Psychiatric Survivors as Therapists Negotiate Difficult Spaces in Mental Health Activism

Research explores how psychiatric survivors who become therapists navigate their dual-identity in the mental health system.

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In an article published in the Journal of Humanistic Psychology, clinical psychologist Alexandra Adame interviewed survivor-therapists, psychiatric survivors who work as psychotherapists and counselors to understand how their experiences shaped their approaches towards activism and psychotherapy in the mental health system.

The findings suggest that participants managed their dual identities by finding ways of working that honored their experiences as psychiatric survivors and their training as therapists, all while interrogating our society’s attitudes and tolerance of madness.

Young man silhouette balancing on slackline rope between two parallel worlds.

At its core, the psychiatric survivor movement is about fighting for human rights in the mental health system led by those who have experienced abuse and/or oppression within it. The movement is characterized by a radical stance of liberation from psychiatry.

Many alternatives to the mental health system generated from this movement include peer support as a central element, such as in mutual aid projects. They also generally eschew hierarchies and distinctions in the delivery of mental health treatment, seeing each person as an expert on their experience.

For this reason, survivor-therapists may appear to be a contradiction in terms. Adame did in-depth qualitative research with self-identified survivor therapists to learn more about how they understand their dual-identity within the mental health system. While previous research has been done on survivor-therapist experiences, this study focused on the struggles of participants learning to be effective therapists and how their survivor identity informs their clinical expertise.

The findings from this study complicate dichotomies in discourses of activism, which perpetuate the us vs. them mentality between clinicians and patients in both the mental health system and the survivor movement.

Adame’s research examines how mental health professionals can integrate their experience of mental health struggles and treatment into their work within the mental health system and outside it. This study is also relevant to therapists interested in fostering a humanistic approach to their clinical practice while moving toward systemic change.

As part of this project, Adame interviewed five participants working as mental health professionals who self-identified as psychiatric survivors. The study found themes in survivor-therapists’ experiences such as drawing inspiration from the strong sense of community in the larger movement, intentionally connecting with their clients in a non-medicalizing, humanistic and holistic manner while getting involved in alternative models of care. This article focused on the case of Matthew as an exemplar to provide a richer look into the project’s findings.

In answering questions about how their experience in the mental health system led them to be involved in the survivor movement, participants described a shift. While initially feeling isolated and harmed by the mental health system, participants constructed and integrated a dual identity as a survivor-therapist despite having no models for effectively doing so. For example. Adame writes:

“The experience of not being able to trust himself because of the doctors’ detached and pathologizing approach was, in Matthew’s words, ‘extremely damaging.’ For Matthew and others in his position, they were made to feel other-ed when hospital staff and doctors were unwilling or unable to connect with them (or at least attempt to) on a compassionate level. Instead, Matthew felt abandoned and ignored in a time of crisis, when he most needed genuine human connection. The lack of human compassion and genuine empathy in the mental health system…subsequently influenced the manner in which the psychiatric survivors chose to practice when they later became mental health professionals themselves.”

Matthew, like other survivor-therapists, desired to be the therapist he would have liked to have had when he encountered the mental health system. After his experience, he began working as a counselor at an alternative treatment home. His desire to become a therapist was motivated by his own interest in bidirectional healing popular in peer-support approaches.

“Matthew highlights a key point of overlap between the survivor movement and what humanistic psychologists have been writing about for years—the central role of human relationships in the healing process, and more generally, for overall well-being in life,” Adame writes. “In the vein of alternative conceptualizations, Matthew went on to challenge the socially constructed dichotomy between mental illness and health/normality, which is a common critique from the movement, but made more complicated when one holds this view as a therapist.”

As Matthew became more conscious of how his psychiatric history influenced his clinical practice, he found himself over-identifying with clients, which, he thought, might have suppressed the expression of some of his clients’ experiences. He learned to rein himself in when responding to his clients by reflecting on the meaning and clinical significance of his resonance with their experiences.

Despite the impossibility of full mutuality in the therapeutic relationship, Adame posits that survivor-therapists can use their unique experiential knowledge to connect with their clients’ struggles.

