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Since the 1960s various mental health consumer organizations have advocated for mental health consumers, and for improved services. Loosely referred to as the 'mental health consumer movement' these bodies are a broad church indeed. They represent everything from liberation collectives aimed at disestablishing organized psychiatry, to State sponsored groups that advise governments on mental health policy and service development. If there is one thing that can be said to characterize the consumer movement it is diversity. There is no single structure that unifies the movement, no national spokespersons recognised by all groups, and no formalized decision making or leadership processes. And yet the consumer movement is recognizably a movement with a common cause, however differently that is seen by individual members. For some the wide range of organizations is the movement's strength; for others it is a problem that allows funders and policy makers to choose at will what views will be included in decision making.
The diversity of the consumer movement is nowhere better illustrated than in the issue of language, reflected in the subtitle of Linda Morrison's book, The Psychiatric Consumer/Survivor/Ex-Patient Movement. Throughout the book this name is abbreviated to the c/s/x movement. The common cause of the movement is represented in the title: Talking Back to Psychiatry, for that is precisely what this movement does. It provides an alternative voice to mainstream psychiatry, and it is a voice that demands to be heard. The book examines the consumer movement in the United States, with some references to its international counterparts. It is the result of a research project in which author Morrison undertook interviews, document analysis, and reflection on her personal experience as a mental health professional and as a user of mental health services. Divided into six chapters and an introduction, the book provides a theoretical outline of the consumer movement, discussion of the research methodology, historical analysis, and chapters on identities, campaigns, and politics. It is brief and accessible, and provides a comprehensive primer to a development that all mental health professionals should be aware of. It a useful summary of the various ways in which consumers have organized around, and in some cases against organized psychiatry.
In the introduction Morrison declares the position of the consumer movement: a refusal to accept the identities prescribed by psychiatry, or by the sociologists who offer an alternative to the medical model of illness. Morrison challenges the sociological model provided by Scheff (whose 1966 work Being Mentally Ill was reissued recently and reviewed by Duncan Double). Double feels that labeling theory still has something to offer an understanding of psychiatry, and it is worth noting that it can be easier to dismiss classic works such as Scheff's in the face of more recent analysis. Stephen Hinshaw has provided a revision of Scheff's views in relation to stigma. Morrison, however, is concerned about Scheff's emphasis on internalization of the "mentally ill" label, and its view of the consumer as a passive recipient of the labels of others. An activist movement clearly needs a theoretical basis that allows a greater role for agency. It is not theory, but experience that drives Morrison to look for alternative explanations for consumers' experiences of psychiatry. Experience led Morrison to question Scheff's model, although she found it to be an appealing non-psychiatric explanation of becoming mentally ill. However she found even Scheff's revisions of his original theory, including the introduction of the concept of shame, to be unconvincing. In Morrison's observation, consumers don't necessarily internalize an identity as mentally ill, they actively resist it. Morrison turned to feminist theory where bell hooks' notion of "talking back" provided a way of conceptualizing the process of identity formation for mental health consumers. Resistance is a recurring theme in the book. Other theoretical influences are Foucalt and Freire. Together her experiences and theoretical analysis provided Morrison with a way of thinking about a social movement that "transformed personal problems into public issues." (p. 27).
Morrison discusses her immersion in the consumer movement in two roles: those of researcher and activist. The research methodology is not explicitly explained, although there is a full account of the research process. Morrison's status as an activist with experience of mental health issues and psychiatric treatment gave her insights into her subject matter, and access to other consumers who might not have trusted a more academically focused researcher. The chapter on the history of the consumer movement provides a fascinating overview of a development that reaches back to the early civil rights and feminist movements, and is littered with the names of now-defunct organizations and newsletters. The movement has also achieved a status which, while always vulnerable to the dominance of psychiatry, is nevertheless well enough established to be almost institutionalized in some of its more mainstream forms.
In Chapter Four Morrison presents the results of her analysis of interviews, drafted into a three stage "heroic survivor narrative". In the first stage individuals enter the psychiatric service system. Whether this occurs with optimism, resignation, or under coercion, the system is ultimately experienced as harmful. Finding their efforts to define their experiences discredited, individuals move on to a stage of resistance, in which they assert their own version of events, including their encounters with psychiatry. The result is the third stage of the heroic survivor narrative, politicization. The personal problem psychiatry wants to treat is now a social issue demanding solidarity and political activism.
Morrison then explores the larger social movement that challenges psychiatric orthodoxy. Through various organizations and campaigns the consumer movement brings issues to public notice. For the individual, personal recovery is deeply implicated in political change. A compelling section of this chapter is Morrison's account of the growth of the National Alliance for the Mentally Ill (NAMI), probably the United States biggest organized consumer organization. NAMI presents the consumer movement with the contradiction of success. It has achieved the goal of voice, but arguably at the expense of the movements' ideals. Arguing for compulsory treatment as a right is indeed a far cry from the liberationist goals of other parts of the consumer movement.
The final chapter is a reflection on the achievements of the consumer movement. Morrison emphasizes the complexity of the movement, and of the issues involved, but asserts, with considerable justification, that the psychiatric consumer movement has earned the status of a social movement. This movement, however, is different to its nearest equivalents of feminism and racial equality because the identity "mental patient" is fully externally imposed; there is no analogous position where the "mental patient" can claim that just as "black is beautiful", so "being a mental patient is beautiful".
Throughout the book Morrison displays an even handed approach. However there can be no doubting her central view that organized psychiatry is frequently disabling, and that it is only by asserting ownership of one's personal narrative that people can expect to recover from mental illness. Many of the ideas in this book are central to the recovery movement, although that movement also faces the contradiction of success. In many countries "recovery" has been appropriated by organized psychiatry, perhaps aware that it offers a real challenge.
Talking Back to Psychiatry joins the growing body of well argued and articulate scholarship of resistance to orthodox psychiatry. As a history of a movement it makes a valuable contribution to the field, but it also serves as a thoughtful analysis of the experience of "being mentally ill" and the process of reclaiming identity.
© 2007 Tony O'Brien
Tony O'Brien RN, MPhil, Senior Lecturer, Mental Health Nursing, University of Auckland, [email protected]
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