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Abstract

Los grupos de apoyo mutuo son una de las acciones colectivas más presentes en el movimiento de salud mental en primera persona o movimiento loco. Entre sus precursores se han destacado, principalmente, distintas propuestas de movimientos sociales y de perspectivas comunitarias y colectivas en salud. En este artículo realizamos un recorrido histórico señalando, como antecedentes, diferentes acciones del movimiento de liberación de las mujeres y el movimiento de salud de las mujeres. A partir de dicho recorrido, realizamos un análisis crítico considerando tres ejes para comprender la emergencia de acciones colectivas en salud mental: la experiencia personal en relación con lo sociopolítico; la construcción de sujetos políticos y de conocimiento; y las relaciones de poder en la gestión de la locura y el malestar psíquico. Mostramos cómo los grupos de apoyo mutuo, en el contexto del movimiento loco, dan continuidad a las trayectorias de gestión colectiva y feminista de la salud, y se posicionan como herramientas para la creación de procesos políticos en distintos contextos socioculturales.
Articles / ARTÍCULOS
SALUD COLECTIVA. 2021;17:e3274. doi: 10.18294/sc.2021.3274
Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2021.3274
Feminist precursors of mutual support groups in
the mad movement: a historical-critical analysis
Antecedentes feministas de los grupos de apoyo mutuo
en el movimiento loco: un análisis histórico-crítico
Grecia Guzmán Martínez1, Margot Pujal i Llombart2, Enrico Mora Malo3, Dau
García Dauder4
1Corresponding author.
PhD Candidate, Program of
Studies in Person and Society
in the Contemporary World,
Departament of Social
Psychology, Universitat
Autònoma de Barcelona.
Member, Reseach Group
Des-Subjectant_Lis. Activist,
mad movement. Barcelona,
Spain. *
2PhD in Social Pyschology.
Associate Professor of Social
Pyschology, Departament
of Social Pyschology,
Universitat Autònoma de
Barcelona. Coordinator,
Research Group Des-
Subjectant_GESPGI,
Universitat Autònoma
de Barcelona, Instituto
Interuniversitario de Estudios
de Mujeres y Género.
Barcelona, Spain. *
3PhD in Sociology. Associate
Professor, Departament
of Sociology, Universitat
Autònoma de Barcelona.
Coordinator, Research
Group Lis-Estudios
Sociales y de Género
sobre la subjetividad, la
corporalidad y el sufrimiento
evitable. Member, Instituto
Interuniversitario de Estudios
de Mujeres y Género.
Barcelona, Spain. *
4PhD in Social Pyschology.
Associate Professor,
Universidad Rey Juan Carlos
de Madrid. Madrid, Spain.
*
ABSTRACT Mutual support groups are one of the most important collective actions in
the psychiatric survivors movement or mad movement. Among its precursors, different
proposals from social movements and community perspectives on collective health have
been mainly well-known. In this article we carry out a historical overview of their an-
tecedents, pointing out different actions from the Women’s Liberation Movement and
the Women’s Health Movement. From this, we perform a critical analysis considering
three axes to understand the emergence of collective actions in mental health: personal
experience in relation to the sociopolitical structure; the construction of political subjects
in this eld; and power relationships in the management of madness and psychological
discomfort. We show how mutual support groups, in the context of the mad movement,
give continuity to the trajectories of collective and feminist health actions, and are posi-
tioned as tools for the creation of political processes in different sociocultural contexts.
KEY WORDS Mental Health, Feminism; Social Support; Collective Health.
RESUMEN Los grupos de apoyo mutuo son una de las acciones colectivas más presentes
en el movimiento de salud mental en primera persona o movimiento loco. Entre sus
precursores se han destacado, principalmente, distintas propuestas de movimientos
sociales y de perspectivas comunitarias y colectivas en salud. En este artículo realizamos
un recorrido histórico señalando, como antecedentes, diferentes acciones del movimiento
de liberación de las mujeres y el movimiento de salud de las mujeres. A partir de dicho
recorrido, realizamos un análisis crítico considerando tres ejes para comprender la
emergencia de acciones colectivas en salud mental: la experiencia personal en relación con
lo sociopolítico; la construcción de sujetos políticos y de conocimiento; y las relaciones
de poder en la gestión de la locura y el malestar psíquico. Mostramos cómo los grupos
de apoyo mutuo, en el contexto del movimiento loco, dan continuidad a las trayectorias
de gestión colectiva y feminista de la salud, y se posicionan como herramientas para la
creación de procesos políticos en distintos contextos socioculturales.
PALABRAS CLAVES Salud Mental; Feminismo; Apoyo Social; Salud Colectiva.
2GUZMÁN MARTÍNEZ G, PUJAL I LLOMBART M, MORA MALO E, GARCÍA DAUDER D.
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INTRODUCTION
Mutual support groups have a long trajectory
in the health eld that can be traced to dif-
ferent precedents, environments and meth-
odological perspectives. In general terms, the
development and initiation of mutual support
groups has been studied based on social(1)
and associative(2) movements that consider as
a starting point the needs of those affected.
