Becky Brasfield’s Vision for Mental Health Justice

Becky Brasfield has emerged as a formidable advocate for change in the complex landscape of mental health care. A certified recovery support specialist and policy researcher at the Human Services Research Institute, Ms. Brasfield has dedicated her career to elevating the voices of service users and dismantling systemic inequities. Her lived experience with psychosis, combined with her leadership in peer support, has made her a powerful critic of traditional psychiatric models that often marginalize those they aim to help.

Her resume includes service as president of the NAMI Illinois Alliance of Peer Professionals, the state’s first peer professional association, and recognition as one of Crain’s Notable Black Leaders and Executives. She has been a fellow with both the IL Care and HSRI Behavioral Health Policy programs and was appointed Commissioner of the Southeast Expanded Mental Health Services Program.

But Ms. Brasfield’s work is as personal and political as it is professional. In this interview, she speaks with Mad in America’s Ayurdhi Dhar about her path to recovery, the harmful impacts of medical gaslighting, and why the future of mental health justice depends on centering the expertise of those with lived experience.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Ayurdhi Dhar: You have written about a diverse range of topics, but I want to begin with the personal. Could you briefly tell us about your lived experience with psychosis?

Becky Brasfield: My lived experience is about illness and recovery. I have a schizoaffective condition, and it’s a severe condition when untreated. For me, getting a proper diagnosis was important—I needed to be honest with myself about what I was confronted with in my experience. For me, it didn’t necessarily have to come from a medical provider. I went through a lot of self-exploration, figuring out what my correct diagnosis was and also getting that affirmed by a professional. I’m a strong believer in self-exploration.

I was hospitalized two or three times in a psychiatric unit. I was incarcerated twice for my mental illness because the delusions were severe enough that I became out of control, and I received mental health probation. But my lived experience goes back to childhood—I’ve dealt with trauma, major depression, suicide attempts, some addiction problems, and night terrors. I don’t use substances anymore. I’m in recovery from a lot of family stress, dealing with racism in America, in schools, and in education, and even sexual harassment—all of which impacted my mental health. We often don’t talk about the social issues that bring about some of these severe conditions that result in diagnosis.

Ayurdhi Dhar: At a recent ISPS conference, you stated that mental health is about much more than mental. What are the larger socio-cultural or structural issues that you think are important in this form of distress that you experienced?

Becky Brasfield: I can’t disconnect the diagnosis from the social condition, and I wish that psychiatry would start addressing that—but that’s not going to happen. It will come from the lived experience and the consumer/survivor movement. Things like family stress, domestic violence, racism, ethnocentrism—even the global wars we are seeing right now—affect people’s mental health.

Recently, my therapist said her clients were crying about things going on in the world, not about their jobs, but about national events. Yet, when you go to psychiatry, it says you have a biological issue, and they will give you medication for it. There’s a disconnect.

When I was in graduate school, what led to my severe psychosis and incarceration, Ayurdhi, was pure and simple racism and sexism. These things that I heard people talk about happened to me, even in this day and time. I walked into school healthy and walked out completely disabled, and that shouldn’t happen in an educational system. We just medicate and blame the lived experience rather than treat the system. That’s why, when I introduced my experience, I introduced not just the diagnosis or the condition, but also the systemic oppression.

Ayurdhi Dhar: A few years ago, I interviewed Michael Ungar, who showed how a child’s mental health might be tied to global oil prices. Ungar connected it with how changes in global oil prices meant someone’s father could not work in a certain oil field, which led to less money at home, which eventually meant the kid could not afford to play in the little league. All we might see in the kid are “symptoms.”

Becky Brasfield: That is a great example. Even well-meaning providers say, “Okay, but what can I do about global oil prices?” I say, you may not be able to directly do anything about that, but you can start by validating. If we deny that these systemic issues are affecting people’s health, then we’re engaging in medical gaslighting. We can say, “You know what, this is happening in the world, and this is affecting you. I’m not going to deny your reality. I may not be able to change it, but I’m not contributing to psychosis. I’m not going to create this denial for you.”

Ayurdhi Dhar: In your experience with the mental health systems, what was helpful and what was harmful? What could have been done differently?

Becky Brasfield: I know not everyone needs medication. Unfortunately, I do, because the damage that was done by all that trauma was so severe. I believe there’s some kind of mild traumatic brain damage that was done.

I had a psychiatric nurse who I thought was very good because she listened to me and was respectful. Unfortunately, in a moment of panic, she prescribed me an injectable. An injectable is a psychotropic medication administered via injection, usually once a month. A lot of people don’t like it. I didn’t want it. It was coercive. I lost some of my vision.