Regardless of how radical they were as therapists, participants’ experiences reflected a struggle with still being “a part of the machine” of the mental health system in some ways. Matthew’s response was to get involved in activism by participating in alternative treatment settings, having his own group practice grounded on values from the survivor movement, and working towards wider social change.

From his perspective, it was important for the survivor movement to avoid making all mental health professionals into antagonists, which could prevent more genuine dialogue with mental health professionals.

“Matthew talked about including and making room for the full range of human experiences in our society. Some people do want help and seek it out in the form of therapy, and clinicians like Matthew are there to provide it. But the point Matthew is getting at is that there are people who are not seeking help, yet others in society have determined that they ‘need’ treatment, that they are sick and incapable of making another choice for themselves. It is a question of how we, as a society, embrace different, and at times, disturbing experiences of fellow human beings.”

Participants were asked what they thought mental health professionals could learn from the survivor movement. They all agreed on abolishing forced psychiatric treatment and the vital importance of patients’ informed consent when taking psychiatric drugs. Additionally, participants identified the need for wider treatment options for people in crisis beyond mainstream psychiatry to decrease people’s dependence on the system.

Adame mentions some alternatives to traditional psychiatric services, including the Icarus Project, comprised of those labeled with bipolar disorder who seek to radically redefine madness. She also mentions alternative communities for people seeking asylum in acute crises, like the Soteria House or the Family Care Foundation, an alternative residential care model in Sweden. Other groups highlighted include Open Dialogue, Hearing Voices Network, and MindFreedom.

However, despite the tensions between survivors and therapists, participants also saw room for dialogue and improvement in the mental health system. This stands in contrast to the attitudes of some in the survivor movement that the system is irreconcilably flawed.

In supporting survivors working in the mental health field (e.g., survivor-researchers), she suggests creating a confidential and supportive meeting space at annual conferences of professional psychology organizations, such as the Society for Humanistic Psychology, for people to engage in dialogue across sides of the mental health system.

 

 

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Adame, A. L. (2014). “There needs to be a Place in Society for Madness”: The psychiatric survivor movement and new directions in mental health care. Journal of Humanistic Psychology, 54(4), 456–475. https://doi.org/10.1177/0022167813510207 (Link)

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Javier Rizo
Javier Rizo is a graduate student-trainee in the Clinical Psychology PhD program at UMass Boston. His current area of research is qualitative psychotherapy research, with a primary interest in promoting human rights-based framework in psychiatry through the education and training of mental health clinicians and researchers. Javier is committed to building a social justice psychiatry, working to incorporate humanistic, interdisciplinary and critical perspectives on mental health, with particular interest in the role of healers and common factors models of psychotherapy.

21 COMMENTS

  1. “Regardless of how radical they were as therapists, participants’ experiences reflected a struggle with still being “a part of the machine” of the mental health system in some ways….From his perspective, it was important for the survivor movement to avoid making all mental health professionals into antagonists, which could prevent more genuine dialogue with mental health professionals.”

    Perhaps we’d have a more robust peer/survivor led system if so many didn’t go into mental health fields hoping to change it from the inside…

    More importantly, I think what we’re fighting as survivors amounts to the same system those promoting critical race theory are fighting. For anyone following that movement right now, the arguments against it are very similar to what survivors of psychiatric harm have been fighting for many years. That is the value of narrative in fighting oppression, the position of the law and other societal institutions in upholding oppression, and the positioning of some lesser oppressed groups over more oppressed groups. In other words, on that last part, the relatively higher positioning of Asians and Jews over Blacks and Hispanics is akin to the positioning of peer workers over patients. (Those who benefit from the status quo by being in a lesser position of oppression.)

    I would love to see more coordination between critical race theorists and antipsychiatry activists, as we seem to have similar objectives and similar barriers to breaking down institutional oppression.

