismissal
Disregard
Contempt
Dependence
Intrusion
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Objectification
Restriction
Labeling
Discrimination
Revulsion
Deprivation
Assault
Abjection
Courtesy
He speaks to me, uh, with respect so that I
feel he values my, my, uh,
humanness…the way he talks, not talking
down to me, but talking directly to me and,
you know, and if I don’t understand
something then taking the time to explain
it.
Recognition
I say…“What color eyes has the [homeless] person that
you meet on the street every day?” “Oh, I don’t know. I
just know he wears a grey coat”…When you see
somebody on a regular basis and you don’t ever look in
their face…. So they’re usually, “Oh, should I give
money?” I say, “No. Give a hello. Because you’re
probably the only person who will have said hello, will
have acknowledged that person, and just saying hello
makes that person feel human, because it’s so much, so
many of us walk right past them, as though they were a
rock.”
Acceptance
I am not here to judge them. I remind them of that.
I really try, uh, and strive towards not imposing
my own values and judgment on people.
Empowerment
Sometimes I do see with a client that it does seem like,
uh, an act of dignity to say “No, I don’t, I don’t want
to take the meds. I don’t want to do that. I’m going
to do this instead.” And, uh, you know, that’s hard
for me to see that or understand that as dignity, uh,
but that’s, I think, what it is in a lot of cases…that
was the most important choice for the individual to
make and that’s the choice that the individual felt
best about and, you know, at the end of the day
whether he is receiving treatment [or not] he still is
an autonomous individual who has to live with his
choices.
Independence
[If you’ve got] a key to a door, which is your home,
a place to live, that’s your own, all that is
dignity…I’m not going to tell you anything―you
are the queen of your castle. You know what I
mean? You can do anything you want.
I really see income and employment as going a
long way in restoring dignity. That it's something
a person does for themselves and they feel
they've done it for themselves, 'cause in fact
they have, they gotten up and gotten there.
Contribution
“Giving something back”
“Making a difference”
Discipline
“Doing chores”
“When I tell someone I'm going to do
something, I do it.”
“Staying straight”
Accomplishment
I’m thinking about a client right now who, uh, who recently
lost his housing and, uh, he’s had a number of other
struggles in his life around mental health issues and so
forth. Things have really been tough for him lately and,
you know, in spite of that, you know, I think what keeps
him going is that he sees his past successes, he sees
his accomplishments as an individual, twenty years ago
and thirty years ago and he understands that he’s not a
terrible person because he hasn’t been able to do A, B,
or C and that he does have individual strengths…so all
of those things make his sense of himself as an
individual more intact and I think thereby give him a
greater sense of dignity.
Enrichment
What I personally do and what I did when I was in the
system is I kept my, um. I love literature. I love, um,
like real literature--I don’t mean current selling
things. I have found that was a real incredibly helpful
tool because it was something that I knew on my
own would help me preserve a certain dignity.
Without that, I became afraid I would then be like
the other people and get squashed down even
more. So literature for me is like about dignity.
Authenticity
You have first to be yourself, what you believe
yourself, and you have to have, uh, strong will.
You have to be really focused more in yourself
than think about other people around you.
Love
It lets them know they’re worthy. It lets them know they
have value, and it lets them be respected in the end
even if maybe they went through their whole life not
feeling worthwhile, not feeling any sort of value…by
being there, by being able to give people what they
need…also just honoring who they might have
been.
Perseverance
One thing that I, that I, that keeps me going in this particular area
of business is the fact that I, I meet somebody at nine o’clock
in the morning. We work very, very hard to get certain things
in place, be it a shelter bed, be it a meal, uh, be it access to
finances or access to a doctor or any of that…and then at five
o’clock I shut my door and I say, “Sorry…I’ve done everything
now. I do have to close the door and go home.” And the fact
that that person comes back tomorrow morning and has faith
and has the internal drive to be able to come back and start
all over again, not once or twice but over a really long period
of time…. Most of us don’t have the drive to do that every
single day. Get up in the morning and know that you’re going
to go through the same steps and perhaps at the end of day
either end up even worse than you were or at the same place.
Control
I know some people, you know, maybe they have a
[disability support] issue and so they get on the phone
and they’re yelling and screaming. But that never got me
anywhere. You try and be, uh, uh. There’s always a
million ways to say the same thing, eh? You know, you
can yell or you can be too kind or quiet about it or there’s
in between, you know? [If] I know I have to call them
‘cause I need something or something, I’m kind of asking
them for something so I better be nice about it, or if they
made a mistake maybe, there’s no point in getting mad
at them. You might stall them in terms of correcting the
mistake if they’re mad at me. So you try to be as nice as
you can.