Now, the medical gaslighting. I told her, “I can’t see.” She said, “Oh, it’s got to be something else. We just did this—it’s got to be something else,” because she didn’t want to acknowledge that maybe this was what happened. I’m not blaming her. I’m saying we need to take accountability so you can tell the FDA about this side effect. She was helpful to me for so long, but she panicked and made a mistake. It happens. Now I’ve lost some of my vision because of a coercive decision, but she doesn’t want to take responsibility.

People are taking these injectables, and we don’t know what effects they have. You can have someone who helps you and also does something that is unhelpful. We must hold those spaces together.

Everybody says we need better training, but it’s the lived experience that has to train the clinicians. They say, “Clinicians are the experts, and the lived experience is not.” Why is lived experience at the bottom of this hierarchy when, clearly, we have feedback to improve the whole system?

Now, I’ll tell you about things that have worked really well. When I was in the hospital, I got peer support. Peer support did a wonderful job because it connected with me and told me, “You don’t have to do anything, but we’re here for you if you want it.” I said, “That sounds good—not coercive.”

I had a social worker who said, “I believe in you; you’re going to work again. You’re going to do something with your life.” They believed in me more than the psychiatrist who told me I’d never work again. Believing in people and seeing hope—that works.

We have to stop the psychiatric abuse that keeps consumers as inferior to everybody else in the system. We’re inferior to researchers, social workers, clinicians, doctors, and family members. It’s all set up to keep us inferior. It has to stop because it’s contributing to abuse in the healthcare system. It is absolutely dysfunctional. Our goal is to stop this and have it totally eradicated.

Ayurdhi Dhar: Can you speak a little bit about that—the medical gaslighting part? What is it?

Becky Brasfield: Some people call it medical crazy-making. If you don’t like that word, medical gaslighting refers to how the medical profession uses tactics to create doubt about the service user’s reality. It’s really a dishonest practice—a cover-up. It comes from a place of self-doubt within psychiatry—they know less than what they’re acknowledging. They have less expertise than what they’re trying to present. To cover it up, they create doubt in the consumer and service user—“Maybe you’re wrong. Maybe you don’t know.”

Ayurdhi Dhar: Reminds me of the psychiatry community’s response to Joanna Moncrieff’s umbrella review a few years ago, which found that the serotonin theory of depression was, well, wrong. Half the psychiatric community responded with, “Oh, this is wrong. Serotonin is absolutely responsible,” and the other half said, “Of course we know it’s not about serotonin. Why are you doing the same research and wasting our time?” I mean, which one is it?

Becky Brasfield: That is an excellent point to bring up because we still haven’t reckoned with that study. I talk to service users all the time, and we knew this a long time ago. How is it possible that everybody on the street knew this a long time ago, and you all are saying something else? You’re not experts—and it’s partially our fault as service users because we keep giving them expert authority when, clearly, this is a sign that something is wrong. There are multiple warning signs.

It’s time for us as a community to make a decision. Do we trust them as a whole—not individually, because there are some great psychiatrists out there—but as a community, do we really trust their judgment?

Ayurdhi Dhar: I know you’ve worked extensively in the field of peer support and the recovery movement. I wanted to talk briefly about what the recovery movement is, especially in the context of psychosis.

Becky Brasfield: I joined a peer movement in the 2000s, and it’s been very helpful to me. It’s about lived experience and lived expertise, about focusing on strengths, and about hope and advocacy. It is so powerful because, as a service user, I’ve learned that I must be an advocate. There is no other way—because if I’m not an advocate in this mental health system, I’m going to end up at the bottom. Peer support is about advocacy when it’s not co-opted.

There are different parts of it. For example, veterans don’t really join with mental health peer groups—they have their own peer support. There is also peer support for substance use recovery. Sometimes the substance use peer groups think they’re better than the mental health peer groups and don’t want to be connected with the stigma of mental illness. Everybody is using the mental health model, but everybody is looking down on us. I’m saying this because I’m not going to let it be a secret. It has to come to the surface. That kind of disrespect and oppression should not be happening in the field.

Ayurdhi Dhar: I want to talk a little bit about when peer support is co-opted, because one of the things I’ve noticed is that some incredible movements come up in the mental health field, and the pace at which they get absorbed or co-opted takes my breath away. I interviewed Diana Rose a few years ago, and she talked about how service users’ voices were being used as sound bites for different researchers. Could you tell me a little bit about how peer support movements can also get co-opted?

Becky Brasfield: I have to navigate these spaces carefully. I was going to publish with a top journal and had been accepted with revisions. The editor wanted me to whitewash the advocacy out of the paper. The issue was the term behavioral health. One of the topics of the paper was that the term behavioral health is a problem for a lot of service users—they don’t like it. I use the term behavioral health to describe a system of mental health, substance use, and adjacent related service networks (legal systems, primary care, housing, etc.) or to describe specific “behavioral” conditions. But I also uplift the perspectives of consumers who do not use this term and feel it has been imposed on them.