    By the way, I don’t want to downplay in any way what the Asian community is experiencing right now. But I want to point out that the hatred stemmed directly from the office of the US President in his calling COVID-19 the “China virus”. It’s ironic that the pushback against Trump came from Asian American Dr Bandy Lee on the grounds of his supposed mental instability. What we aren’t allowed to push back against in our meritocratic culture is the very notion of power itself, who holds it, and whether power over others is ever legitimate. To authoritarian expert psychiatrists, their power has been earned and is thus legitimate, allowing them to bypass critique of whether power itself is the fundamental problem. Similarly, those who question how legal structures uphold oppression against those othered by society, whether for their race or their mental distress (and often both) are accused of being opposed to laws and rules entirely. Both segments are gaslit by those in positions of power who are unable or unwilling to critically view their own position.

    Those in peer positions within the mental health system must also examine the power structures they serve to uphold if they truly want to change the outcomes for those on the receiving end of mental health “care”.

    • Interesting, and a likely wisdom inspired take, kindredspirit. Albeit, I can’t say I’ve personally yet done a lot of research into critical race theory. Although I do know it is a “divide and conquer” theology, which is a war tactic.

      But I have no doubt, “Psychiatric Survivors as Therapists Negotiate Difficult Spaces in Mental Health Activism.” Since so do peer supporters, and even the ethical psychiatrists, who are at the top of the medical caste system.

      https://www.madinamerica.com/2021/05/drowning-doubts-why-i-think-about-leaving-psychiatry/

      And I do also agree with largely everything Astra stated. Especially, “Trust is earned. Until psychiatry makes amends with its inherent mistrust of the patient …, I cannot trust even myself to work among them.”

      Especially, since I’m a former patient, whose medical records state about my life, “not believed by doctor.” By a psychiatrist who eventually literally declared my entire life to be a “credible fictional story,” prior my leaving that unrepentant, idiot psychiatrist. And then I decided it would not be worth being a “peer supporter,” during peer training. Because they’re still teaching the debunked “chemical imbalance theory” in the peer training classes.

      I also agree with Astra, “All of them are potential antagonists because the system they operate in tolerates abuse and neglect.” And it is the violent and abusive psychiatric system that is the problem.

      But the bigger problem is that caste systems are bad, and the entire American medical industry is set up as a caste system, despite this being very anti-American. And it is because the American medical system is set up as a caste system, that systemic change is needed.

      In America, we’re all supposed to believe “all people are created as equal.” So having our medical system set up as a caste system, which has less than zero to do with the belief that “all people are created as equal,” is the problem.

      We really do need to get rid of “Rockefeller Medicine,” since Rockefeller even confessed in his own writings, to being a globalist, thus anti-American.

  2. “From his perspective, it was important for the survivor movement to avoid making all mental health professionals into antagonists, which could prevent more genuine dialogue with mental health professionals.”

    I am grappling with this statement. I never know what I am going to get when I interact with a mental health professional. All of them are potential antagonists because the system they operate in tolerates abuse and neglect. They hold power over me, inherently, by their position as “healer.” Yes, some of them do try to offset that power imbalance and can be life changing, I’ve met them few and far between.

    After my undergraduate degree in psychology and 8 years of lived experience in the mental health system, I just cannot trust the majority of “them.” I will not be hostile outright to individual practitioners — but just saying I cannot trust them, I am sure I could be labeled as “paranoid” and therefore hostile. Trust is earned. Until psychiatry makes amends with its inherent mistrust of the patient as a system, I cannot trust even myself to work among them.

    Smaller movements may be the better option. I just don’t know how I’d be able to support myself.

  3. Critical Race Theory is related to Marxism and Communism, etc. Its goal is one of division to pit one race against another in a superficial hierarchy, based not on “the content of one’s character, but the color of one’s skin.” The Anti-Psychiatry Movement is based on the Freedoms as outlined in the Bill of Rights. It is the freedom to make decisions about one’s brain and body and to say no to abuse or torture. It is in line with the Nurenburg Decision created after WWII and the medical experiments Jews and others without their permission were subjected to during that time. It also honors any and all peoples such as those subject to what happened people of color in Tuxegegee, AL and the sterilization of disabled and people of color, etc. in various institutions in North Carolina. THERE IS ABSOLUTELY NO RELATIONSHIP BETWEEN CRITICAL RACE THEORY AND THE ANTI-PSYCHIATRY MOVEMENT. The latter stands for medical freedom, which is freedom which anti-Communist. Please don’t confuse the two. Many have suffered and died for the freedom of ALL AMERICANS. And thus, so, the Anti-Psychiatry Movement. Choose Wisely. Your life, well-being, livelihood, health, etc. may depend on it. Thank you.

