The psychiatric survivors movement (more broadly consumer/survivor/ex-patient movementTalking Back to Psychiatry: The Psychiatric Consumer/Survivor/Ex-Patient Movement (2005)) is a diverse association of individuals who either currently access mental health services (known as consumers or service users), or who have experienced interventions by psychiatry that were unhelpful, harmful, abusive, or illegal.
The psychiatric survivors movement arose out of the civil rights movement of the late 1960s and early 1970s and the personal histories of psychiatric abuse experienced by patients. The key text in the intellectual development of the survivor movement, at least in the US, was Judi Chamberlin's 1978 text On Our Own: Patient Controlled Alternatives to the Mental Health System. Chamberlin was an ex-patient and co-founder of the Mental Patients' Liberation Front. Coalescing around the ex-patient newsletter Dendron, in late 1988, leaders from several of the main national and grassroots psychiatric survivor groups felt that an independent, human rights coalition focused on problems in the mental health system was needed. That year the Support Coalition International (SCI) was formed. SCI's first public action was to stage a counter-conference and protest in New York City, in May 1990, at the same time as (and directly outside of) the American Psychiatric Association's annual meeting.About Us — MFI Portal In 2005, the SCI changed its name to MindFreedom International with David W. Oaks as its director.
Common themes are "talking back to the power of psychiatry," rights protection and advocacy, self-determination, and building capacity for lived experience leadership. While activists in the movement may share a collective identity to some extent, views range along a continuum from conservative to radical in relation to psychiatric treatment and levels of resistance or patienthood.
History Precursors The modern self-help and advocacy movement in the field of mental health services developed in the 1970s, but former psychiatric patients have been campaigning for centuries to change laws, treatments, services and public policies. "The most persistent critics of psychiatry have always been former mental hospital patients", although few were able to tell their stories publicly or to openly confront the psychiatric establishment, and those who did so were commonly considered so extreme in their charges that they could seldom gain credibility.Dain, N. (1989) Journal of the History of the Behavioral Sciences Volume 25 Issue 1, Pages 3 - 25 In 1620 in England, patients of the notoriously harsh Bethlem Hospital banded together and sent a "Petition of the Poor Distracted People in the House of Bedlam (concerned with conditions for inmates)" to the House of Lords. A number of ex-patients published pamphlets against the system in the 18th century, such as Samuel Bruckshaw (1774), on the "iniquitous abuse of private madhouses", and William Belcher (1796) with his "Address to humanity, Containing a letter to Dr Munro, a receipt to make a lunatic, and a sketch of a true smiling hyena". Such reformist efforts were generally opposed by madhouse keepers and medics.Crossley, N. (2006) Contesting Psychiatry: Social Movements in Mental Health Chapter: contextualizing contention. Routledge
In the late 18th century, moral treatment reforms developed which were originally based in part on the approach of French ex-patient turned hospital-superintendent Jean-Baptiste Pussin and his wife Margueritte. From 1848 in England, the Alleged Lunatics' Friend Society campaigned for sweeping reforms to the asylum system and abuses of the moral treatment approach. In the United States, The Opal (1851–1860) was a ten volume Journal produced by patients of Utica State Lunatic Asylum in New York, which has been viewed in part as an early liberation movement. Beginning in 1868, Elizabeth Packard, founder of the Anti-Insane Asylum Society, published a series of books and pamphlets describing her experiences in the Illinois insane asylum to which her husband had her committed.