The precursors of mutual support groups have
also been studied from the perspective of
community mental health,(3) the social model
of health(4) and collective mental health.(5,6)
Other precedents can be found in an-
thropological studies on self-management of
health processes, such as those carried out by
Eduardo Menéndez on the self-care of illness
and the management of alcoholism.(7) Studies
on mutual support groups that emerged in re-
sponse to the crisis of the Welfare State can
also be highlighted, namely in Catalunya.(8)
Also important to mention are studies that have
incorporated debates regarding the autonomy
of groups with respect to the practice of health
professionals of different specialties.(9)
Specically in the mad movement, some
of the most recognized theoretical-practical
precedents are Prior Kropotkin’s mutual aid,
the Alcoholics Anonymous self-help groups,
Paulo Freire’s liberation pedagogy, the work
of Carlos Martín Beristain and Fransec Rieira
on the community as support, and the Hear-
ing Voices Network, among others. In mental
health and within the Mad Pride movement,
mutual support groups arise from the needs
of people who hear voices, survivors of psy-
chiatry and people with psychic suffering, to
generate safe spaces (independent from the
health system) to share their own experiences.
The feminist movement and feminist
theory have generated important knowledge
and practices in the eld of health through-
out their development. Feminist activisms
and feminist studies in health have brought
together knowledge from different disciplines
to reexamine, among other things, different
health-diseases processes in women’s mental
health, as well as to critique gender biases, the
reproduction of inequalities, and the violence
exercised in psychiatric practice.(10,11,12,13,14,15)
In this article we develop a historical and
critical analysis that reveals possible intersec-
tions and parallels among the development
of mutual support groups in the context of
the mad movement (and, more concretely,
in groups with a gender and feminist orienta-
tion), and the collective and group proposals
of the feminist movement (specically in re-
lation to health and mental health).
The aim of tracing these intersections and
parallels is, on the one hand, to identify com-
monalities among the methodological and
epistemological proposals of different collec-
tive processes in the feminist movement and
the mad movement. On the other hand, we
seek to lend visibility to the historical, epis-
temological and political distance that has
marked the relationship among feminisms,
madness, and pyschiatrization processes, and
has been analyzed in different texts particu-
larly connected to mad activism.(16,17,18,19,20,21)
In this way, we are interested in outlining
this historical-critical relationship to highlight
not only parallels but ruptures, and to recog-
nize the potentialities and limitations of social
movements regarding their agencies in men-
tal health. Taking into account the diversity
in feminist movements, we will specically
center on the intersections among the wom-
en’s liberation movement, the feminist con-
sciousness-raising movement, the women’s
health movement, and the mad movement.
The article is written principally based on
the rst author’s experience in the mad move-
ment and in migrant and antiracist move-
ments with feminist perspectives. It collects
reections that are the fruit of a constant en-
meshment of her painful/healing experiences
in relation to eating, the possibilities of re-
sistance to pyschiatrization, the experiences
of migration, and professional and academic
training in social psychology. Also present is
her participation in different mutual support
group networks, in Spain and Latin America,
that have sustained her in different ways. All
members of the author team share a number
of spaces of research, activism and feminist
study.
Feminist precursors oF mutual support groups in the mad movement: a historical-critical analysis 3
SALUD COLECTIVA. 2021;17:e3274. doi: 10.18294/sc.2021.3274
This article also forms part of a study in
progress analyzing encounters and disagree-
ments among feminisms, the psychological
sciences and social movements in relation
to mental distress and madness, particularly
based on historical and documentary analysis
with feminist perspectives.
In this article, we rst present a historical
overview that contemplates the development
of feminist consciousness-raising groups, self-
help groups in the women’s health movement,
psychotherapeutic groups with a feminist ori-
entation, and nally, mutual support groups
within the mad movement. We emphasize
feminist views of mental health within these
groups, and we present some of their primary
methodological characteristics and their rela-
tionship to the historical and political context
in which they emerged.
In the following part of the article, we
develop a critical analysis based on three
categories that have been fundamental in the
social sciences, critical theory and feminist
epistemology and that we propose will help
to understand the complexity of the emer-
gence of collective and self-management
processes in mental health. In order to meet
the previously described aims, the references
we have utilized are primarily books that
have been of historic importance in the de-
velopment of the feminist movement and the
women’s health movement, as well as recent
articles regarding Mad Pride, mutual support
groups, the feminist politicization of distress,
and mad feminism; and, also signicantly,
activist texts in different formats coming from
blogs, social networks and special publica-
tions, and that show the development of the
groups in the political contexts of feminism
and the mad movement.
PRECURSORS
Consciousness-raising groups
Feminist consciousness-raising, a “radical
weapon”(22) and an “uncomfortable trea-
sure,”(23) has dened a large part of the move-
ment since the 1960s. Although its prece-
dents can be identied in different contexts
and time periods,(24) Kathie Sarachild, from
the USA, is attributed the formal coining of
the term in 1968, to dene the practice of
collectivizing personal experiences among
women regarding their social situation, and
giving these experiences political meaning
that leads to transformative action.
This effort materialized into feminist
consciousness-raising groups, sometimes
called “bitch sessions,”(22) a group practice of
support formed in the heart of radical fem-
inism (concretely, in the group New York
Radical Women). Among other things, these
groups allowed women to connect to their
feelings and desires in order to communi-
cate their subjective experiences in their ev-
eryday lives, sentiments including rage and
angst.(25,26) In this practice, hearing the simi-
larities in lived experiences among women
validated these experiences and gave them
meaning in terms of systematic oppression.