  4. “Critical Race Theory is related to Marxism and Communism, etc. Its goal is one of division to pit one race against another in a superficial hierarchy, based not on “the content of one’s character, but the color of one’s skin.”

    No, sorry. This is so grossly misinformed that I don’t even know where to start.

    • KindredSpirit, I am sorry but I am not grossly misinformed. I am very, very informed. Let’s put it this way. Critical Race Theory has absolutely no place in the Anti-Psychiatry Movement. At the very least, it can prove divisive which is what the Anti-Psychiatry Movement can least afford. I stand by what I know about Critical Race Theory. I shall not change it. I will continue my Anti-Psychiatry Stance. In my opinion, both Psychiatry and Critical Race Theory are nothing but evil. I will try to respect your opinion. Please try to respect mine. Thank you.

  5. i don’t see how pursuing a career in the mental health industry as a psychiatric survivor could be beneficial. I suppose having a salaried position with job stability is the only real perk I can think of…admittedly, that’s a huge one. Other than that…

    the industry itself is dedicated to enslaving anyone they can. to top it off, the entire industry — from the prominent psychiatrists who write books and offer their lies/”expert opinions” on TV on down to the counselors barely scraping by working in public/community mental health clinics — is based in fraud, deception, control, and violence. and yet…

    one can see the appeal of wanting to change/reform a system, I suppose. Obviously, it does not help that the stigma of psych labels and “treatment” are difficult to escape, and I think the level of difficulty is actually greater, now, than it was in decades past. Neoliberalism, maybe?

    To paraphrase Szasz, once again: the mental health industry cannot be reformed. It must be abolished. 🙂

  6. I know there has been talk about Critical Race theory in regards to this article. I have already spoken against and will continue to do so. One other point about Critical Race theory that concerns and makes the lights go off in my head is that it appears it is another EXPERIMENT from alleged so-called experts who are trying to implement this in our society only to see the results without regard to ethics or consent. It sounds a little like psychiatry, etc. that many of us are survivors of and have horribly abused by… I wish I did not see danger here, but, unfortunately, I do! When storms are in the forecast. the kindly TV meteorologist tells his audience to be “weather-aware.” As far as Critical Race theory goes, I suggest being “society and culture aware.” It is possible, maybe probably we are being gaslighted again. Thank you.

      • Actually, it isn’t. It’s the BIG PICTURE view of how systemic oppression affects and shapes the cultural narrative and lived experiences of both those labeled as “mad” and “bad”. “Bad” has been the historic view of Blacks in this country. CRT critically analyzes the historic as well as the current cultural view of race and how racism endures against Black folk through systemic factors rather than individual racist acts. It directly addresses “colorblindness”, which has been mentioned several times in recent MIA headlines. Hint: there is no such thing. Considering oneself colorblind is just about the same as “fighting stigma” and “raising awareness” of “mental illness”. Neither addresses the systemic nature of the oppression.

        That is: The education system targets both groups for deviance by funneling to psychiatry and the juvenile in”justice” system. The legal system targets both groups for use of force, loss of rights, and extrajudicial death by cops. Both groups have shortened lifespans as a result of a combination of medical neglect and medical malpractice (when we aren’t straight up being experiemented on!) The media shapes public narratives of “mental illness” as well as the supposed “dangerousness” of Black men (and Black people generally). Both groups experience high rates of poverty and homelessness as a result of job discrimination and financial targeting.

        We know all of this. MIA has published and is currently publishing about these issues. All I did was link the two together at their systemic roots. And just because Faux News and a cabal of Republican governors heads are exploding over CRT doesn’t change the facts.

        It is liberal racism in action to suggest that CRT isn’t relevant solely in order to avoid controversy!

