Saturday, September 23, 2006

E- Book To Recommend

On : A Fragile Revolution:

I would like to recommend this e-Book to anyone interested in the patient perspective and more. The link for the Net Library is included in the title of this post. Though there are only a few ‘reviews,’ included here also, they are, as might be predicted in relation to the reviewers quoted, quit negative and defensive about the maintenance of the psychiatric status quo. That doesn’t surprise me at all, nor do I expect it would surprise most of the psychiatrized people. Rather it surprises us whenever it is NOT the case since the majority are backing the C.T.O and drugging agenda.

Later, I will include some excerpts from this book and my own commentary on it for those who are unable to access it through on line Net Library systems.

Title: A Fragile Revolution: Consumers and Psychiatric Survivors Confront the Power of the Mental Health System
Author: Everett, Barbara.
Publication: Waterloo , Ont.
Wilfred Laurier University Press,
ISBN: 0585325901
ISBN: 0889203423
Subject: Ex-mental patients-- Ontario --
Political activity.
Mental health planning-- Ontario --
Citizen participation.
Mental health policy-- Ontario .
Language: English

What interests me most about this is that while I was myself telling my recovery therapist almost the same things in 96, a social worker about twenty miles away, in the city next to me, was writing about the same sort of things as if she were sitting in the room with me. Naturally both of us must be invalidated about the power parts in order to preserve the ‘system’ which I have often said seems to have taken on a life of it’s own and no one wants to let it die a natural death, even though keeping this beast alive is only prolonging the agony and suffering.

Book Reviews from People largely pro system, yet still interested.

A Fragile Revolution: Consumers and Psychiatric Survivors Confront the Power of the Mental Health System by Barbara Everett;
Waterloo, Ontario, Wilfrid Laurier University Press, 2000,
251 pages,
CA$32.95 softcover

Ronald J. Diamond, M.D.

I approached A Fragile Revolution with anticipation. Here was a book addressing a critically important issue in mental health treatment. I had given some thought to the parallels between the consumer movement and other social movements of disempowered people. I had written about the issue of power in the mental health system. I am also a white middle-class psychiatrist and am automatically accorded privilege because of my position in the world. I do not like to have my world challenged any more than the next person, and I needed to take all of these feelings into account as I read the book.

Barbara Everett starts by describing her grandfather, who died shortly after being discharged by a psychiatric hospital. She also describes some of her work as a clinician in situations that left her feeling frustrated by her inability to help. It is clear that her involvement is personal as well as academic.The initial section on the history of the consumer movement is excellent. The chapter entitled "Power and Protest," a central chapter of the book, is more mixed. I was already familiar—if somewhat uncomfortable—with the author's contention that any power differential entails oppression. Here she goes on to reference radical writers who have even stronger views about power. For example, Wartenberg's characterization of power as "a violent life-or-death struggle" does not fit with my understanding of the problem of power in mental health systems.Nor does Gill's view that "the mechanisms of dominance have created a society that is structurally violent."Later the author cites Alice Miller, who "charges that our Western child-rearing techniques are inherently hurtful, coercive, humiliating, and often violent—the same criticisms that are often leveled at psychiatric treatment." It is unclear in these passages whether Everett is giving her opinion or mechanically citing the radical literature.

On the other hand, Everett's brief review of Goffman's conception of total institutions and Janeway's ideas about totalitarian regimes seemed highly relevant to the consideration of power in mental health systems. The issue of power is central in mental health treatment, and this chapter is a central part of the book. I found some portions of the chapter challenging and intriguing, and others just annoying. The chapter contains important information, but it is also difficult, slow reading.

It took me a while to recover from the chapter on power and get on with the rest of the book. Everett's discussions about "partnership," about the different meaning behind the terms "consumer" and "survivor," and about possible retaliation against consumer activists are all excellent and important. Her description of the failure of a well-funded consumer group is illuminating. As I read it, I wondered how often, despite our best intentions, we set up such groups to fail. The discussion about whether consumer-survivors can participate without being co-opted is worth the price of the entire book.

A Fragile Revolution annoyed me and in parts was difficult to read. Nevertheless, I would recommend it to any mental health professional who is interested in the consumer-survivor movement and concerned about issues of power in our relationship with consumers. I finished the book wanting to phone the author and continue the discussion, to argue with her and to agree with her. Maybe this demonstrates why the book, with all of its imperfections, achieves its goals.

Dr. Diamond is affiliated with the department of psychiatry at the University of Wisconsin, Madison. He is also medical director of the Mental Health Center of Dane County in Madison.

A Fragile Revolution: Consumers and Psychiatric Survivors Confront the Power of the Mental Health System
by Barbara Everett
Wilfrid Laurier University Press,
Waterloo, Ontario,
263 pages

Review by Dick Rowson and David Seaman, NAMI Literature Committee

Even though it is easy to fault the author's call for a new "power contract" between medical professionals and psychiatric survivors (the term used by the author), those who know the terrible consequences of mental illness cannot and must not be denied a key role in the treatment paradigm. That medical practitioners all too often ignore consumers' insights into their own and other consumers' needs lies at the heart of the problem.

A Fragile Revolution is a book that those firmly committed to the neurobiological basis of severe mental illnesses should read and ponder.The Canadian author is a former social worker and psychotherapist. She bases her analysis of recent developments in the Ontario, Canada, mental health system on her own frustrations with that system and its failure to involve consumers effectively in their own treatment.

Everett conducted in-depth interviews with 19 consumer/survivor members of a social action group, the Ontario Psychiatric Survivors Alliance (OPSA), which is now defunct. OPSA participated a few years ago in government efforts to overcome maltreatment by bringing the consumer into the center of the decision-making process in that province's mental health system.

Everett aspires to scientific objectivity in dealing with these matters, but her approach is based on an underlying political agenda, that of postmodern social protest. Psychiatric survivors relate to these concepts because they see themselves as oppressed by involuntary hospitalization and forced medication. However, as anyone who has lived with the realities of medically diagnosed mental illness in a family member knows, denial can stand in the way of treatment. And extending to the patient the right to refuse medication needs to be trumped by the danger this may pose to self, family, and to the community as a whole.

So, while it is legitimate to suggest, as this book does, a new "power contract" between consumer/survivors and the medical practitioners, or to ask-as did the author of another work recently reviewed, Towards a Sociology of Schizophrenia (University of Toronto Press), "Why should sociology allow the individual to remain the exclusive domain of the medical and psychiatric professions?"-a realistic balance must be maintained.

In the opinion of the reviewers, self-help and political protest have their place if informed by scientific reality. As slow and as callous as some medical practitioners may be, the ability of the professional to extend the limits of scientific knowledge and use that knowledge within whatever "power contract" may be conceived is an absolute necessity and remains our only realistic hope.

Paranoid Patty Commentary:

I have my own opinions about 'realistic' hopes of course. There will be lots more to come on this. I never run out of ideas even though many university students here like to point out how I keep saying the same things basically. I want to confirm that. I do keep saying the same things, over and over, from one angle of approach or another, believing that if enough of us do this for long enough, eventually it will penetrate the minds of all those who are having such a difficult time hearing the perfectly obvious.

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