All posts by Samantha

Book review: Calling out for mad liberation – “On our own: patient-controlled alternatives to mental health “

This article is the last article written by our friend Samantha (see obituary p. 4) On Our Own is a classic anti-psychiatry text that has had a significant impact on radical mental health.

On Our Own: Patient-Controlled Alternatives to the Mental Health

By Judi Chamberlin

Hawthorne Books, New York 1978.

Judi Chamberlin travels a tumbling path towards the title of her book, through her own experience of the mental health system towards her ideal goal of patients helping each other to keep themselves together. She outlines the problems faced by mental patients and she beats a tinny improvised drum calling out for mad liberation through consciousness-raising.

Chamberlin’s focus on patient- controlled alternatives will strike a resonating note with brave readers who hold high the banner of direct democracy or seek to level the power of authority figures. She even discards the radical theorist R.D. Laing, for continuing a distinction between “healers and healed” in his writings and anti-psychiatry experiments based on them. The intensity of her railing against this distinction may seem arbitrary and extreme without considering the viewpoint of mental patients being treated, usually involuntarily, for conditions in their own minds. The patient faces an isolation not imposed on sufferers of other illnesses, at a time when human companionship may be the only alleviating factor.

The isolation can continue long after the patient is declared “cured,” and a hospital stay or mental disability discharge carries a stigma in looking for jobs, lovers, or friends. Judi goes to great length to show how the discrepancy in power between the psychiatrist and patient remains immense, and unjustified. Danger of harming self or others is legal criteria for involuntary commitment and a patient can be held in custody with only the psychiatrist as a witness of her motives, but the psychiatrist has no more ability to see human intentions to commit acts of violence or self destruction than anyone else. Confronting this authority and dismantling this false expertise lies at the heart of reaching freedom. Judi Chamberlin stays true to this goal and remains extremely vigilant in dealing with any experts who place themselves higher than the patient.

The chapter dedicated to Judi’s own experience with psychiatrists and hospitalization provides her credentials as an ex-patient seeking to raise consciousness and help other patients get by, as well as giving readers a straightforward account of a psychiatric survivor. I empathized with her years of anguish in and out of hospitals, and I was impressed that she described in simple terms the humiliations she experienced as inherent in the hospital system, rather than depending on excesses and abuses. Whether in a ‘cottage’ or a locked ward, group therapy or isolation, Judi comes to fear and hate the physical control inherent in the system.

It is fascinating to me that she sought treatment out between stays, finding the experience of living outside the hospital system with family or a shitty husband unbearable. This is a fact seldom admitted in an exposé of the mental health system, and I find it courageous to be able to admit that you can’t deal with everyday life on your own.

A turning point in her view of the system occurs when she becomes extremely miserable after a mental hospital discontinues her tranquilizers upon admission, and she experiences a variety of physical and mental withdrawal symptoms, such as a churning stomach, dizziness, crawling flesh, anger, and frustration. Another patient tells her she is probably undergoing withdrawal from the medications she was prescribed by her doctor, which had previously not affected her. A light turns on in Judi’s head, as another patient has offered her an unexpected insight into her condition: “I got my first ‘therapy’ at Hillside under that tree, and it came from another patient.” Instead of a “relapse” into mental illness, the absence of the previously ineffective drugs produces new symptoms. Withdrawal from psychiatric drugs is a viewpoint I have never heard from a doctor, and I have recently only come across when a friend mailed me the Icarus Project and Freedom Center’s Harm Reduction Guide to Coming Off Psychiatric Drugs. But patients have been sharing this knowledge since psych drugs became prevalent in the 1950s, and it helps clarify some experiences in my own life.

Judi’s experiences with the Vancouver Emotional Emergency Center will probably seem familiar to anyone lucky enough to turn to a close circle of compassionate people who have had similar experiences. Strangers or old friends, they do their best to patch together what is needed and listen, and offer relief from the mind games and deceit. The “unmaking of a mental patient” happens as she realizes there are other ways to get the human help she needs and a new life opens up to her. We imagine her able to say the word crazy with a wild grin of abandon and laugh, and Judi is now able to pose a new question: how can others systematically receive the help they actually need?

Judi gets down to business and explores organizations operated by the mad for the mad, working for mental patient’s liberation. She explores the many difficulties ex-patients face because of bias, rather than any danger to themselves. She covers many of the details of various organizations’ daily work, highs and lows, including a whole chapter on funding. She describes groups working both in crises situations, like the Vancouver Emergency Center, and on the long term problems faced by ex-patients, such as Project Release in New York and the Mental Patients Association in Vancouver. She compares the shoestring collectives with a potent “conscious” analysis gained through long discussions, to organizations better funded with a more confused relationship to the system. I was fascinated that many of the groups emphasized ex-patient housing, and a little dazzled that a group of mental patients on welfare in 1978 could pick up cheap city apartments. A goal now that would be classified as dreamy seemed bluntly practical to Judi Chamberlin.