The groups were created spontaneously, with
minimal structure and with the commitment
of establishing nonhierarchical norms that re-
inforced decision-making through consensus
and specied that every participant shared
the same responsibility for the content and
process of the group.(27)
According to Sarachild herself, in addi-
tion to assuming, among other things, “that
our feelings are saying something politi-
cal,”(28) “the purpose of consciousness-raising
is to reach the most radical truths regarding
women’s situation in order to take radical
action,”(18) which would inevitably bring
about “a transformation in the spirituality of
the patriarchal era” by permitting the “leap
to ‘subjects’ of women who recognize one
another as complete human beings.”(29) The
consciousness-raising groups practice resis-
tance against a patriarchal culture and society
that have historically established the associ-
ation/dissociation between subject-man-mas-
culinity-culture-civilization-mind-rationality
and object-woman-femininity-nature-savage-
ry-body-irrationality.(30)
Indeed, “the consciousness-raising gath-
erings emerged from writings that formulated
the basic theory of the women’s liberation
4GUZMÁN MARTÍNEZ G, PUJAL I LLOMBART M, MORA MALO E, GARCÍA DAUDER D.
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movement”(31) in the United Sates, recogniz-
ing that “this was just the start of a radical
comprehension of women and of other issues
like class, race and revolutionary change.”
Throughout the following two decades,
the radical weapon of feminist conscious-
ness-raising would coexist with practices man-
aged by women themselves beyond the USA
and Europe, and would transgress compul-
sory heterosexuality and the bourgeois white
feminism of the upper-middle class. Some
examples, highlighted by Francesca Gar-
gallo,(31) include a number of spaces in Latin
America established in response to military
dictatorships and US imperialism starting in
the 1970s. Such activist practices came from
combatant leftist women who declared them-
selves autonomous from male political organi-
zations. Among other things, they prioritized
working with women from the laboring class
and levied important critiques at the feminist
demands of consciousness-raising and auton-
omy without combatting poverty and lack of
access to education and health care.
This same author highlights how, in the
1970s, these women did not allow the prac-
tice of consciousness-raising in small groups
to be established as their only political ex-
pression. Among other things, they constantly
questioned the lines between feminist groups
and women’s movements. They also gath-
ered to discuss the political problems of their
countries and to manifest their solidarity with
women living under military dictatorships.
Shortly thereafter, in 1981, the groups
Grupo de Autoconciencia de Lesbianas Fem-
inistas (GALF) in Peru and Ayuquelén in
Chile emerged, both connected to other so-
cial and political struggles, allowing for the
“generation of radical political thought and
action by explaining how heterosexuality
was a normative and compulsory system with
terrible effects for women at the economic,
social, cultural, symbolic and emotional lev-
els, limiting their autonomy and freedom.”(32)
As Martha Zapata(33) describes, in Mex-
ico the conceptualizations of the rst con-
sciousness-raising groups were directed at
developing a strong notion of autonomy
and independence in relation to politics and
political institutions. This character perme-
ated the development of the movement pri-
marily during its rst decade, and would later
shift into logics centered on solidarity and
identities.
Such experiences include projects like
the La Revuelta collective, as well as leftist
activist initiatives closely connected to aca-
demia, in which women began to meet in
order to talk about their social situation, po-
liticizing their relationship with their bodies
and desires, and questioning the use and con-
ceptual categories of language.(31)
More recently, this practice has been re-
covered by feminist activists in different con-
texts in Mexico. One example described by
Layda Jackqueline Estrada Bautista(34) is the
experience of the collective El Akelarre in the
city of Xalapa, Veracruz, that emerged as the
initiative of a group of women who sought
to share knowledge and space in an environ-
ment of safety, freedom and support among
participants.
While in their rst decades of existence
the consciousness-raising groups represented
a collective way to face discontent and op-
pression, as well as the consequences of the
unequal legal situation of women within the
patriarchal structure, on a number of occa-
sions the radical feminists expressed their
refusal to consider these groups a type of
therapy. They explained that the conscious-
ness-raising groups were not seeking individ-
ual solutions and that participants were not
reected in the mirror of disease.
In 1969, Carol Hanisch(35) in the text
“The personal is political,” says that:
Therapy assumes that someone is sick
and that there is a cure, e.g., a personal
solution. [...] Women are messed over,
not messed up! We need to change the
objective conditions, not adjust to them.
Therapy is adjusting to your bad per-
sonal alternative.
That same year, Irene Peslikis(36) of the Red-
stockings collective explained that the idea
that women’s liberation is a type of ther-
apy is in fact an impediment to developing
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SALUD COLECTIVA. 2021;17:e3274. doi: 10.18294/sc.2021.3274
feminist consciousness. This is because it im-
plies thinking that oneself and others can nd
purely individual solutions to one’s problems
and, additionally, because it reproduces the
belief that if women get together to analyze
and study their own experiences it is be-
cause they are sick, and not because they are
revolutionary.
From Italy in 1970, Carla Lonzi and the
collective Rivolta Femminile(29) explain that
“feminist consciousness-raising is different
from all other types of self-awareness, in
particular that proposed by psychoanalysis,
because it takes the problem of personal de-
pendency to the heart of the female species.”
In this context, the critiques and debates
among Dorothy Tennov,(37) Hare-Mustin(38)
and Laura Brown(39) about feminist psycho-
therapy as an “oxymoron” should be high-
lighted, as well as the concern “while waiting
for the revolution, what do we do?”