        Solidarity means standing up for other oppressed groups as well. Especially when the means of oppression are largely the same and we’re fighting to liberate ourselves from the same systems.

        • POSTING AS MODERATOR:

          Very well said, and I thank you for taking the time to make this important point.

          From a moderator’s viewpoint, an argument about whether or not “Critical Race Theory” is being taught in the schools or should be or is dangerous or not dangerous doesn’t really get to the point of the article, which is about “mental health activism.” However, comments connecting CRT to “mental health” oppression such as you have done will continue to be welcome. I hope the distinction is clear.

          • The current political theatre over whether CRT should be taught in high schools is really beside the point. CRT as an intellectual take on systemic (the language its legal scholar founders used was “institutional”) racism has been around for decades.

            It’s main reason for creating controversy is that it confronts power head on as the root source of the oppression. This creates fierce opposition from those who perceive a potential loss of power as a result of efforts to address inequities. Its opponents use all sorts of ad hominem, straw man and other fallacious attacks in poor attempts to discredit the literature. Power (to create hierarchies among mental health professionals as well as those under the supervision of MHP) is also the oppressive force used by Psychiatry to keep most of those designated as “peers” under control. This is not particularly controversial and has been written about at length by both groups here at MIA. It should be noted that my ilk – non-compliant psychiatric survivors -exist at the very bottom of the pile and it’s no wonder that many people choose to become peer workers in the system in order to score good patient points.

            And I could have kept going with the similarity of oppressions. Another well known one is how CPS targets Blacks (and other minorities) is pretty much identical to its treatment of those with MI/SMI labels. But white families that can afford lawyers can openly abuse their children in many cases. Black families and those with MI/SMI are far more likely to have CPS called for unfounded reports, more likely to be threatened with termination of parental rights and also far less likely to be able to afford the costs associated with a legal fight for their children.

            There is also the forever search for genetic differences between Blacks and whites as there is between the psychiatrically labeled and so-called “normal” people. What’s really fun is when they combine the two, like this study did: https://www.verywellhealth.com/adhd-genetic-differences-race-5080249

            My intent is not to inflame those with knee jerk reactions based on opposing political view. My position is also not opinion but instead is based on ongoing study. I simply wanted to connect the dots on an intellectual level for those capable of following along. While my initial comment might have been better placed under another article, it doesn’t change the veracity of what I said.

            Although I can appreciate the efforts of psychiatric survivors who become mental health professionals with the intent of disrupting the system from the inside and expanding the rights of the labeled I can’t praise those whose objective is to create a better mental illness system. One is fighting the power from within and the other is upholding existing power structures and frameworks. (And that’s how CRT came into discussion to begin with. It has current cultural relevancy as well as many similarities to the oppressions experienced by and objections of those with MI labels, and especially to those of us who consider ourselves fully antipsychiatry.)

  7. I am a psychiatric survivor. I do not consider myself at the bottom of the pile. Although, I have my bad days, I do not consider myself oppressed. Yes, I am white woman, basically raised in the middle class milieu, I do not consider myself fragile or privileged. I do not consider myself a victim, as, I think I do share some responsibility for what did psychiatry, etc. did to me. However, that does not free psychiatry, etc. from the evil they did to me and they continue to do to others who do not deserve it. If I choose to consider myself, any of those terms, oppressed, bottom of the pile, or even fragile or privileged then I become those terms and I am no longer who I am or who I have been created to be. The main thing is that now, free of psychiatry, etc. I am able to discover whom I truly am. To consider myself any of the terms I have listed in this post, I will again not be responsible for discovering who I am, just like when I was under psychiatry, etc. very evil spell. To think of oneself in any one of those terms listed above, no matter who you are or your situation in life is a lie and a projection of someone else’s ideas upon you; a tell-tale tool of the very evil psychiatry, etc. a tell-tale tool that you will not be able to discover who you truly are; one of the greatest reasons for our life on Earth. Why would I want to relive that again? Thank you.

  8. I am amazed at how many people do this. Isn’t it almost a Stockholm Syndrome sort of a situation? I know at least one young woman who is considering this.