Thirty years have passed since the publication of this book. There are many experiences that date both Chamberlin’s direct experience of hospitalization and the alternatives she discusses: the thorazine “concentrate” and the Great Society War On Poverty funding for community projects are both things of the past. Yet there is a striking skeleton of her work that is easy to recognize, fleshed out in this society. Current drug regiments still focus more heavily on tranquilizing and sedating patients, with only mixed results for actually alleviating unpleasant symptoms. Likewise, confinement and physical force continue to hide behind the guise of treatment. Some of the innovations or alternatives shot down in the book now are mainstays of treatment: community mental health centers are at the core of most outpatient treatment, and a lot of us grew up sleeping through various psychotherapy snore sessions first introduced in the 1960s.

One weakness of the book is the way it lumps mental patients together in a broad mass, without addressing the distinctions between what mental patients experience because of their individual identities. Her vision of liberation is broadly based on a feminist model, but little attention is paid in this work to differences in organizations and institutions caused by race, class, gender, and sexuality. While this broad topic may be beyond the range of this book, the reader is left with the impression of mental patients seeking liberation as predominantly white and middle class. The horrors of the eugenics movement make it imperative to acknowledge the dirty work done by the psychiatrist on poor women and women of color, and any serious attempt at mad liberation must integrate this analysis.

As I reflect on my own experience, Judi’s does seem to minimize certain ambiguities. Can patients always solve each other’s problems? Is there really no useful role for well-intentioned professionals? There are times when a little tranquilizer might give me the sleep I need to keep from being a pathetic nervous wreck and there are times when other patients provide advice that is not helpful.

On the other hand fear and hostility towards professional psychiatrists is a gut reaction based on real problems, and although psychiatry is constantly toting its reforms, restraints, isolation, andeven electroshock are features of most hospitals, and most patiaents have felt the breath of fresh air another patient’s honesty can bring. I am impressed that Judi presents these views so forcefully.

On Our Own could end up on the tables of many people asking the same questions as Judi Chamberlin. How to get out of a depressing anguish? How to work together to provide some relief when we our troubled? How do we keep vulnerable people safe from psychiatric abuse? Judi provides few solid answers, but her unshaken faith in our ability to provide those answers to each other is an inspiration.


Viva Women’s Choice clinic – budget cuts close feminist health center

Women’s Choice Clinic in Oakland, California was forced to close April 8 after running out of money. Women’s Choice was the oldest feminist health center in the United States — performing abortions since 1972, a year before the Roe vs. Wade decision made abortion legal. Women’s Choice Clinic performed low cost, sliding-scale abortions, as well as offering gynecological exams, STD testing, and birth control, all in a supportive, comfortable environment. Volunteers made sure women could learn as much about their health care options as possible, and that doctors listened to the concerns of women and paid attention. The clinic provided feminist health care centered on compassion, dignity, and respect. These subversive practices ran counter to the practice of professional medicine, where male experts distanced themselves from women’s bodies and voices.

“Coming to a feminist health care center feels like coming home,” noted Linci Comi, an activist who has worked with the clinic for over thirty years and is currently its executive director.

The state’s chronic failure to reimburse for Medi-Cal (California’s supplemented medi-caid) payments forced the clinic to close. Ninety percent of the clinic’s clients received free abortion services through Medi-Cal, and the clinic no longer had the money to cover basic supplies and licensing fees. “It’s heartbreaking, class warfare on poor women,” says Comi.

“Unfortunately, relying on Medi-Cal has put us under the thumb of the state,” according to Annah Wilson. And the State’s thumb is stingy and ugly, barely providing money to cover the cost of supplies, often over six months late in payments, and refusing to pay on the slightest grounds. “We had to survive on private donations for over thirty years, and the community did as much as it could to support us.” Unfortunately the economic slump means that the community couldn’t really step up once more and rescue the clinic.

The clinic’s dedication to providing care to low-income women was no accident, but an integral part of the politics of reproductive justice. The battle must be fought not just to keep abortion legal, but to make free abortion available on demand. This is a part of the broader battle to give all of us access to the free health care we need to live. The Hyde Amendment, passed by Congress in 1976, chipped away at abortion access by taking away Medicaid funding for abortions, but California and Hawaii still provide Medicaid abortions with state funding. While nothing has changed legally, the state tightened the screws by reducing the rates of payment on Medi-Cal abortions and delaying payments.