Emergence of self-help groups
In the same decade, the emergence and ex-
pansion of the consciousness-raising groups
established the bases for the development of
self-help groups (or “self-knowledge groups”
in the Spanish translation) in women’s health,
being particularly representative the collec-
tive reappropriation of bodies through the use
of speculum, the denouncement of violence
in gynecology and self-knowledge in sexual
and reproductive care. The groups emerged
as a critical movement in themselves, within
the women’s health movement, in that they
made it possible to examine how the deci-
sions about women’s health generally fell to
male doctors.(26)
As Nancy Tuana(40) describes, the wom-
en’s health movement, widespread in the US
in the 1970s and 1980s, was not just a liber-
ation movement but also an epistemological
movement of resistance, in the sense that it
made possible to share, construct and redis-
tribute knowledge and power based on ex-
periences and bodies in ways not shaped by
sexism and androcentrism.
While the self-help groups were being
developed in health, mental health profes-
sionals like Phyllis Chesler and Jane Ussher
in the US, Ellen Showalter in England, Franca
Basaglia in Italy, Mabel Burin in Argentina,
and Carmen Sáez in Spain, among others, de-
nounced the patriarchal causes of distress, as
well as psychiatric violence and its particular
consequences in women.
Starting in the 1980s, and inuenced by
both radical feminist consciousness-raising
and Betty Friedman’s The feminine mys-
tique with the idea of the problem that has
no name, self-management in health began
to formally take on the experience of distress
and mental health. Some of the organizations
in the USA most recognized for their work in
holistic and community health, including not
only physical but psychological health in net-
works of self-help groups, with both a gender
and anti-racist perspective, are: the National
Black Women’s Health Project (NBWHP),
the Native American Women’s Health Ed-
ucation Resource Center (NAWHERC), the
National Latina Health Organization, and the
SisterSong Women of Color Reproductive
Justice Collective, among others.(26)
These organizations were formed by
black women, women of color and indige-
nous women, who reshaped self-help to in-
clude the health problems most prevalent in
their communities. In addition to physical
health, they were concerned with suffering
related to racism and colonialism, as well as
difculties derived from their exclusion from
health systems (including the reproduction
of racist and sexist biases in health services,
and the little familiarity of professionals with
non-dominant cultures and religions). In this
sense, “the whole process of self-help was
supposed to lead to social justice work.”(26)
The self-health groups expanded rapidly
throughout the US with the goal that women
would acquire for themselves an active role
in their own health, from learning to moni-
tor their own blood pressure to the collective
management of psychic distress.
Their development was marked by differ-
ent debates regarding the role of profession-
als within the groups,(41) the contradictions
6GUZMÁN MARTÍNEZ G, PUJAL I LLOMBART M, MORA MALO E, GARCÍA DAUDER D.
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and the risks of reproducing conventional
medical discourses,(42) the particularities of
their emergence in the context of the devel-
opment of neoliberal policies (specically in
the US) and their possibilities and limitations
as a form of resistance.(7) An ample litera-
ture-based and empirical description of the
development of self-help groups in the wom-
en’s health movement in this context can be
found in Hannah Grace Dudley Shotwell’s
doctoral dissertation “Empowering the body:
The evolution of self-help in the women’s
health movement.”(26)
By the end of the 1970s, women’s emo-
tional self-defense groups were also in ex-
istence and were dynamized by feminist
activists and professionals who explained:
Changes in the status of women and the
roles they are seeking to play in modern
society have necessitated rapid attitude
and behaviour change on the part of a
large number of women. Mental health
professionals are being asked increas-
ingly to facilitate such change.
All of the above would mark an important
step towards the professionalization of fem-
inism in the mental health eld.
Feminist group pyschotherapy
As Carolyn Zerbe(44) observes, conscious-
ness-raising groups and health self-help
groups, along with the development of a fem-
inist theoretical framework regarding wom-
en’s mental health, established the bases for
the development of different methodologies
in group psychotherapy, in an attempt to uti-
lize the tools of consciousness-raising to break
with traditional forms of therapy, as well as
to transgress androcentric models of mental
health and maintain a feminist commitment to
connecting the personal and the political.
In Ibero-America, the following experi-
ences of feminist-oriented group work can
be highlighted: the therapy groups oriented
towards homemakers with depression de-
veloped by Carmen Sáez Buenaventura(45);
the reection, economic dependency and
mental health of women groups by Clara
Coria(46); the women’s therapeutic groups
by María Asunción González de Chávez,
Carmen González Nogueras and Lucia Val-
dueza(47); and group reencounter therapy by
Fina Sanz,(48) among others.
Overall, these initiatives all aim to gen-
erate consciousness regarding gender condi-
tions and inequalities and their repercussions
in subjective distress, as well as recognition
of the possibilities of resistance and decon-
struction. Additionally, as they consider
women as agents of health,(49) some of these
groups made it possible for participants to
acquire the tools needed to initiate similar
group processes outside of the initial psy-
chotherapeutic context. Agents of health are
“those individuals and/or collectives who,
knowing the community’s resources, use
those resources to improve quality of life,
which undoubtedly has an effect in psychic
well-being.”(49) It should be highlighted that
these initiatives coincide temporally with the
work carried out by part of the antipsychiatry
movement, in which (despite the movement
being largely lead by men) a number of femi-
nist women were key: Franca Basaglia (Italy),
Mari Langer (Argentina), Sylvia Marcos (Mex-
ico), Carmen Sáez Buenaventua (Spain), and
María Huertas (Spain), among others. In the
same way, in these processes the epistemo-
logical proposals and the ethnographic work
of the eld of collective mental health(50)
stand out, allowing for the recognition of
knowledge not necessarily delimited by the
hegemonic epistemologies in the medical
eld in Spain(6) and Latin America.(5)
Mad Pride and mad feminism
In parallel, the 1970s, 1980s and 1990s
would be crucial for the creation of meanings
and political practices in the eld of mental
health led by the very people psychiatry di-
agnosed. These decades implied a critical
review of both feminist psychotherapy and
the feminist movement in general, including
consciousness-raising groups and the radical
Feminist precursors oF mutual support groups in the mad movement: a historical-critical analysis 7
SALUD COLECTIVA. 2021;17:e3274. doi: 10.18294/sc.2021.3274
context in which they emerged. Such cri-
tiques would be raised by people who had
experienced intense psychic distress, mad-
ness and psychiatric oppression, including a
number of feminist activists.
