The recovery movement was at first initiated by family members of psychiatric patients, together with patients and former patients. Intellectuals in the 1970s made themselves heard too, around classic themes such as freedom versus coercion, ethnic and social justice and the right to be different.

The word ‘antipsychiatry’ refers to the civil rights movement of critical psychiatry.

The 1960s and 1970s: the time of ‘antipsychiatry’

Historical research into ‘antipsychiatry’ in the Netherlands in the 1960s and 1970s shows that it was a humanising, patient-oriented movement that found wide resonance (Blok 2004).

The negative connotation of the movement and of the name ‘antipsychiatry’ came later, mainly through the framing by a group of professors and journalists (Blok 2004). Because of this unjustified negative framing, the term is still used in the Netherlands to discredit perceived criticism of psychiatry.

The 1970s and 1980s: origin of the recovery movement

In the 1970s another civil rights movement arose, overlapping in ideals and situated in the same spirit of the times. This time with the direct involvement of patients, who found their way into society in the process of deinstitutionalisation of the 1980s.

This is the so-called client movement, which from the end of the 1990s turns into the recovery movement and works for the right to influence and to creating together as equals (Hunsche 2008, 2022; Ostrow and Adams 2012). This is partly because the core of ‘recovery’, in the sense of recovering perspective, has difficulty flourishing in traditional mental health settings (Schizophrenia Commission 2012).

The 1990s: the hearing voices movement

The hearing voices movement arises, like the recovery movement, in the 1990s.

This movement came out of the work of Marius Romme, Sandra Escher and Dirk Corstens. It connects with the ‘old’ critical psychiatry and with the recovery movement, but also introduces new elements.

Hearing voices was presented for the first time as part of human diversity. That clashed with the then dominant paradigm of biological psychiatry and with the conviction that hearing voices was no more than a symptom of the genetic brain disease ‘schizophrenia‘. Among users of psychiatry it caught on, resulting in the worldwide emancipatory Hearing Voices Movement.

The 21st century: the moral era of medicine

A new critical movement arises, this time from the perspective of the philosophy of science and linked to open science and the moral era of medicine.

This movement questions the theory behind the dominant North American model of specific medication for specific brain disease, the level of investment in imaging research and genetics in psychiatry, the traditional design of psychopharmacological research and, more generally, the value of professional knowledge for the practice of mental health care.

In 2019 Gardner and Kleinman wrote about psychiatry’s identity crisis in the New England Journal of Medicine, and in 2020 Braslow and colleagues wrote about psychiatry’s myopia in JAMA Psychiatry. It is striking that commentaries of this kind can now be published in the most prestigious scientific journals of medicine.

There is also the worldwide Mad in America movement, an influential platform of criticism of the traditional medical model of psychiatry. In the Netherlands and Belgium one can think of the work of Trudy Dehue, Jim van Os and Paul Verhaeghe.

Recovery movement and science

Partly under the influence of the recovery movement, a movement in science arises in the 1990s that takes over a number of classic themes of the critical psychiatry of the 1970s. It is fed by professional knowledge and by knowledge from experience. It is often a matter of people with different kinds of expertise creating together, among other things in the form of user research centres, which have also taken root in the Netherlands.

Much of this work is aimed at a critical scientific analysis of the medical model and of how it can give rise to epistemic injustice.

Epistemic injustice

Epistemic injustice is a form of injustice done to someone because this person is not recognised as a full holder of knowledge.

In psychiatry epistemic injustice arises when the patient is not heard, and the psychiatrist starts exclusively from his own professional knowledge. As a result he remains relatively deaf to what the patient says.

A well-known dilemma, described by Marius Romme and Sandra Escher in 1989, is the person who hears voices that have personal meaning for him, while the psychiatrist ‘hears’ them as a symptom of the genetic brain disease ‘schizophrenia’.

Influential examples of a positive development in science are:

• The report Understanding Psychosis and Schizophrenia of the British Psychological Society
• The formulation of the CHIME framework (Leamy et al. 2011)
• In the Netherlands, the HEE project on recovery-oriented work (Boevink 2017)
• The influential work on the term psychosis susceptibility by Bill George and Aadt Klijn (2014)

The work of Will Hall (2013) and Peter Groot (2013) on tapering off psychotropic medication, withdrawal symptoms and the invention of tapering strips has also been influential among users and, increasingly, in care and science.

Innovation in care

Tapering strips can in fact be regarded as the most important innovation in psychopharmacology of the last 50 years. The fact that they were invented by patients is a fascinating given. Peter Groot of the User Research Centre of UMC Utrecht received a royal honour for it on 30 September 2021. A meaningful moment for the Dutch civil rights movement of patients in psychiatry.

Recognition of the contribution of the recovery movement

Taking up patient-driven scientific renewal in the practice of mental health care is desirable, but it matters whether the source of the progress is recognised.

Many innovations are sensitive to the process of silent co-optation.

• The fact that the relationship between trauma and psychosis long met with resistance from academic psychiatry has almost been forgotten again (Read and Bentall 2012).
• The option of psychotherapy for people with psychosis is now in the guideline ‘as a matter of course’.
• Withdrawal symptoms that occur when tapering off antidepressants were first widely recognised in a Dutch ‘consensus document’ in 2018.

In reality these are practices that had to establish themselves through a struggle that sometimes lasted decades.

It is important to keep a collective memory of this alive. It is comparable to the depathologising of homosexuality in the 1970s, which is now of historical significance and offers a lasting, valuable reflection on the field of psychiatry.

Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.

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Blogs by Jim van Os can be read here

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