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Book Reviews   |    
A Fragile Revolution: Consumers and Psychiatric Survivors Confront the Power of the Mental Health System
Reviewed by Ronald J. Diamond, M.D.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.9.1260
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by Barbara Everett; Waterloo, Ontario, Wilfrid Laurier University Press, 2000, 251 pages, CA$32.95 softcover

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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.

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