For example, in 1975 Judi Chamberlin
explained the need to create an autonomous
movement in which the people who were
experts by experience would be the ones to
speak of madness and psychiatric oppres-
sion. In her text, Chamberlin describes how
feminist analyses that only address the sexist
components of psychiatric practice ignore
the situation of psychiatrized people/mental
health service users and former service us-
ers/patients as an oppressed group.(16) Three
years later, she published the book On our
own: patient-controlled alternatives to the
mental health system, which is considered
one of the foundational texts of Mad Pride.
Along these lines, Dee dee Nihera pub-
lished in 1985,(51) along with Persimmon
Blackbridge and Sheila Gilhooly an im-
portant critique of the feminist movement’s
overlooking of psychiatric violence and its in-
visibilizing of sanism or mentalism(16) within
the movement and in feminist professional
practice:
I have been named “pshycho” and
“schizo” by feminists who disagreed with
my opinions, and I have found myself
incarcerated by feminists with degrees,
indoctrinated in patriarchal ignorance.
These are not isolated incidents. I’m not
the only madwoman treated this way by
feminists and by society at large.(51)
In 1990, Kate Millet wrote The Loony-Bin
Trip, narrating her experiences of madness
and psychiatric internment and reclaiming
the space of madness for generating feminist
resistance.(15) Eight years later, recognized
feminist Shulamith Firestone would publish
Airless spaces. In the book she narrates her
own experiences in a poetic register that
speaks of the intersections among madness,
precariousness and psychiatrization. Years
later, after Firestone’s death, other activists
like Susan Faludi would recognize a certain
abandonment on the part of the feminist
movement regarding the process of psychic
distress, psychiatrization and precariousness
of some of its members.(52)
In 1993, the rst Mad Pride protest was
held in Toronto, and a year later, in 1994, Judi
Chamberlin would debate Phyllis Chesler’s
position (with precedents that can be traced
years earlier), demanding, among other
things, the right to self-representation for psy-
chiatric survivors.(53) These and other critical
reviews of psy professionals on the part of
activists go deeper, questioning the “mental
illness business” regardless of whether it is
exercised from a place of feminism.(51)
Along these lines, different activists
have questioned the lack of representation
of women and queer people, including the
reproduction of patriarchal and colonialist
logic within the mad movement itself, as well
as the lack of referential gures represent-
ing the diversity and complexity of madness
and experiences in mental health institutions
marked by other types of institutional vio-
lence.(54,55,56,57,58,59,60,61)
Recently, the activism of mad feminisms
has looked at these critiques in greater depth,
defending a feminist perspective of madness,
as put into evidence by different activist
scholars.(14,16,17,18,19,20,53,54,59,60,62,63,64,65,66,67)
A brief summary of the development
of mutual support groups in the mad
movement
Starting in the 1990s with the emergence of
Mad Pride, critical activism in mental health
was for the rst time led by “experts by expe-
rience,” similar to what would occur in the
Independent Living Movement,(68) generating
meaning for dissidence and the politization of
madness based on rst-hand experience.(69,70)
In its development, the participation of
feminist activists would be crucial, activists
like Judi Chamberlin or Kate Millet who took
on the political identity of “survivor of psychi-
atry” or “madwoman” as an act of resistance.
Additionally, as was promoted by the wom-
en’s health movement, a number of proposals
8GUZMÁN MARTÍNEZ G, PUJAL I LLOMBART M, MORA MALO E, GARCÍA DAUDER D.
