Patient Advocacy and Liberation
In the US, the latter half of the 20th century saw a swell of patient-led energy around mental healthcare treatment and policy. As people directly affected by psychiatric care, patients and former patients alike had vested interests in representing themselves, their own experiences, and their needs. On patient involvement, Tomes (2006) writes, “As of 1970, then, the claim to have special insight into mental disease by having actually experienced it was a novel assertion” (p. 722). Patients who organized in the 1970s were influenced by the radicalism of the 1960s, as well as the efforts of other liberation movements for civil rights, gay pride, and women. Intellectually, early activists drew from the works of noted figures in the “anti-psychiatry” tradition, particularly Thomas Szasz and R.D. Laing. They embraced their mental conditions as a unique way of being while challenging the portrayal of madness as illness. Societal change and acceptance, they posited, were better for their well-being than repressive measures such as involuntary commitment and extreme treatments.
Beginning with the formation of the Oregon Insane Liberation Front in late 1969 or early 1970, local and national organizations focused on patient and consumer rights developed around the country. Over the following years, shared goals emerged, as did disagreements amongst movement activists. Naturally, there were a range of stances on psychiatry and mental health services. By the 1980s, rifts in the movement were reflected by the preferred terms used by its different segments. Amongst the various circulating designations, “ex-patient,” “survivor,” and “consumer” were three of particular prominence.
Naturally, each identity had its own social and political implications. McLean (1995) states that those who referred to themselves as either “ex-patients” or “survivors” tended to reject the medicalization of mental illness and forced treatment. The National Association of Mental Patients (NAMP) opted to use “survivor” — a choice that both indicated strength and drew parallels with survivors of the Holocaust. Others chose to align themselves with the “consumer” identity, including the National Association of Mental Health Consumers (NAMHC). Instead of positioning themselves as opposed to psychiatry, the title of consumer conveys a willingness to collaborate with the existing psychiatric establishment, and emphasizes the idea of individual choice in the mental health services marketplace (Tomes, 2006; McLean, 1995). Today some of this language endures: consumer and survivor, in particular, have gained acceptance from governmental and independent agencies (Torrey, 2011).
