Book Review: We've Been Too Patient

Image: The cover of the book is light blue with a large illustrated dandelion going to seed. A few seeds fly away from the flower in multiple directions covering the top half of the book. In the center of the book in large white illustrated letters reads "We've Been Too Patient." Below that in smaller, navy blue letters reads "Voices from Radical Mental Health." Below that in slightly smaller white capital letters reads "STORIES AND RESEARCH CHALLENGING THE BIOMEDICAL MODEL." Across the bottom of the book are the author's names in navy blue letters "L.D. Green and Kelechi Ubozoh, Foreword bu Robert Whitaker."

As the cover of the book shows, "We've Been Too Patient" is a collection of voices from radical mental health movements in a variety of mediums including storytelling, poetry, academic essays, and other types of nonfiction. It is organized into two larger sections- narratives and interventions- allowing contributors to share stories and offer solutions. This book did a relatively good job of being inclusive of a wide range of voices from people who have identified with, been diagnosed with, or otherwise personally experienced mental health disturbances in ways that were medicalized (with and without their consent.) This is a refreshing update from a lot of radical mental health voices that were often heard the most- mainly middle class white people with depression and anxiety disorders (whose voices have also helped me immensely, don't get me wrong.) This book offers a much needed expansion on the topic and I am happy to see that it will likely be accessed by wider audiences outside the movements such as mental health professionals currently immersed in the biomedical model. I am going to use diagnostic terms in this review for brevity's sake and because I honestly don't have a wide enough vocabulary to know how to describe these experiences otherwise. However, I do not intend to label anyone's experience. I have chosen to share more personal anecdotes than I usually do in reviews because it was the only way I could think of to properly explain my nuanced perspective.

I want to start with two minor notes, one positive and one negative. 

First, this is not something I normally discuss, but the graphic design of the print version of this book is really lovely. The use of different complementary fonts, light grey graphics, and dandelion seeds scattered across each chapter was a really nice touch and made for an enjoyable experience of a tough subject.

Second, there is a troublesome problem with the foreword of this book. Given that Deaf communities are used as a model for radical mental health movements in more than one instance in the book, it was pretty disappointing that Robert Whitaker used "deaf" as a pejorative at least 5 times in his only 8 page introduction. I am not sure if it was not properly edited, or if it was included after the rest of the book (which is very well edited) was put together. I won't dwell on it much longer, but it should have been addressed.

Moving on... I have fairly long history with radical mental health communities and literature. Some of it was amazing and probably saved my life. The Icarus Project literature was handed to me at a time that I really needed it and it changed me for the better. At other times, some aspects of these communities and ideas created struggles for me and other members. I do believe that sometimes, individuals in radical mental health movements can swing into territory that often excludes those with the most severe symptoms and or struggles with mental health. In their valid and desperate attempts to escape the often abusive biomedical psychiatric model, they'd create a polar opposite model and express that there is no mental illness, only problems with society and environment. This lacked nuance and mainly manifested in people reducing everyone into a category of creative artists with "dangerous gifts," claiming mental illness was not actually an illness, just a different way of thinking pathologized by society. There is a lot of truth to this, but it can be all too reductive. There are many radical people who have never and will never consider themselves particularly creative nor do they see their mental health struggles as gifts in any way. A similar critique can be made of the social model of disability. There have been healthy disabled people who claim that with societal and environmental changes, all disabled people could have access to the world as abled people do. But, for unhealthy disabled people- such as those with chronic illness(es)- this would surely improve things and help, but would not make their struggles disappear.

