Phyllis Vine’s Fighting for RecoveryPays Homage to Judy Chamberlin, Mother of Mental Health Activism

To state that Phyllis Vine’s 324-page Fighting for Recovery: An Activists’ History of Mental Health Reform (Beacon Press, 2022) is ambitious, well, that’s an understatement. With a PhD in history, an MPH, and a brother diagnosed with schizophrenia, Vine is also the kind of journalist who can bring to life the last 75 years with objectivity, insight, and empathy. That period begins with so-called “mental patients”trapped in the post-World War II snake pits of state asylums and ends with them freely utilizing private, peer-run respite centers as alternatives to hospitalization.

Such a title implies the victory of virtuous underdogs against villainous defenders of the status quo. However, the notion of an “activists’” history is a bit of a misnomer. Although the author’s sympathies are with the “mental patients’ movement,” in part, because of her brother, BJ’s, personal stake in the outcome, she is too much the even-handed researcher and reporter to ignore the psychiatric establishment’s point of view.

Of course, any good story requires tensions between protagonists and antagonists. One of those is that, for all the progress made by the ex-patient/survivor/consumer/peer forces, “recovery” as a goal remains painfully out of reach for too many individuals and the mental health care system as a whole. An ironic case in point is that after years of inadequate and unwanted treatment, BJ eventually found the services that suited his needs, making him part of a fortunate minority.

Another caveat about the title is that the “fighting” was too often in-fighting not just on “our” (peers’) side but on the “theirs” (providers’) as well. From its founding in the late 1970s, the National Alliance on Mental Illness (NAMI) believed that, as family members, they could speak for their loved ones who were too ill and dependent to speak for themselves. This “paternalism” clashed with the avowed “self-determination” and “self-help” of psychiatric ex-patients and survivors who began organizing in the early 1970s as an outgrowth of 1960s’ political ferment. (In the last decade, NAMI has adopted a more peer-empowering agenda, but there is no space for this nuance in Vine’s history.)

This animosity was in the air when, at the first Alternatives conference in 1985 to form the National Mental Health Consumers Association, as a counterweight to NAMI and traditional organizations like the National Mental Health Association (now “Mental Health America”), the patients’ rights movement split into reformist and rejectionist wings, with notably Joe Rogers in the former camp, Judy Chamberlin and Sally Zinman in the latter, and Howie the Harp counseling compromise between the two. Such divergence in tactics undermined the impact of those “On Our Own” (title of Chamberlin’s famous memoir), which is why voluntary, self-help has morphed into (under-) paid peer support since the 1990s.

On the other side of the slate, psychiatrists enshrined their “scientific” break with psychoanalysis in the third edition of the Diagnostic and Statistical Manual (DSM) and researchers pursued neurobiological causes in search of a cure. (Initially a rebellion against psychiatry’s blaming of “schizophregenic” mothers, desperate NAMI members understandably bought into this “silver bullet” approach that also included an unholy alliance with Big Pharma.)

Meanwhile, the small Community Support Program in the National Institute of Mental Health (NIMH), whose budget never amounted to more than a few million dollars, seeded experiments not just by renegade psychiatrists, psychologists, and social workers but also the self-help efforts of ex-patients and survivors, including the initial Alternatives conferences that continue to this day.

Vine is at her best when chronicling the political intrigues within and between these countervailing forces, balancing research into primary sources, including the papers of Judy Chamberlin at UMass-Amherst, and interviews with many of the primary actors in this drama. She provides the big picture of political posturing at the state and federal levels, repeatedly demonstrating how changes in political winds and administrations, such as from Presidents Carter to Reagan and Trump to Biden snatched defeat from the jaws of victory and vice versa. Interestingly, she gives credit to Rosalyn Carter’s and Tipper Gore’s reform efforts, but ignores those of Hilary Clinton’s.

The latter missed opportunity is an example of another tension—between Vine, the mental health historian and Vine, the creative journalist. How could she be systematic and comprehensive while providing the “cinema verite” of individual scenes and actors? Sometimes I couldn’t tell whether she had more to say if space allowed or whether she overstated the importance of a particular policy or player to the detriment of others, such as devoting so many pages to the clash between Bradford Reynolds, an official in Reagan’s Justice Department and Senator Lowell Weicker (D-CT), who investigated abuses of patients’ rights.

Vine judiciously balances the limitations of the medical model, especially all the money spent unsuccessfully on biological research and medication, with the success of the drug, clozapine (“Clozaril”) for some peers living with schizophrenia. Especially intriguing is her expose of how psychiatrist E. Fuller Torry (a NAMI brother of a sister with schizophrenia) managed to raise the hackles of his own colleagues and become the chief nemesis of the peer movement with his crusade for more involuntary hospitalization of the “homeless and violent mentally ill.”

Though she credits Courtney Harding, Pat Deegan, and Bill Anthony for their ground-breaking research in and practice of psycho-social rehabilitation, and highlights such programs as Assertive Community Treatment (ACT) and clubhouses, I would have preferred her casting a wider net on how peer specialists, like me, have rounded out mental health treatment in the last quarter century.

I bristle at the constant laments by politicians, the press, peers, and even Vine that “the system is broken,” while ignoring such longtime but underfunded successes as New York City’s Mobile Crisis Teams (MCTs) that employ peer specialists as well as social workers instead of the police when responding to psychiatric emergencies. There are many other examples beyond the purview of this book review.

But, like other caveats mentioned, this does not detract from the overall brilliance and colorfulness of Vine’s portrayal. We may not be all one big happy family doing our best for the “least amongst us,” but Phyllis Vine has outlined the common ground on which mental health peers and providers have stood in the past and may continue to do so in the future.

Living with bipolar disorder for 50 years, Carl Blumenthal has been a peer specialist since 2002 and serves on the board of Baltic Street Wellness Solutions (formerly Baltic Street AEH).Full disclosure: He’s part of a family with behavioral health challenges and got his start as a peer advocate volunteering for the NYC-Metro chapter of NAMI.