SALUD COLECTIVA. 2021;17:e3274. doi: 10.18294/sc.2021.3274
would align with what Dee dee NiHera had
defended in the early 1980s:
I advocate survivors [of psychiatry] leav-
ing the professionals and creating peer
alternatives rather than participating with
professionals in reforming their system of
support for us.(51)
Along these lines, one of the most visible strat-
egies starting in the 2000s was the conforma-
tion of mutual support groups. In the context
of the Mad Pride movement, these groups
have had diverse applications, although they
all coincide in certain key aspects. While
the groups’ particularities also merit deeper
analysis, including their political positions
regarding the mental health apparatus (and
its patriarchal, colonialist, and capitalist log-
ics present both in and out of the Mad Pride
movement), certain common bases include:
self-management external to professional
practice and the mental health apparatus;
not seeking therapeutic ends (although the
groups may have “therapeutic effects”) as
a possible alternative (in some cases, as a
“complement”) to the psychotherapeutic and
psychiatric approach to distress; and facing,
collectively, the violence experienced within
the mental health system.(2,71,72) The mutual
support groups have meant a support strategy
in processes of demedicalization, as has been
shown by different collectives and research
studies specically situated in the Chilean
context,(73) although other alliances, not
necessarily or formally organized as mutual
support groups, have also been described as
representative of the same processes.(74)
At present, a number of studies, materials
and experiences can be found that are the fruit
of the systematization/socialization of activist
knowledge over time. To mention just some
of these initiatives in the Ibero-American
context (although this compilation may be
quite limited), in Spain these include: Xixón
Voices, Xarxa GAM, ActivaMent Catalunya
Associació, Radio Nikosia, Federación Anda-
luza En Primera Persona, Proyecto Ícarus, Fli-
pas GAM, Grupos de Apoyo Mutuo en salud
mental de Valencia, Colectivo ZOROA and
INSANIA*, among others. More references
in this same geographic context can be found
in compilations such as the one elaborated
by Marta Plaza.(75) In Latin America, Colec-
tivo Chucán, Autogestión Libre-Mente, Locos
por nuestros derechos, and Grupo de Apoyo
Mutuo Buenos Aires, among others, can be
mentioned. In this context, activists of the
Red Esfera Latinoamericana de la Diversidad
Psicosocial have shared different experiences
regarding the creation and continuity of mu-
tual support groups in Uruguay, Peru, and
Costa Rica,(76) and SinColectivo has done the
same in Mexico.(77)
Throughout their development, some
groups were generated explicitly as projects
for women and queer people, such as the
“non-mixed” mutual support of Colectivo
InsPiradas, and the women’s groups of the
collectives Grupos de Apoyo Mutuo en salud
mental de Valencia, ActivaMent Catalunya
Associació, and Radio Nikosia; and others
were established with decolonial and an-
tiracist perspectives, such as the Círculo de
Feminismo Loco Latinoamericano and To-
loache-Red Antirracista de Locura Feminista.
CRITICAL ANALYSIS
Given the previous historical background, we
develop below a critical analysis applied to
health, based on three elements that emerge
from contemporary critical theory, the social
sciences and feminist epistemology: the di-
chotomy individual-society (translated to the
relationship between personal experience
and the social structure); the construction of
political subjects and subjects of knowledge;
and power relations.
The choice of these categories of analysis
respond to the article objectives. They allow
us to analyze:
1. How some of the overlap between Mad
Pride and feminist perspectives have
generated counterhegemonic forms of
understanding the subjectivities and per-
sonal experience of distress and madness,
Feminist precursors oF mutual support groups in the mad movement: a historical-critical analysis 9
SALUD COLECTIVA. 2021;17:e3274. doi: 10.18294/sc.2021.3274
especially based on a criticism of patri-
archy and other systems of oppression,
which are articulated in different forms of
psy violence.
2. How feminism and the demands of Mad
Pride have allowed for the construction of
political subjects and subjects of knowl-
edge, as well as different strategies of re-
sistance to the distress and violence of
pyschopathologization and psychiatriza-
tion processes. While these strategies gen-
erate discord in their development, it is
from this place they transform the concept
of “mental health” itself.
3. How, from the perspective of social move-
ments (in this case feminist and mad
movements), it is necessary to continue to
question the power relations that, based
in demands centered on the construction
and solidication of identities, can end up
positioning themselves as universal and
hegemonic.
In summary, these categories correspond to
the historical, epistemological and political
thread we have traced throughout the article.
Personal experience in relation to the
sociopolitical
The feminist initiatives described establish
ruptures and transgressions in different ways,
especially regarding the androcentric model
of dening and intervening in health-disease
processes and understanding distress, emo-
tions and the connections between what is
private and public; in particular, these initia-
tives analyze this model’s consequences for
women’s subjectivities and bodies. Addition-
ally, they challenge the traditional dissocia-
tion between individual and society that has
marked a large part of the debates in modern
science and medical practice in the West.
Based on the organization of collective ac-
tions connected to social movements, these
groups construct a logic of comprehension
of personal experience as indivisible from
social dynamics and the historical-political
structure. In this context, we analyze below
the proposal of each group and collective
action based on three phrases that reveal po-
sitions regarding the individual and the so-
cial: “the personal is political,” “the political
is personal,” and “the personal is collective.”
Emerging from the women’s liberation
movement, the feminist consciousness-rais-
ing groups were organized around “the per-
sonal is political,” a phrase that synthesizes
the process of “raising consciousness” re-
garding issues generating distress that were
experienced as “private” and individual but
in reality were shared by other women, and
therefore were connected to a larger and
identiable power structure, namely, the pa-
triarchy. Although the consciousness-raising
groups were not part of the health eld (in-
deed, they rejected this notion), it was from
precisely this distance that they generated
autonomous knowledge and practices that,
even without this being the explicit aim, col-
lectivized distress in women, challenging the
individualist logics of understanding of dis-
tress present in the elds of health and psy-
chology. It is interesting to analyze different
pyschologicist derivatives of feminist con-
sciousness-raising, in relation to the proposal
of raising collective consciousness regarding
certain situations of inequality and oppres-
sion.(18,41) It should also be mentioned that the
original term of “consciousness-raising” has
been translated into Spanish as both “conci-
entización” and “autoconciencia,” with the
latter being more widespread.
