This paper analyzes the history of the modern consumer/survivor movement and its impact on the policy-making climate in the mental health field. The growing attentiveness to consumers' perspectives is presented largely as a consequence, not a cause, of radical restructurings of the mental health system. Consumers' perspectives have entered policy discourse in the wake of policy failures and have flourished in a climate of perpetual crisis and tight budgets. Precisely because it has been such a contested arena for so long, the mental health field has produced some innovative responses to demands for patient empowerment.
The Spanish influenza arrived in the United States at a time when new forms of mass transportation, mass media, mass consumption, and mass warfare had vastly expanded the public places in which communicable diseases could spread. Faced with a deadly "crowd" disease, public health authorities tried to implement social-distancing measures at an unprecedented level of intensity. Recent historical work suggests that the early and sustained imposition of gathering bans, school closures, and other social-distancing measures significantly reduced mortality rates during the 1918-1919 epidemics. This finding makes it all the more important to understand the sources of resistance to such measures, especially since social-distancing measures remain a vital tool in managing the current H1N1 influenza pandemic. To that end, this historical analysis revisits the public health lessons learned during the 1918-1919 pandemic and reflects on their relevance for the present.
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