Sunday, January 11, 2009

Review: On Our Own

[Judi Chamberlin. On Our Own: Patient-Controlled Alternatives to the Mental Health System. Lawrence, MA: National Empowerment Center, Inc., 1977.]

This is a simple, direct, well-written, movement book. It was written by an ex-psychiatric inmate who identified with and participated in what she described as the "mental patients liberation movement." What is most interesting about this book, which contrasts it with a lot of what I have seen and read about from radical and not-so-radical professionals, is that it is not just about what's wrong with psychiatry but about how to start building real alternatives.

The book starts with a discussion of Chamberlin's analysis of the psychiatric system. Then she moves into an extensive account of her own experience in that system. This is much like many others I've read in the last several months -- it is powerful, and it clearly illustrates the coercion and dehumanization that are part of psychiatry. Her words show to me yet again how experiences of distress so easily result in people getting swept up into situations and practices they did not choose and that do not provide the sort of assistance they need or want, or they provide useful resources but demand an awful price. Her story, unlike many of the others, also illustrates the power of a particular alternative: She already had a long, difficult history of entanglement with mainstream psychiatry and she was in a period of distress. Though not Canadian, she happened to be in Vancouver, and happened to find her way to the Vancouver Emotional Emergency Centre. This was a place where people could live for short periods while in crisis that was not controlled, staffed, or connected with professionals or hospitals. It was a project of the Mental Patients' Association, a group run democratically by ex-patients.

Next the book goes on to talk about "consciousness raising," both as a process that people who have been oppressed by the psychiatric system experience and also as the emergence of a movement that included the creation of alternative spaces. She addresses head on the politics of alternatives: there are a wide range of things that have adopted that label in the context of what tends to be understood as "mental illness" and organizational responses to it. Some label anything that is not a huge hospital an "alternative," and many community-based services still deeply integrated into the psychiatric system have identified themselves in this way. Chamberlin means something quite different, though. To her, a genuine alternative is one that operates collectively, democratically, and non-hierarchically -- it is controlled not by professionals but by either ex-patients only or some combination of ex-patients and non-patients.

The book then goes through an examination of the key alternative or quasi-alternative organizations that existed in North America in 1977. None perfectly embody the kind of alternative Chamberlin wants to see, but a number are important and exciting explorations. She devotes an entire chapter to what she sees as the most promising of the alternatives, the Mental Patients Association of Vancouver. She describes its governance by ex-patients, its day-to-day functioning, its ideals, its ways of dealing with problems and crises. I couldn't help but suspect that the portrait was perhaps just a little too generous, knowing first-hand how hard it can be for any space with aspirations to being truly participatory and non-hierarchical to meaningfully reach those goals, but at the same time her excitement for a different way of doing things that is acutally happening is a vitally important thing to recognize, respect, and follow. The book ends with a return to the theme of coercion versus co-operation, and reaffirmation that any approach to supporting people who are experiencing emotional distress must involve only the latter and never the former.

On Our Own is well-written, well-argued, accessible, and compelling. Regardless of their specific purpose, I always find something exciting when reading about different ways of living and organizing our lives that are not just expressions of desire or anticipation but actual descriptions of inevitably messy and conflicted attempts to actually make them real. I should add that this book was received very positively when it was first published by others in the anti-psychiatry milieu. The interview participant at the centre of the chapter I am currently writing was involved in founding the first group for survivors of the psychiatric system in Ontario not too long after this book came out. After a number of name changes, the group decided to call themselves "On Our Own," both because it reflected their analysis and because of the importance they gave this book.

Yet it also feels a bit lonely, this book. A bit sad, because it embodies such great hopes that were never quite realized. I realize that a book like this is only ever a snapshot of much more involved conversations that happen over coffee and beer, at conferences and in living rooms, about how movements can and should and will move forward. So this was not a solitary intervention that then slipped beneath the waves, even if we can't see the conversations of which it was a part from this end of history. In fact, I'm sure that in the U.S. context there must have been more books after this that dealt with alternatives and practicalities and politics of making them happen. I'm not aware of anything else with such a significant amount of Canadian content, though. And I know that an introduction added to the book about ten years after initial publication says that there were many more alternatives present at that point than during the original writing. But I don't have the impression that a lot of them have survived to 2008. Maybe I'm just unaware, or I've been looking in the wrong places. But I sort of have the impression that, with certain important exceptions, 'alternatives' are now mostly integrated into the psychiatric system, and are therefore not alternatives at all in Chamberlin's understanding. I'm interested in whether the MPA, which still exists, continues to have the participatory democratic organizational form that made it so exciting both to Chamberlin and to my interview participant back in the '70s, because I know a lot of organizations that have survived from that time have taken on conventional, hierarchical, professionalized structures. The dismantling of space for alternatives -- space to be creative, to explore, to appropriate resources in the service of advancing a different vision for society -- is one of the many tragic results of neoliberalism, and one that is seldom noted even by those who are committed to defending the more conventionally organized sorts of resources that neoliberalism has stolen and is still trying to steal from ordinary people.

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