At the same time, but now with the ex-
plicit objective of inuencing the health eld,
women advocated the practice of appropriate
of their bodies as a political act based on the
phrase “our bodies, our lives.”(78) In this same
context and in parallel, the self-help groups
explicitly addressed the psychological conse-
quences of the patriarchy and other sociopo-
litical structures, while emotional self-defense
groups in the US would position themselves
as a bridge between consciousness-raising
and feminist psychotherapy groups.
As Emilce Dio Beichmar(79) describes,
if the feminist consciousness-raising groups
were organized around the notion “the per-
sonal is political,” the feminist psychotherapy
10 GUZMÁN MARTÍNEZ G, PUJAL I LLOMBART M, MORA MALO E, GARCÍA DAUDER D.
SALUD COLECTIVA. 2021;17:e3274. doi: 10.18294/sc.2021.3274
groups were organized around the inverse
notion: the political is personal. Based on the
feminist proposals of professionals, speci-
cally with training in psychoanalysis, feminist
psychotherapeutic practice would pay atten-
tion to how “all that is social and universal is,
at the same time, taken on by a subject that,
in their individual appropriation, subjecti-
vates the social and universal, marking it with
the history of their intersubjective transforma-
tions and drives.”(79) This makes it possible to
understand the functioning of social power
in psychic and subjective space and to gen-
erate, through recognition of the dynamics
of subjectivation and desire, resistance and
subversions,(80) addressing women’s suffering
from psychosocial perspectives.(81)
If “the personal is political” was the key
of the women’s liberation movement, and
“the political is personal” was the key of fem-
inist psychotherapy, in the mutual support
groups of the mad movement, “the personal
is collective” is an especially representative
phrase: the movement prioritizes not only
identifying political structures of oppression
and resistance, but also constantly collectiv-
izing that experience, fundamentally from a
place of reciprocity.(8,82,83) No issue, be it psy-
chic distress, delusions, behaviors, or mis-
treatment within the mental health system, is
to be experienced isolated and disconnected
from other similar experiences that, for the
rst time, do not require expert knowledge
external to the experience itself. In terms of
collectivizing the experience, the mad move-
ment represents a rupture with the classic
psychiatric recommendation of not interact-
ing with other diagnosed people to avoid am-
plifying the distress.(84)
The epistemic-political subject
As Patricia Rey Artime explains in her “chron-
icles of madness,” the gradual “revolutions”
and the “mirror games” or subjective interac-
tions that have shaped the mad movement and
mutual support in this context evidence tra-
jectories of activist desires in the construction
of a political subject (madman/madwoman/
mad person).(84) Based on a reading of Chan-
tal Mouffe,(85) this construction of collective
identity is not essentialist, but rather makes it
possible to identify and denounce the multi-
ple ways in which the category “mad” is con-
structed as subordination, and from this place,
subvert the performativity of the term.(86)
Along these lines, the trajectory of the
consciousness-raising groups, the self-help
groups of the women’s health movement,
the feminist psychotherapy groups and wom-
en’s mutual support groups coincide in the
construction of a “subject of distress” who is
made into an agent of her own health-disease
processes, subverting the passive category
of “object of study” and intervention and
establishing a horizontal relationship in the
dimension of gender. To put it another way,
by sharing the social experience of being
women, they position themselves as subjects
of knowledge regarding their own processes
of distress, generating collective forms of re-
pair with respect to the patriarchal structures
related to these processes. This translates into
a disruption of the traditionally androcentric
and individualist denitions and interven-
tions in mental health.
In this context, the particular goal of the
mutual support groups among women is that,
in addition to politically constructing and
positioning the female subject as an agent
of health, the groups are established based
on defending a mad subject that also resists
the hegemonic psychiatric and psychopatho-
logical order. Again citing Chamberlin’s
thought,(16) they would not only denounce
the patriarchal causes of distress and the sex-
ism in psy practice, but recognize mad sub-
jects (specically pyschiatrized women) as an
oppressed collective.
In this sense, resuming the historical
analysis, this second category allows us to
highlight how the process has been a parallel
one in historical terms. That is, we can see
how madness and the denouncement of the
violence of pyschopathologization and py-
schiatrization processes has historically been
at the margins of the feminist movement’s
demands. And conversely, we see that the
construction of mad demands from feminist
Feminist precursors oF mutual support groups in the mad movement: a historical-critical analysis 11
SALUD COLECTIVA. 2021;17:e3274. doi: 10.18294/sc.2021.3274
perspectives have not always come from the
mad movement.
Subversion of hierarchies and power
distributions
Along the lines developed above, we can iden-
tify different nodes of knowledge-power in the
methodologies of each group or collective ac-
tion, tracing parallels that, while not absolute,
may be pertinent to the understanding of some
of the feminist precursors to the mutual sup-
port groups in the context of Mad Pride.
The consciousness-raising groups, the
self-help groups and the mutual support
groups are all a priori established based on
nonhierarchical norms, consensus-based de-
cision-making, and shared responsibility for
the content and process of the group. This dif-
ferentiates them from group psychotherapy,
in which one person is designated as leader
or facilitator and, as such, directs the reec-
tions toward a particular objective, maintain-
ing a certain therapeutic distance with other
participants. In this sense, the particularity of
mutual support groups may be that the con-
cepts “mutual” and “horizontal” are equiv-
alent to “reciprocal” in that all participants
give and receive support at the same time,
without a person in the role of expert-profes-
sional. The priority is the organization and
application of mutual support groups outside
of mental health facilities, be they traditional
or community-based.