    What they miss, of course, as patients, is the incredible amounts of pressure within the profession to not step out of line.

    I know of a very few who were trained more or less conventionally and then left. They did OK. They actually found better therapeutic methods outside of the field.

    But to stay in a field that is so broken yet so irrationally defended would seem to me highly unwise.

    • I do think that it may be like Stockholm Syndrome in many cases. However, I also think that there are people who decide to become “peer supporters” etc. because they don’t have any better job opportunities. For many people (e.g. those who are open about their psychiatric diagnosis) this may even be the only job opportunity.

      In my country (Poland) these posts seem to be coveted and there are very few of them. People with lived experience can’t simply apply for one of these posts: from what I have read, psychiatrists may offer this job opportunity to some patients – well, of course they are not going to choose rebellious patients.

      In my own case, I am painfully aware that this would currently be the only chance of getting a steady job which would not be very stressful and exhausting (job opportunities for women are very limited in my country). It would be much easier to work as a peer supporter than e.g. as an overworked carer in a care home. But of course I would never want to work for the psychiatric system, obey psychiatrists, ask people if they are taking their “meds” etc. Anyway, as a rebellious patient I have never even been offered such an opportunity!

      • This is fascinating to find out more about the scene in your country!

        My understanding about the people interviewed for this study is that they had their own experience in the system, then went on to become fully-trained psychotherapists (or similar) so they could continue to work in the system.

        From the one woman I know the best who is considering getting a Masters in Psychology, she seems simply very fascinated with people who have emotional problems that affect their cognition and behavior (as she has also experienced in herself). There seems to be an almost magnetic pull to such people. I believe this phenomenon may have something to do with the kinds of people who end up practicing as professionals in this field.

  9. Good morning, Javier.

    May I thank you for your astute article?

    If you will permit me to play with it, in the spirit of congenial discussion with you, I should like to say that this quote gave me a tickle.

    “At its core, the psychiatric survivor movement is about fighting for human rights in the mental health system led by those who have experienced abuse and/or oppression within it. The movement is characterized by a radical stance of liberation from psychiatry”.

    I am cooking a Spanish omelete so will not dwell. But I am a psychiatric survivor in terms of being a psychiatric medication survivor. I am as yet unsure if I am a critical psychiatry buff or an abolitionist or what the heck I am. One day I am this, the next day that. One day I am leftist, the next day I am quite the opposite. I like the freeness at the heart of schizophrenia that hold that you can be left in peace to passionately and fervently believe what the dickens you wish to believe. I have for instance met schizophrenics who are very anti-American and schizophrenics who are very pro-American. And part of that may have been due to their paranoia. But to patronizingly and paternalistically say all of it was simply due to those peoples “paranoia” does a disservice to the championing of human rights FOR ALL so venerated by psychiatric survivor groups.

    Not that you were saying that. I am merely discening a prevallent ethos in the psychiatric survivor movement that biases one set of human rights against another set of human rights.

    You mention a “radical stance of liberation from psychiatry”.

    That is fine. It is just that we are all so “different” and I would like the “movement” to not fear that “difference”. I myself am today not inclined to want to liberate myself from psychiatry, since my schizophrenia needs it in the utter abscence of any other practical alternative that can be rolled out tomorrow in my town. I am not impressed by psychiatry. But I want to see it like a religious option for some. The free world must have many, many, many free options. Can a religion have too much power? ANYTHING CAN. I support the “movements” endeavour to curb the wonton excesses of that power.

    I dont believe hatred of people is how curb power.

    • I truly enjoyed reading this article. I feel now that my own duality, conflict, and niche in the mental health arena is understood by others and hopefully, many more after reading this work. This area and article need further investigation and more attention should be invested in understanding this VERY liminal space. ‘Othering’ on its own merits is one thing. Existing in the margins of an already marginalized people. That’s another. Then, when you are living in between the margins, well that’s the most isolating, scary, and misunderstood space of all. In a system that is ineffective already and completely useless to those described in this piece, I hope we can give these folks more airtime in the advocacy world and legislation proposed to fix the MH system. Kudos to the author!

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