Are Mental Health "Peer Support Workers" Experts by Experience?

Are Mental Health "Peer Support Workers" Experts by Experience? The author reports no conflict of interests. In this well-argued paper, Dr. Abdi Sanati asks whether a person's experience of mental illness could be the basis for professional expertise and concludes that, "on its own," it cannot be. Elsewhere he states that "the different forms of knowledge that are required for expertise … could not be produced solely on the basis of personal experience" (Sanati, 2024, 107). The qualifications "on its own" and "solely" suggest that personal experience of mental illness could be the basis for professional expertise if other conditions are also met. What are these conditions, and can they be met? Gratefully, Sanati provides an excellent exposition of a concept of expertise and the conditions that are required for satisfying it. Expertise needs to be thought of as a "form of life" that requires more than the accumulation of knowledge and cannot happen in isolation. To become an expert, you need to be part of a community through which you can acquire factual knowledge (knowledge-that) and acquire the practical capacities and dispositions (knowledge-how) that enable you to conduct actions related to your area of expertise. With training over time, experts develop tacit knowledge that enables them to "ap ply background theories to new cases," which is why an expert is able to deal with a multitude of cases that appear different from each other. Experts should be able to hold a relatively cohesive view of their subject matter and see how it all 'holds together'. The importance of community for the possibility of becoming an expert is further emphasized by Sanati's appeal to Wittgenstein's Private-Language Argument. A 'private language,' if such a thing were to exist, is a language that enables the person to express mental states with reference only to what is occurring in the speaker's mind and known through introspection. This language, in being private, makes sense only to the speaker and is not comprehensible to others. Introspection allows privileged access to my mental states, which thus become a unique source of knowledge available only to me. And the argument against such a private language is that it is impossible, for in being unintelligible to others, it becomes nonsensical as such. The reasons behind this have to do with the nature of language as a rule-based activity that requires intersubjective agreement, engaging in which is to partake in a form-of-life. [End Page 113] Putting aside the details of the Private-Language Argument, I am interested in the conclusion that Sanati draws from it. He starts by pointing out that what is taken as the basis for expertise-by-experience is the supposed privileged access to one's mental states that leads to a unique form of knowledge. It is this knowledge that underlies the claim to expertise. Sanati's view is that one cannot acquire a kind of knowledge completely inaccessible to others yet expressed in language as this would amount to use of a private language, which is impossible. And so, the person is either expressing nonsense or is merely using shared language. If the latter, then the alleged uniqueness of the experience is lost as it has been brought under a rule-based form of life. Sanati seems to imply that experience can only constitute a unique form of knowledge if it arises from a single mind through introspection and use of a private language. Given that this is not possible, the experience can no longer be unique. But I do not see why it cannot be a form of knowledge which, while not being unique to a single individual, is still an expression of human experience that only a proportion of the population go through, the proportion who are diagnosed with a certain mental health condition. In other words, a form of knowledge does not to have to be unique to be distinct, and if it is distinct then perhaps it can constitute the basis for expertise if other conditions are also met. In fact, this is suggested by Sanati's conclusion when he writes: "for the community of experts to exist there...