Our movement is brimming with great ideas. From the inspiring potential of Open Dialogue to the simple hope of support for medication withdrawal, from the vision of the Hearing Voices Movement to the growing research on peer supports, nutrition, and trauma informed care, we have wonderful solutions and real possibilities for change. And we have powerful outspoken champions pushing hard across the country and around the world working to put these visions into reality.
We also have common sense on our side, as our growing voice for sanity in mental health care resonates throughout society. Skepticism about forced treatment has deep roots in the US since One Flew Over The Cuckoo’s Nest broke the taboo about psychiatric violence. Calls for greater holistic and collaborative approaches resound today throughout all medicine, with a steady stream of research endorsing more humane and people-centered healthcare. Critiques of Big Pharma are widespread in the media and an ongoing dimension of our healthcare debates; more and more people have experienced firsthand the broken promises of psychiatry’s pill promotion. When I talk with people around the country and US — people who have been in the system, family members, professionals, and yes even many psychiatrists and researchers at institutions ranging from Harvard Medical School to Oregon Health Sciences University — there is a clear level of agreement with our ideas, that more compassion and listening, and less medical authority and pharmaceuticals, are needed.
We’ve all been busy pushing hard for these alternatives, these programs and reforms.
And we’re also going to fail.
Fail, that is, unless we completely change our strategy. That’s right, nothing is going to change unless we change how we are doing this work.
Either we realize the truth of this — that we are going to fail without a new strategy — or we risk betraying the trust and hope that people have put into us as leaders for reform. We risk becoming a professional complainer class — funded and salaried ‘advocates’ calling for change who have no real incentive to switch strategies when the reforms fail, because the money and influence for being a professional complainer continue to flow.
I have no intention ten years from now of writing another essay or making another speech or doing another training or making another film about how the “system has to change.” I”m just not interested. I don’t want to be a professional advocate and reformer.
I WANT TO WIN.
If you think it’s not possible, if you think a real total transformation of our mental health system is not possible, then you have no business advocating for change in the first place. It’s hypocritical, and you should get out of the way of people who are taking real change seriously.
And if you do think real change is possible — I mean real change, such as an end to homelessness in the US, widespread trauma prevention programs, Open Dialogue style response as the standard of care, a drastic curtailment of toxic meds, an end to forced treatment, the disappearance of diagnosis as the gatekeeper for services, truly caring dedicated compassion when people are in crisis — if you DO think these and other basic minimums of an effective mental health system are possible, then you can’t continue to support the present failed strategy of reform. Because we will just continue to fail.
I’ve been advocating for system transformation for more than 15 years, when I started waking up to mental health politics and we developed Freedom Center as a support community and multi-issue social justice organization. I’ve devoted countless volunteer hours to this cause. My life has been in this cause. I’ve worked with dedicated, caring people around the world to bring forward this vision and call for common sense — again and again, for 15+ years.
Yes, today our voices are louder and our movement bigger, and yes there are always “signs of hope.” Yes there are “small steps.” But come on people, let’s be honest — our movement has been a failure so far.
(And please note the “so far.”)
15 years later we don’t have a transformed mental health system. It’s not here. Instead we have the same abusive failed system that harvests and processes “psychotics” like agribusiness harvests and processes factory farm animals. And we actually have worse than just a failure to transform the US system. What we have is that the US pioneered system is poised to spread globally and wreak havoc around the world, which it is already doing.
And I do I wish the “peer movement” aspect of our work was actually achieving real change. But traveling around the US and taking a look at what counts as peers hired in the mental health system? It’s just not real change. What’s happening in the “peer” world is very far from the Western Massachusetts Recovery Learning Community’s vision of peer leadership. And my colleagues at WMRLC will be the first to point out that their work is limited by the need for larger social change.
No, it’s clear that we have — so far — failed.
So what do we need to do instead?
The way forward is clear. The US, the richest and most powerful country in human history, fails to make any headway on real issues — from the environment, to health, to peace, to racism and to caring for our children — because we no longer have a democracy in this country. “One person, one vote” — a cherished ideal people in the labor, abolition, and women’s movements gave their lives for — became one dollar one vote. Republican, Democrat: it’s the same pitch-to-the-rich money-raising mockery of real democratic process. Slavery era mechanisms like the Electoral College and Senate, gerrymandered voting districts, special interest lobbying, voter disenfranchisement — what we have today in the US bears no resemblance to democratic governance. We have a money-driven circus posing as democracy.
And the result is clear: no amount of “advocacy,” no amount of convincing or educating or proposing or promoting to get our ideas out there will ever make a bit of difference. It just doesn’t matter if 25%, 45%, 65%, even 99% of all citizens in the US agreed with the agenda of the mental health reform movement — the 1% still runs the show at the end of the day. Persuading public opinion to be on your side only makes sense as a strategy if public opinion translates into public policy. It doesn’t. Public opinion counts for nothing. The opinion of money is what counts in what our country has as a democracy.
If you don’t think this will change, then you don’t believe real mental health reform is possible. Because getting money out of politics and returning to one person one vote is what it will take to achieve real mental health reform in this country. We have to end the corruption of our public priorities — including our health priorities — by private monied interests. And I don’t mean Democrat vs Republican. Both are corrupted by money. (Ask anyone serious about educational reform, for example, about the role of teacher’s unions blocking any initiative from the Democrats).
I’ve written about this before on Mad In America (“Thinking Upstream: Winning Real Reform”). I’ve been talking about it every chance I get, and have remained committed to no longer advocating single-issue change but always pointing out the deeper, upstream issue of money corrupting democracy. I’ve met with mental health advocate leadership across the country and around the world.
Here is what I usually encounter.
The leadership of our mental health advocacy groups agree that yes, money has corrupted democracy in the US and this has resulted in blocking potential for real reform. But they aren’t willing to actually act on connecting their small single-issue efforts with the larger movement against the corruption of our democracy.
Why? This is where we see the corruption of our own movement. Because instead of following through on the implications of money in politics blocking the possibility of real reform, leadership continues to advocate in the narrow way. Reforming democracy is not on the agenda. So leadership continues promising what cannot be delivered, pushing small change as presumably the idea that will catch on but never does, and setting us up for more failure. And in so doing, we have to ask: has the leadership of mental health reform organizations become a leadership class of professional complainers? Getting the grants and donations, stirring hopes and making promises, but really focused on fulfilling contracts and job descriptions and keeping the money and influence flowing? Is our leadership actually presenting a winnable strategy? Or are we setting ourselves up for more failures as a movement?
As I’ve written about there are many initiatives on getting money out of government that we can link up with — both on the liberal and the conservative side. One of the national leaders of anti-corruption work is Lawrence Lessig, whose efforts I have just given some money to. I want to ask you: are you serious about transforming the mental health system? Not just complaining and getting a few small changes here and there, but really and truly winning a society that meets people’s needs when they go into emotional crisis and distress? Are you?
One current initiative Lessig is leading is a legal challenge to winner-take-all electoral college voting. The electoral college effectively robs voters not in “swing states” (both Democrat and Republican) of any influence in choosing a president. Lessig has a strategy to change that, and it has far-reaching implications for the possibility of any future mental health reform.
What’s your strategy?
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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