Participation and empowerment are core issues in contemporary mental health policy. Involving (ex-)users as 'experts by experience' has become an internationally accepted guiding principle for civil society health promotion, especially in the wake of the 2006 UN Convention on the Rights of Persons with Disabilities. However, this 'mainstream user involvement' also meets with scepticism from user self-advocacy initiatives and organisations. 1 This can, for example, be seen in the words of Diana Rose, a 'user/survivor academic' at London's King's College, who, while criticising the austerity policy in the British healthcare system, emphasises the significance of local, 'hidden' and often radical grassroots groups:This activism is barely visible socially because 'the mad organising' is an oxymoron and there are material conditions for not being persistently open. It is hidden, it is suspicious and it is angry but with a righteous anger. 2 This quote addresses key topics of today's 'consumer/survivor/expatient' (c/s/x) movement: structural disadvantaging, emotionalised protest, mobilisation capacity and media (in-)visibility; in short, the chances and contradictions of (ex-)users' political 'struggles for recognition '. 3 The history of this movement, however, has not yet been fully explored. Historical discussions are usually limited to the second half of the twentieth century; moreover, comparative studies are missing so far. The main objective of this chapter, therefore, is to