Lieutenant-General Romeo Dallaire remembers well the day he was told by his boss to get some help. In his words, this was not so helpful, because fourteen years ago, there was no help. It was the late 1990’s and the military had entered an exceptionally traumatic era for which they were unprepared. The thinking was that because the wars were over there would be no more casualties. However, with increasing numbers of casualties occurring at home, it was time to acknowledge that, PTSD was the real injury that was taking lives. The raft of suicides of those who had served in Rwanda was problematic for General Dallaire. He told the audience that he could not accept the military’s stand that these deaths were unrelated to the mission. So much so that when he met the press all those years ago, he was compelled to speak the truth as he knew it and said; eleven suicides were due to operations and I risk being the twelfth.
It was at this point that he crashed and finally sought treatment for the severe PTSD that had overcome his life since his return from the mission in Rwanda. Now in his 14th year of treatment, he credits peer support for keeping him alive. As he says, for me, it arrived in the nick of time – it saved my life. In military terms, he defines it as the instrument that that permitted him to live. The loss of soldiers by their own hand has taught us that PTSD can be terminal. This is the real tragedy of war and we must find effective ways to help our soldiers and their families recover. Peer support, according to General Dallaire is an essential part of this process. In his experience, it is the glue and the bridge that holds the entire treatment plan together.
There is no one pill for this thing.
General Dallaire spoke with compassion and insight about how the challenges and disagreements on treating mental illness can affect us. In doing so, he used the example of dreams, and how some doctors feel it best to suppress dreams while others want to use dreams as the subject of talk therapy. As such, he has learned that it’s a bit experimental until you find the thing that helps to start you to stabilize. Ultimately treatment is an individual thing but he believes that it was peer support specifically that helped to stabilize normalcy in his life. It was also helpful for him to understand and accept that meds could be normal for him. He acknowledged that it was the instrument of peer support that brought the attitudinal shift in me. He told us how he came to realize that the un-medicated person was no longer the person he wanted to be. In other words, that person is not the person I was. In retrospect he recalled that he came back from Africa quite different and once on meds a reasonable facsimile finally came back. Lived experience has taught him that it is one thing to be treated and quite another to feel that you are establishing some normalcy. In his view, the peer supporter is there to be sure that you are evolving; it’s the glue and the bridge for all other treatment. There is no doubt in his mind that peer support has its role right along with the professionals. General Dallaire credits peer support for helping him to develop the skills he needs to manage his life. He calls this resource a prosthesis for the mind. He compared this to the use of a physical prosthesis such as is used to reestablish functionality when a limb is lost. Modern medicine has supplied us with a multitude of high tech options for the physicalprosthesis. And, as compared to the use of a prosthesis for the mind, the user has the freedom to decide when and where it will be used.
So, what about prosthesis of the mind?
For mental illness, he believes that we should be creating the same sense of urgency; after all, mind injury equals body injury. And, this needs to happen now, NOT months or years after the injury. General Dallaire is emphatic on this point; really, the sooner the better. So, how does he see this working? In his experience, the process of rebuilding is based on stabilizing with meds, therapy and peer support. The prosthesis becomes stronger as you learn to understand and recognize the warning signs of your vulnerability. You have your own list of things not to do anymore, and certain conversations to avoid. As well you learn how to sense when things are going in the wrong direction. All in all, this is the prosthesis that helps to keep you out of trouble. However, General Dallaire points out that, you can never predict when you might need to use your mental prosthesis. So he instructs us that you must build your prosthesis so that you can rely on it at any time. For example, you can never predict when an overwhelming scenario might cause a trigger and without the prosthesis things can quickly get out of control. In his case when that happens, it’s like being two people – one in the play back movie in his head and one trying to stop. That’s what it’s like for him without the prosthesis. He also reminds us that building a mental prosthesis is an on-going project. Experiences still may happen even 20 years later that activate the mental teleprompter. The vulnerability is always there so to cover this you must sustain the prosthesis and understand the triggers. You can do this with peer support and that is why it must be on-going. The peer supporter can serve to attenuate the vulnerability and keep you from going downhill. There is enormous significance of where peer support fits in – rebuilding normalcy for those who are ill. It is an essential part of the medstherapy-peer support triangle. General Dallaire’s comment about how he, hated going to therapy, definitely struck a chord of recognition with the audience. Although he acknowledged that sometimes it was satisfying he also commented that they burn me out. He also shared that, between sessions I am most vulnerable but then I can walk through the session with my peer supporter and sometimes prepare for the next. He is encouraged to know that people are building this capacity in our society. He well understands that there are so many people being held back by an illness – and that not all wounds are visible. Much more is needed to be done.
I turn to you this morning and ask that you bring the intellectual exchange to build the depth and bring peer support into the mainstream.
General Dallaire would like to see peer support come into the workplace, community and organizations like the NHL. He feels that we need to mature like the military and, deal with, not mask the injury because not to do so is irresponsible. He explained that to make this happen we need to provide the metrics needed for the agreement to change policy. This evidence must be more than just experiential, in order to get the job done. We must have intellectual rigour. We are a mainstream asset; we must play by the mainstream rules to get money. You, as peer supporters are in the trenches, getting boots dirty with little recognition, support and often getting a hard time. That can be changed if we have the vision to go after the support we need. Peer supporters are not an afterthought or just a supportive body. We must move the body politic; in such a way that you are recognized as multiplying the other assets. That is why treatment is more effective when peer support exists. He suggests that if we look at the peer dimension through the military lens, we will see it as the force multiplier of what meds and therapy can do. Peer support is not a supporting function but is used to maximize the effect of all other treatments. In this model we must also ensure support to the peer supporters. Where is this happening? Ensure that your peer support structure includes sustaining support. That is a risk level you are only helpful when you are well in order to do your job.
You save lives.
General Dallaire is thankful that peer support finally arrived for him after four failed suicide attempts. He is quick to credit this intervention for the reason that he is here today. But, he also points out that peer support needs to be extended to the collateral damage that is the family. How are they being sustained? Where there are psychologically injured forces members there is sure to be stress and family tension – kids get caught in this too. Suicide is a risk for this group too. So General Dallaire is certain that without addressing the family, the treatment will not be maximized. In his opinion, peer support is the most valuable, best and cheapest. Everyone counts. We are all equivalent, no more, no less, just equal. So the program must be 100% effective it’s not good enough to claim 85% or to claim that our suicide rate is no more than average. Call us crusaders of the 100%. We need to be – it will be a challenge. In closing, General Dallaire ask us to envisage peer support as; NOT support, second tier, nice to have or backroom but rather as one of three pillars of mental health. You are going to keep the person alive. You ARE the force multipliers of the other instruments. You reinforce the other treatments by keeping the other person committed and improving. It’s about thriving not just surviving.
Lieutenant-General, Roméo Dallaire’s highlight keynote address at 9:00am, Friday May 2nd, 2014. National Conference on Peer Support, 2014.