I am a person who has dealt with psychiatric abuses and has been in the system in some shape or form since I was 9 years old. I have had the bruises on my arms from hospital workers being rough for the fun of it and was on a giant cocktail of psych meds (including some later taken off of the market for destroying organs) as a teen that I believe caused damage to my development. I also got a B.S. in psychology, did research in cognitive neuroscience, worked in a clinical facility for people with intellectual disabilities and mental health struggles, and still voluntarily go to therapy because I believe that psychology holds many truths. Along with my personal experiences, have one parent who died by suicide and another that has extremely severe, near constant paranoid psychosis. They refuse any treatment and live in a nightmare world. When you have a beloved and caring parent who claiming everyone around them is part of a vile government conspiracy to destroy them because of something they wrote on their computer; someone who is getting into fights with people on the street for being "in on it;" someone who is banging on your windows or yelling in your face in the middle of the night after hearing voices telling them you are being pimped out for heroin by your roommate to the free masons and lying about it; someone who later claims you are dead and visit them as an angel to tell them that the corporeal version of you is an evil doppelganger; someone who gets arrested 3 times in one week- once found sitting in the middle of a highway in the dark- and who disappears for years at a time to escape anyone who tries to help, it becomes very distressing to hear all of this boiled down to just a "different way of thinking" or just a manifestation of a struggle with "dangerous gifts."

Did the state of the world, trauma, stressors, triggers, and other circumstances outside of biological functions play a huge and dominating part in this? Absolutely. But, I have spoken to radical mental health community members who experience psychosis who shared that it is only (often non-consensual) hospitalization and/or drugs that help them get out of psychosis. They shared that it was terrible every time and that the system needed major improvement, but it would happen any time they stopped their meds. They often feared judgment from other radical mental health people if they spoke the truth about this. One of the only essays in the book that centers psychosis- by Imogen Prism- touches upon this in stating, "For me, meds do the job. They do it quicker and dirtier, and with potentially devastating long-term results, but they do the job." They express that they have survived 4 involuntary hospitalizations within terrible often medieval institutions. They also admit that they are "not sure" of the solution. They do offer many ways that they have found within and outside these systems that work for them and may work for others. This was very real, honest, and was one of the best essays in the book.

While the phrase "dangerous gifts" is used multiple times by multiple contributors in this book, they use it in a way that it was likely intended by its original creators- as descriptors of how they relate to their own experiences with mental health struggles- not a dismissal of any need for medical intervention. There is a constant focus on adopting recovery and harm reduction models over biomedical models- which is something I whole-heartedly agree with. The adoption of trauma informed therapy and community models of mental health and support were and still are some of the best teachings that come from radical mental health movements. Many writers shared very real experiences with pain and heartache that came with their struggles along with tangible techniques they used to keep themselves stable enough to enjoy life. Some of the people who were involved in founding radical mental health communities like The Icarus Project went on to get degrees and positions in psychology fields and are bettering the system. 

There was only one academic essay- by Jonah Bossewitch- that manifested my aforementioned issues with the "dangerous gifts" and "mental health issues are not illnesses, just problems with society" type of thinking, but the essay also offered a lot of really good history, information, and critiques. So, I still consider it a very positive and necessary contribution to the book. The entries by Kelechi Ubozoh were particularly informative in that they included both stories of her personal and community experiences with mental health along with a large catalogue of suggestions of how to deal with mental health struggles. She also brought a personal perspective that included the intersection of race, gender, and Black community with mental health struggles. These are conversations that Black people have been having for some time, but they have not been centered enough in radical movements.

The epilogue of the book by Jessie Roth ties everything together in recapping the need for recovery and harm reduction models over purely medical models. They also remind the reader to look at the book as a whole. The wide variety of voices make it clear that these communities are not one dimensionally anti-psychiatry (like scientologists, for instance.) They remind the reader that for some people, medications are ok, they and the system just need a ton of improvement.

The only thing that I think this book needed was more voices talking about psychosis and the best ways to cope with it, particularly when it becomes dangerous (usually for the person suffering it more than anyone else.) Psychosis is one of the experiences that is punished tortuously in institutions and represents a huge amount of people- especially sufferers of color- that are murdered by police. Some techniques that work for non-psychotic disorders like depression may help, but psychosis also needs it's own focus. I still often feel lost in finding ways to navigate that aspect of mental health crises. I believe this book could appeal to a wide variety of readers from people like me to completely unexposed psychiatrists in the field looking to update their education. In fact, the latter group needs to read this book. The voices represented here are far reaching and diverse and the people contributing were willing to be vulnerable and share their lives with us. This is more difficult than many people may imagine. So, to those in the field, accept this gift with open arms. We all could learn a thing or three.

This was also posted to my goodreads.