Transcendence
I cannot really control the actions of other people and
sometimes you get a bad reaction from other people
and people may have heard it and you don’t want to
feel slighted but that’s, you know, and you can’t sit
there and focus on it…kind of taking a step back
and realizing that hey, this is not really my problem.
Preparation
My approach has sort of changed in that I’ve sort of
accepted the fact that…there may be medical doctors
out there, family doctors in Toronto that would suit my
needs, but as of now I haven’t found one…So that I’ll just
use him as my once-a-year appointment. I need to go in
for some check-ups related to my condition and I’ll just,
I’ll just do that. And not expect much from him. And I
think that’s going to probably help me with dignity and
how I feel about myself, because if I don’t expect much
from him…then maybe if I don’ t expect much of him
then I won’t be, like I won’t be so upset after the
appointment.
Avoidance
It’s like a clear glass bell jar around me, but not having a
door on the outside and I’m on the inside because, uh,
for me―I’m not as, uh, as easily affected as I once
was―but that was a problem for me, where like some
people could just like open the door, dump their shit in
and close it and I’d be like “Oh, what’s all this crap?” and
I’d feel overwhelmed by whatever it was…. [But now] I’ve
got the door on the inside so I can keep the door shut.
But I mean it’s cracked, it happens, and for me dignity is
an ongoing battle to, to, to not lose it, to keep it.
Concealment
I don’t know if I’m supposed to say this. This is the
dignity: I’ve been closeted. I’ve been using drugs
since I was fifteen years old. I’ve been closeted
‘cause I raised a son by myself and everything and I
had so much to lose. I just could not afford that, you
know? So, uh, that’s where, uh, my dignity came. I
would do the church thing and hallelujah on Sunday
and then call the crack dealer.
Advocacy
I would say advocating on behalf of clients, uh, who,
uh, may not be well served by their community
service provider or who may be facing discrimination
of one kind or another…trying to remove obstacles
and barriers, uh, to help them live a more full and
dignified life.
Presence
I may not do anything, but the fact that I am there
makes a very big difference…. If I am with my
client, my client will feel and be treated
differently. If I am not, my client will be treated
deliberately poorly.
Support
I think it’s pretty hard for someone to conduct
themselves with dignity if they don’t get the
resources [like food, wealth, opportunities, equity] to
do it.
It’s basics [that] give people dignity.
Leveling
We call each other on a first name basis and try to,
um, minimize the differentials…we try to make
sure that as much as we can be seen on the
same level in terms of, you know, we’re all
people. We try to be real and genuine in our
work and not create this huge difference
between [the clients] and us.
Resistance
Saying “no.”
Saying “no more.”
“Standing up” for oneself
Dignity Work
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For self/for others
By individuals/by collectives
Transitive
Affirmative/defensive
Dignity work
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Creating dignity
Maintaining dignity
Protecting dignity
Reclaiming dignity
Jacobson, N., Trojanowski, L., and Dewa, C.S. (2012)
“What do Peer Support Workers Do? A Job
Description.” BMC Health Services Research 12: 205
(July 19).
Peer support work
• Direct work
• Indirect work
• Advocacy
• Connecting to resources
• Group planning and
development
• Experiential sharing
• Administration
• Building community
• Team communication
• Relationship building
• Supervision/training
• Group facilitation
• Receiving support
• Skill building/mentoring/goal
setting
• Education/awareness
building
• Socialization/self-esteem
building
• Information gather and
verification
Invisible work
• Forging collegiality
• Legitimizing the peer role
Peer support mechanisms
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Lived experience
Approach
Presence
Role modeling
Collaboration
Peer support as dignity work
Affirmative and
defensive dignity
work
Dignity work at the
individual,
organizational, and
societal levels
Connecting to resources & info
gathering = advocacy & reducing
deprivation
Skill building/mentoring/goal setting &
socialization/self esteem building
= moving toward positions of
confidences and away from
positions of vulnerability
Experiential sharing & relationship
building & group facilitation &
community building = build
solidarity & reduce asymmetry
Invisible work = collective dignity
work
The dignity audit
Using dignity as a lens to assess policy and
practice
Examine: structure (position, relationship, setting,
and social order); process (processes of
violation and promotion); outcomes (objects and
consequences)
Identify: types of intervention
(affirmative/defensive); points of intervention
(person, organization, system, society); logic of
intervention; barriers to change
Acknowledgments
My thanks to all of the interview participants and to
my research assistants, Vanessa Oliver and
Andrew Koch.
This research was funded by the Social Sciences
and Humanities Research Council of Canada and
the Mary Beck Professional Development Fund at
the Centre for Addiction and Mental Health.
[email protected]
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