The editor said, “I know our audience—the clinicians, the psychiatrists—and they don’t want to hear criticism of this. They don’t want to hear the lived experience perspective about a term they’re using to describe us. They don’t want to hear our view.” The only way to get it published was to take that part out.

I withdrew. That’s the co-opt. You say you want the lived experience writer to participate, but you don’t want the lived experience perspective in the paper. You just want to check a box—we have a lived experience writer. They’re co-opting the peer movement.

I have another example. I saw that there was a lived experience homelessness conference in California. I said to the organizer, “Why is a homelessness/unhoused conference costing $350 and held at a hotel?” He said, “Oh, well, we have scholarships.” I said, “This is the problem. You don’t understand—when somebody is unhoused, they don’t have time to fill out an application for a scholarship. You’re supposed to be centering them. You make it free and then make the people who are housed pay $350.” That’s how you do it. She never wrote back. The National Football League and some big tech companies were sponsoring it!

Ayurdhi Dhar: I see the same thing with the global mental health movement. At a recent conference that was all about public health, I asked them, “You’ve been talking about structural determinants like poverty, discrimination, violence, and trauma creating mental health issues in the global south. How do you fix that?” They responded with antidepressants. We co-opt and absorb the whole movement around structural determinants of mental health, give it lip service—it sounds good, but there’s no real change.

You’ve talked about how the knowledge and expertise of people with lived experience has to become the lead authority in mental health. What would that look like for you?

Becky Brasfield: It’s going to be a transition. Right now, lived experience is an authority in many ways. A lot of the things that lived experience advocates for are leading the field. Look at holistic health care, the many pathways model, peer support, the hope model, the recovery model. But the problem is that we ourselves are still giving psychiatry the expert authority role in our minds. We’re still depending on their research, thinking, This is right, this is law.

The shift happens when we have a global consciousness change—when we recognize they are not the experts they purport to be. The system that they have created is dysfunctional, and we start to see that there is the possibility for a new system.

What does that look like? It starts when we begin rejecting false prescriptions for our problems. If I have a problem with domestic violence and someone says, “Take this antidepressant,” that’s a false prescription. It might be one option, but an antidepressant isn’t going to solve domestic intimate partner violence. It’s not going to save my life or keep my children safe.

We have to reject false solutions. That’s why my ISPS talk was about reality testing. When you have a problem that’s rooted in social issues, we have to start by acknowledging that and validating each other. The new way for society is among each other—among lived experience, among survivors, among ex-patients, among service users. We start by validating the reality that our problems are not solely caused by a biological issue, and we start naming what they were caused by. It’s an honest movement—This is why I got sick. This is what happened.

Then the next step is acknowledging that all of these policy changes coming out for mental health are superficial. Mental health is connected to how we think as a society, and governments and other powerful entities are invested in knowing how people think and how their minds work.

If you perceive your world accurately, that is helpful to your mental health—but it may not be helpful to certain systems. There are systems that are committed to making you think and perceive differently. Just acknowledge that and understand it. The system of psychiatry is set up so that other systems can function. As soon as we start to understand that and start getting honest, the whole system will change.

Ayurdhi Dhar: I really like the idea you put forward about these false solutions. There has been some wonderful work done about psychology and its historical allegiance to very fascist regimes—giving scientific backing to these dangerous ideas.

Becky Brasfield: It will come down to an intellectual standoff. I think, ultimately, brighter ideas will prevail. People will be shocked by what they see is happening in the field, realizing that the “experts” didn’t know what they were doing, that they didn’t have the skills we thought they had, and that there was so little behind those numbers and studies. When it all comes out, I believe the shift will happen.

Ayurdhi Dhar: If we look at the history of psychiatry and psychology, it’s littered with abuses—things that we laugh about and are horrified by, like prefrontal lobotomies or pulling teeth out to cure schizophrenia. I have to remind my students that for physicians and researchers at that time, this was serious work, and they backed it with statistics and evidence, claiming excellent outcomes. Egas Moniz even received a Nobel Prize for the prefrontal lobotomy—the same thing we now see in horror movies. What are we doing today that, 30 years from now, people will say, “Oh my God, what was wrong with these people?”

Becky Brasfield: The one thing that has helped me through all my trials and tribulations is being absolutely honest about the psychiatric establishment, my own health care, and myself. By not putting them in a place of authority over my own ability to understand myself and my health care, I’ve continued to recover. I will never, ever give the field that authority over me again—ever.

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