Letter

In Reply: We appreciate the numerous letters regarding our article, "Evolution of the Antipsychiatry Movement Into Mental Health Consumerism." We apologize for erroneously listing Mr. Frank as the founder of Support Coalition International. We also acknowledge that a fundamental problem was the need to summarize in 3,000 words three decades of history. This required limitation necessitated, as Mr. Oaks points out, "the authors appear[ing] to observe us from afar."

Mr. del Vecchio writes, "Today's consumer movement is not 'radical.' It is a mainstream, cornerstone approach to improve mental health care quality." We disagree. Quoting from the eighth edition of Kaplan and Sadock's Comprehensive Textbook of Psychiatry, "it is important to distinguish between the mental health 'consumer movement,' which has been positive through empowering patients … and the 'consumer/survivor' movement, which has advanced a radical reform."

Mr. Oaks, Mr. Ludwig, Dr. Lehrman, and Mr. Chabasinski all maintain that our basic hypothesis is false. They maintain that the survivor movement had nothing to do with the antipsychiatry movement. We dispute this point of view. As Tomes ( 1 ) noted, "The modern consumer/survivor movement arose in the wake of a radical restructuring of the U.S. mental health system between 1950 and 1970, resulting from deinstitutionalization, new psychotropic drug treatments, the widening legal conceptions of patients' rights, and the intellectual critiques associated with the antipsychiatry movement." We maintain that the antipsychiatry ethos, as disseminated by its seminal thinkers, was maintained as the antipsychiatry movement declined. It significantly affected two other movements: the consumerist movement that had been in existence since the late 19th century and the survivor movement, which dates back to worldwide deinstitutionalization. Many of the resultant hybrid radical consumer-survivor coalitions have carried forward, to this day, a message almost identical to that of the earlier antipsychiatry movement: that organized psychiatry is a self-serving guild that oppressively sacrifices consumers' needs and has little basis in science.

Mr. Haan and Ms. Hill state that the survivor movement is "not 'anti-psychiatry'" but is against "the way the profession treats people" and against "psychiatric oppression," which Ms. Hill defines as "any language or action that would allow for mental health treatment … to be forced upon any individual." Her listed doctrine could have been taken directly from the 1960s antipsychiatry manifesto, which contended that society deals with undesirables by locking them away. Foucault, as noted in our article, argued against society's pressing need to sequester members who would not comply with its definition of "Reason."

Mr. Oaks notes that survivor organizations encompass many disciplines, including psychiatrists. We never asserted otherwise. As Dain ( 2 ) notes, "Over the years psychiatry has been a target for antipsychiatry groups competing for influence or authority over the mentally ill. At various times these groups have included neurologists, social workers, new religions, consumers, and psychiatrists themselves." The authors of several letters state that members of their movements do not consider themselves antipsychiatrists. However, many members do. Weitz ( 3 ), in an article titled "Call Me Antipsychiatry Activist—Not 'Consumer,'" made the point, and organizations such as the Antipsychiatry Coalition emphasize it.

Mr. Oaks disputes our contention that in response to pressure from the antipsychiatry movement, psychiatry marginalized electroconvulsive therapy and psychosurgery, and he states that both are now resurging. In 1991 Fink ( 4 ) noted, "In spite of its acknowledged efficacy and safety … electroconvulsive therapy remains a controversial treatment, with limited use … the controversy results from attack by the antipsychiatry movement." The demise of psychosurgery following the antipsychiatry movement has also been documented by Feldman ( 5 ). He noted that after the turbulent 1960s, "Public and political scrutiny severely restricted, or actually banned, the use of psychosurgery in many American states, as well as in other countries such as Germany, Australia, and Japan."

Finally, the authors respectfully disagree with Ms. Van Tosh, who maintains that our essay widens an already existing schism and "could easily drive help-seeking consumers from the development of a therapeutic relationship." We believe our essay offers a balanced view of the antipsychiatry movement's evolution. However, we applaud and close with her sentiment, "Yes, some psychiatrists and consumers may be at war over ideology, but it is the struggle and eventual healing that can result in ultimate recovery. In this most fundamental instance, psychiatrists and consumers can make a new history that is based on mutual understanding and compassion."