Early 20th century
A few decades later, another former psychiatric patient, Clifford W. Beers, founded the National Committee on Mental Hygiene, which eventually became the National Mental Health Association. Beers sought to improve the plight of individuals receiving public psychiatric care, particularly those committed to state institutions. His book, A Mind That Found Itself (1908),Clifford Beers, A Mind That Found Itself, Pittsburgh and London: University of Pittsburgh Press, 1981 described his experience with mental illness and the treatment he encountered in mental hospitals. Beers's work stimulated public interest in more responsible care and treatment. However, while Beers initially blamed psychiatrists for tolerating mistreatment of patients, and envisioned more ex-patient involvement in the movement, he was influenced by Adolf Meyer and the psychiatric establishment, and toned down his hostility as he needed their support for reforms. His reliance on rich donors and his need for approval from experts led him to hand over to psychiatrists the organization he helped establish. In the UK, the National Society for Lunacy Law Reform was established in 1920 by angry ex-patients sick of their experiences and complaints being patronisingly discounted by the authorities who were using medical "window dressing" for essentially custodial and punitive practices.Phil Fennell (1996) Treatment Without Consent: Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845 Routledge, 1996 pg108 In 1922, ex-patient Rachel Grant-Smith added to calls for reform of the system of neglect and abuse she had suffered by publishing "The Experiences of an Asylum Patient".Rachel Grant-Smith (1922) The Experiences of an Asylum Patient John P. McGovern Historical Collections and Research Center
We Are Not Alone (WANA) was founded by a group of patients at Rockland State Hospital in New York (now the Rockland Psychiatric Center) in the mid to late 1940s, and continued to meet as an ex-patient group. Their goal was to provide support and advice and help others make the difficult transition from hospital to community. At this same time, a young social worker in Detroit, Michigan, John H. Beard, was doing some pioneering work with psychiatric patients from the “back wards” of Wayne County Hospital. Prior to the advent of psychotropic medication, patients on the “back wards” were generally considered to be "hopelessly sick." Beard began his work on these wards with the conviction that these patients were not totally consumed by illness but retained areas of health. This insight led him to involve the patients in such normal activities as picnics, attending a baseball game, dining at a fine restaurant, and then employment. Fountain House had, by now, recognized that the experience of the illness, together with a poor or interrupted work history often denied members the opportunity to obtain employment. Many lived in poverty and never got the chance to even try working on a job.
The hiring of John H. Beard as executive director in 1955 changed all of that. The creation of what we now know to be Transitional Employment transformed Fountain House as many members began venturing from the clubhouse into real jobs for real wages in the community. Importantly, these work opportunities were in integrated settings and not just with other persons with disabilities. The concept of what was normal was pervasive in all of what Fountain House set out to do. Thus, Fountain House became a place of both social and vocational rehabilitation, addressing the disabilities that so often accompany having a serious mental illness and setting the wheels in motion for a life of recovery and not disability.
Originated by crusaders in periods of liberal social change, and appealing not so much to other sufferers as to elite groups with power, when the early reformer's energy or influence waned, mental patients were again mostly friendless and forgotten.
1950s to 1970s The 1950s saw the reduction in the use of lobotomy and shock therapy. These used to be associated with concerns and much opposition on grounds of basic morality, harmful effects, or misuse. Towards the 1960s, psychiatric medications came into widespread use and also caused controversy relating to adverse effects and misuse. There were also associated moves away from large psychiatric institutions to community-based services (later to become a full-scale deinstitutionalization), which sometimes empowered service users, although community-based services were often deficient. There has been some discussion within the field about the usefulness of antipsychotic medications in a world with a decreasing tolerance for institutionalization:
"With the advent of the modern antipsychotic medications and psychosocial treatments, the great majority are able to live in a range of open settings in the community—with family, in their own apartments, in board-and-care homes, and in halfway houses."
Coming to the fore in the 1960s, an anti-psychiatry movement challenged the fundamental claims and practices of mainstream psychiatry. The ex-patient movement of this time contributed to, and derived much from, antipsychiatry ideology, but has also been described as having its own agenda, described as humanistic socialism. For a time, the movement shared aims and practices with "radical therapists", who tended to be Marxist. However, the consumer/survivor/ex-patients gradually felt that the radical therapists did not necessarily share the same goals and were taking over, and they broke away from them in order to maintain independence.
By the 1970s, the women's movement, gay rights movement, and disability rights movements had emerged. It was in this context that former mental patients began to organize groups with the common goals of fighting for patients' rights and against forced treatment, stigma and discrimination, and often to promote peer-run services as an alternative to the traditional mental health system. Unlike professional mental health services, which were usually based on the medical model, peer-run services were based on the principle that individuals who have shared similar experiences can help themselves and each other through self-help and mutual support. Many of the individuals who organized these early groups identified themselves as psychiatric survivors. Their groups had names such as Insane Liberation Front and the Network Against Psychiatric Assault. NAPA co-founder Leonard Roy Frank founded (with colleague Wade Hudson) Madness Network News in San Francisco in 1972.Obituary Leonard Roy Frank (1932–2015), The Journal of Critical Psychology, Counselling and Psychotherapy, Lloyd Ross, March 2015. Retrieved June 27, 2021.
In 1971 the Scottish Union of Mental Patients was founded. In 1973 some of those involved founded the Mental Patients' Union in London.