Although this organization means a
subversion of the “professional-user” hier-
archy (as well as the gender hierarchy, in
the case of mutual support groups among
women), it should be highlighted that other
markers of inequality may be present and
at the same time be overlooked (in mutual
support groups as well as in the other group
methods we have described). To give some
examples, during the development of the
feminist consciousness-raising groups and
the women’s liberation movement in the US,
bell hooks(87,88) questioned the politicization
of distress, explaining that politicizing a sub-
jectivity and self that has been historically
negated on the basis of a referential subject
with shard sex-gender oppressions but ex-
clusively white, middle-class and heterosex-
ual could paradoxically be depoliticizing for
non-dominant subjectivities. In a similar way,
others such as Rachel Gorman, a mixed-race
mad activist from Canada, and Louise Tam
from the US, critique the mad movement for
constructing a subject of madness based on
dominant culture, that could reproduce patri-
archal, colonialist, classist and racist logics in
the act of reappropriating madness and resist-
ing psy violence.(55,56)
CONCLUSION
The collective processes in health with a fem-
inist perspective that have been an important
part of the movement since the 1970s can be
recognized as precursors to contemporary
processes in collective health in the mental
health eld, specically the “non-mixed”
mutual support groups and mutual support
groups among women.
The mutual support groups have con-
tributed to generating transformations in the
conceptualization of distress, madness and
mental health, comprehending them as col-
lective phenomena that do no necessarily
need to be medicalized or institutionalized.
Indeed, this aim is a characteristic shared by
mutual support groups and other epistemolo-
gies and practices of mutual support that are
not formally organized into mutual support
groups, as we have described. In this way,
other practices of collective mental health, as
well as social protests directly or indirectly
connected to mental health, make alliances
in the construction of knowledge and de-
mands possible.
In line with the aims of this study, by way
of a conclusion, we will highlight some of the
characteristics of mutual support groups that
have been present not only in the develop-
ment of Mad Pride and other social move-
ments, but also in different collective actions
of the feminist movement. We have identi-
ed, based on this historical-critical analysis,
12 GUZMÁN MARTÍNEZ G, PUJAL I LLOMBART M, MORA MALO E, GARCÍA DAUDER D.
SALUD COLECTIVA. 2021;17:e3274. doi: 10.18294/sc.2021.3274
the following parallels among mutual sup-
port groups and feminist consciousness-rais-
ing groups: seeking to gain awareness as an
oppressed collective; politically collectiviz-
ing distress (instead of it being a therapeutic
objective); and sharing responsibility in the
construction, dynamics and continuity of the
groups, establishing minimal norms.
With respect to the self-help groups, a
common characteristic is that of sharing expe-
riences of psychological distress and relating
them to the needs of a particular collective
and certain structures of oppression.
In relation to the groups of feminist psy-
chotherapy, the mutual support groups share
the methodology of addressing mental dis-
tress in a group manner. Nevertheless, mu-
tual support groups have less in common
with group psychotherapy in particular than
they do with social movements in general (in-
cluding the feminist movement). Put another
way, the mutual support groups share with
feminist psychotherapy their emergence from
a social movement to generate more just and
equitable relations (especially in terms of
gender). However, this is a characteristic that
the mutual support groups in the context of
Mad Pride share not only with the feminist
movement, but also with other social move-
ments. Additionally, these groups explicitly
attempt to mark their distance from the psy-
chotherapeutic context and the mental health
apparatus. For this reason, as occurred with
the feminist consciousness-raising groups, it
is from this very distance that the mutual sup-
port groups position themselves as attractive
alternatives to collectively manage psycho-
logical distress. However, they are in danger
of being reappropriated by traditional as well
as community and collective mental health
services, upsetting the logic of self-manage-
ment and horizontality of those with rst-per-
son experience.
The particularity that mutual support
groups offer, as we have recognized through-
out this article, is that, in addition to establish-
ing themselves based on the recognition and
defense of the social experience as subjects
who are female and/or dissident in sex-gen-
der terms, they do so from the subversion of
the category “madwoman/mad person,” a
category that has historically delegitimized
the female and queer. In the context of the
mad movement, the mutual support groups
go deeper, identifying the people with expe-
riences of psychic diversity or dissidence and
neurodiversity/neurodissidence, survivors of
psychiatry, psychiatrized people and/or peo-
ple who have been users of the mental health
system as a collective with particular histo-
ries of oppression. This should be considered
along with the aforementioned concern of
different activists regarding other markers of
inequality present both inside and outside of
the mad movement, as well as different forms
of experiencing both madness and sanism.
In conclusion, the mutual support groups
form part of the most important contempo-
rary proposals of collective action in health,
including the mental health eld. As occurred
in other practices of self-management in
health and in social movements, feminisms
have been key in the construction of these
processes. Among other things, a historical
analysis allows us to put into evidence how
the dichotomy subject-object of knowledge
has been subverted, transforming social prac-
tices in health and potentiating processes
of personal and collective agency based on
madness and distress.
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https://doi.org/10.18294/sc.2021.3274
Received: 7 Nov 2020 | Modi ed: 17 Feb 2021 | Accepted: 1 Mar 2021 | Publication online: 28 Apr 2021
CITATION
Guzmán Martínez G, Pujal i Llombart M, Mora Malo E, García Dauder D. Feminist precursors of mutual support groups
in the mad movement: a historical-critical analysis. Salud Colectiva. 2021;17:e3274. doi: 10.18294/sc.2021.3274.
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