On the website of a leading client business we read, “Our mission is to advocate for the rights of mental health clients everywhere.” A leading integrated services agency says similarly on its website, “Join the fight for equal rights for people with mental illness? Contact ..” I’ve wrestled with my thinking a long time to understand why I’m not moved as I should be. Obviously patients’ rights are important, but this rings out as ‘too adversarial’ for me: I’m a sensitive person, a person with a Vision, not a combat person.

The first thing I picked up on, some thirty (30) years ago when I first ran into an early version of this perspective, was an organization problem. I had been a successful community organizer within a mental patients liberation framework, already by then, but what I saw there was bad organizing. Saul Alinsky advocated for a radical method of organizing the disempowered and the marginalized: He said the cause is not so important, what matters is putting the people in motion and creating an activist core. I heard in this, “A nurturing style of organizing is counter-indicated, we should select out a few of the most competitive people and weed out the rest.”

Eventually I’ve come to realize that this exclusionary top-down strategy is reinforced by the entitlement regime that dominates the lives of mental health clients. What we find is a self-help politics which fights for ‘self-help’ services as a kind of ‘entitlement’ for the client activists. This is unfortunate because it attributes responsibility to the managers of the system rather than laying it on the ethical standing of the client activists themselves. This tends to promote a competitive environment on the clients, likewise it tends to discourage accountability of the clients to client values, to the client culture.

The alternative broader tool for the clients than a simple patients’ rights advocacy is a work program for civility, for earning respect via social accountability. This is the tool I’m learning to call ‘client psychology’, the mentality of creatively managing an adversarial behavior management regime. This approach does not lead us to enhance our sense of entitlement to an unhealthy level of selfishness, rather it moves us to connect deeply with the moral balance of our social existence. Ultimately this challenges the essentially behaviorist methodology of psychology, as those involved directly in madness issues construct a new civility, one that makes society behave differently.

Andrew Phelps