Who Gets to Define Healing? How People Shaped Dignity and Power in Mental Health Care

The history of mental health care is not a neutral story of scientific progress. It is also a story of power — who held it, who was harmed by it, and how ordinary people, communities, and advocates fought back to reclaim their own definitions of what it means to heal.

As a social worker, I believe we cannot fully understand mental health today without understanding this history. Because the systems we inherited were not built with everyone in mind. And the work of healing — real healing — requires us to name that honestly.

For much of the 19th and 20th centuries, psychiatric institutions were not primarily places of healing. They were places of containment. People who deviated from social norms — whether due to genuine mental illness, poverty, disability, queerness, or simply being a woman who refused to comply — could be institutionalized with little legal recourse.

The diagnoses themselves reflected the biases of those in power. Drapetomania, a so-called condition invented in 1851, claimed that enslaved Black people who sought freedom were mentally ill. Homosexuality remained classified as a mental disorder by the American Psychiatric Association until 1973. Women who expressed grief, anger, or independence were routinely diagnosed with hysteria.

These were not scientific conclusions. They were political ones — dressed in the language of medicine to give them authority.

But alongside this history of harm runs another history — one of resistance, self-determination, and community-led healing.

Black communities, excluded from or harmed by mainstream psychiatric care, built their own networks of mutual aid and support. The Civil Rights Movement itself was an act of collective psychological liberation — a refusal to internalize the inferiority that white supremacy demanded.

Latine and Indigenous communities maintained healing traditions — curanderismo, plant medicine, ceremony, storytelling — that Western psychiatry dismissed as superstition but that carried profound psychological wisdom. These traditions understood what modern trauma research is only now confirming: that healing is relational, embodied, and rooted in community.

The disability rights movement of the 1970s and 1980s gave us the rallying cry "Nothing About Us Without Us" — a demand that people with disabilities, including psychiatric disabilities, be centered in decisions about their own care. This movement fundamentally challenged the paternalism embedded in mental health systems.

The consumer/survivor/ex-patient movement — made up of people who had experienced psychiatric hospitalization — began organizing in the 1970s to demand dignity, informed consent, and the right to refuse treatment. They insisted that lived experience was a form of expertise, not a disqualification.

Who gets to name a condition? Who decides what recovery looks like? Who determines whether someone is "well enough" to return to their community?

These are not only clinical questions. They are political ones.

When we define healing as the absence of symptoms, we center the comfort of systems over the wholeness of people. When we define recovery as the ability to return to work, we subordinate human dignity to economic productivity. When we pathologize the grief of communities living under oppression, we locate the problem in the individual rather than in the conditions that created the suffering.

A more honest framework asks different questions: What does this person need to feel safe, connected, and alive? What does their community need to thrive? What structural conditions are producing this pain — and what would it take to change them?

None of this means that therapy, medication, or clinical care are inherently harmful. Many people — including many people of color, LGBTQ+ people, and people with disabilities — have found genuine healing through mental health treatment.

But it does mean that culturally responsive, justice-informed care is not optional. It is essential.

It means:

• Acknowledging the historical reasons why many communities distrust mental health systems — and earning trust rather than demanding it
• Centering the client's own definition of healing rather than imposing a standardized outcome
• Understanding that symptoms often make sense in context — that anxiety, hypervigilance, and dissociation are often rational responses to irrational conditions
• Holding space for cultural and spiritual frameworks of healing alongside clinical ones
• Advocating for structural change as part of the work — because individual therapy cannot heal what policy and power have broken

When people from marginalized communities seek therapy, they are doing something quietly radical. They are asserting that their inner lives matter. That their pain deserves attention. That they are worth healing.

In a world that has historically told Black, Latine, Indigenous, queer, and disabled people that their suffering is either invisible or their own fault, choosing to heal is an act of resistance.

And when therapists and social workers show up with cultural humility, historical awareness, and genuine respect for the wisdom communities already carry — we become partners in that resistance rather than obstacles to it.

The question of who gets to define healing is still being answered. By researchers and clinicians, yes — but also by communities, by advocates, by people sitting in therapy rooms and healing circles and kitchen tables, insisting on their own wholeness.

I am honored to be part of that conversation.

If you are ready to explore what healing looks like on your own terms, I am here. Book a session through Headway or find my profile on Psychology Today.