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A Fragile Revolution: Consumers and Psychiatric Survivors Confront the Power of the Mental Health System

by Barbara Everett

Wilfrid Laurier University Press, Waterloo, Ontario, 2000, 1-519-884-1970. 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.