I have seen the revolutionary banner of Women’s Choice Clinic literally out on the streets demonstrating for women’s freedom, and against war and oppression, and it’s so important that we continue to struggle now, and stand up for truly free, truly universal health care, and for women seeking reproductive freedom. A seated pro-choice president doesn’t mean we can sit back and relax, and the clinic’s closure should be a wake up call. It’s time to demand systematic changes and free up resources sucked down by the war, quiet the carping of anti-choicers and keep them from carving away at abortion access by putting political and economic pressure on the fourteen feminist health centers operating today. It’s great if political changes can provide us with renewed hope and inspiration, but the work remains to be done to make the vision of reproductive freedom clear and real.

Clinic volunteers actively worked against forced sterilization, helped pioneer informed consent, put the health of women above all other considerations, and analyzed the larger structures of oppression in their work. We need voices like these to speak out loud and strong, because of the history of birth control being a tool of population control, white supremacy, and eugenics, extending into the birth control options pushed on low income women and women of color offered in clinics today. This activist voice is especially needed when anti-abortions critics are becoming more sophisticated, by co-opting real fears of racist genocide.

Women’s choice used a loophole in Medi-Cal to provide abortion funds to more women: pregnant low-income women are immediately eligible for temporary Medi-Cal, without having to go through quite as many hoops. Women’s Choice was one of the last stops for women short on cash seeking an abortion, since the big box abortion clinics prioritize the bottom line, and cut corners to make more money and leave low-income women out in the cold. Comi gave an example of big box clinics creatively adding to Medi-Cal billing by inserting unwanted Intra Uterine Devices, an involuntary birth control device, just to tack on charges. What a fucked up excuse for limiting reproductive freedom!

The clinic has faced round after round of budget shortfalls bravely, responding to previous Medi-cal cuts by trimming down to a skeleton crew of paid staff and relying almost completely on volunteers. In some ways, this switch back to volunteers rejuvenated the activist culture at Women’s Choice, as young women with no formal health care training, but as dedicated to learning about health care as the clinics founders, began performing duties such as blood work, counseling, sonograms, and assisting surgical procedures. This is more involvement than the passive roles (paperwork) interns are usually subjected to.

“Women’s Choice Clinic showed us a whole new way to approach health care that valued patient education and empowerment. And they have left an important legacy — there are literally hundreds of health care professionals now in the field who did their clinical hours and certifications at Women’s Choice Clinic. We are better off for WCC’s work, and it is a crying shame that they can’t continue,” according to Kim Barstow, a former clinic volunteer.

“I feel stripped of hope,” laments Annah Wilson, the clinic’s volunteer coordinator, “but I also feel a renewed sense of urgency, and a need to funnel people away from the mainstream health system. The counter-narrative of Women’s Choice made it possible for me to work with the mainstream health system in what I felt to be a subversive way. I needed a place where I could speak out frankly against oppression.”

Carol Downer, Lorraine Rothman, and other women, started a self-help group in Los Angeles, which became the Feminist Health Center in 1971. These women studied women’s anatomy, physiology, and abortion techniques, and started providing abortions on their own, as well as teaching women to do their own cervical exams and inventing a technique called Menstrual Extraction, which women can use to empty the contents of the uterus manually. Northern California women caught on quickly, starting the Oakland Feminist Health Center and a network of clinics.

The new self-help clinics broke new technical ground in women’s health care, as well as breaking barriers to women becoming involved in their own health care. Vacuum evacuation was pioneered by the newly legalized self help clinics and based on the insights and research done by women’s self care groups. This is why abortion is so safe today, and women should never have to face the immense physical and emotional danger of an unwanted pregnancy. When challenges to abortion reached a fever pitch in the 1990s, Rothman again began distributing information about how woman could directly take control of their own health care, as the services at clinics deteriorated in the climate of fear, writing A Woman’s Book of Choices. Young women responded by forming new self-help groups to learn about their own bodies (Slingshot was a part of this new generation and has published information about menstrual extraction and do-it-yourself women’s health consistently.)

The clinic’s work isn’t over. As a licensed medical clinic, they must continue to provide medical records for seven years, and clinic workers plan to keep providing health information, unwanted pregnancy prevention, reproductive health information, on a street level, as the West Coast Feminist Health Project. “There is still a lot we can do without a licensed clinic,” according to Comi. This means the community can’t just mourn the loss of the clinic, but needs to keep helping to carry the burden, and organizing for reproductive freedom. “There is still hope that something will change in the political situation, or we can get a new source of funding.” The clinic is looking for storage space, legal support (the nonprofit may need to file for bankruptcy), design work, and people who want to help come up with a strategic vision.

So if you are ready to get back to the basics of grassroots feminist work, meeting in living rooms, contact them and offer you support at WCFHP, P.O. BOX 70432, Oakland, CA 94612. They also love to hear from former volunteers, and are keeping an archive, so drop a line if you were one of the many people who did everything from clinic defense to counseling, and have recollections or snapshots. “We’re not going to let them destroy us,” said Comi.