An introductory definition, in summary: Mad Studies brings activism and scholarship together. It emerged in Canada and is increasingly becoming an international movement (Le Francois, Menzies, and Reaume 2013; Beresford and Russo 2016). One useful definition presents it as a field of scholarship, theory, and activism concerning the lived experiences, histories, cultures, and politics of people who identify as mad, mentally ill, psychiatric survivors, consumers, service users, patients, neurodivergent, and disabled (Castrodale 2015). Emerging from consumer/survivor movements, Mad Studies refuses a biomedical view of what is commonly called "mental illness" or "mental health," instead taking up a framework of madness.
Paraphrased from the introductory passage discussed in Beresford, P. (2020). 'Mad', Mad studies and advancing inclusive resistance. Disability & Society, 35(8), 1337-1342. This is a summary, not a verbatim quotation.
For qinlizhe, and researchers and people involved in action who identify as qinlizhe, Mad Studies is clearly a compelling field, with considerable appeal. Recently, though, I've also been thinking about its possible, or already existing, problems. Beresford's 2020 article on Mad Studies and the word "mad," and Beresford and Rose's 2023 article on decolonizing global mental health, both remind us that Mad Studies faces limits of its own even as it challenges psychiatry and global mental-health systems.
When discussing Western research or action, a fairly general criticism is "white-centred" or "Global North-centred." But I don't think we can move the discussion forward by stopping there. Drawing on these two articles and some thoughts of my own, I want to break the challenges down more specifically.
The first challenge is the lack of a relatively coherent theoretical foundation and shared identity. Put Mad Studies alongside gender and disability movements and this becomes more apparent. Gender minorities and disabled people have also long faced discrimination, stigma, and pathologization. Over time, however, their movements have developed relatively rich theoretical resources and languages of identity that can accommodate internal differences while offering a rallying point. This doesn't mean gender or disability identities are fixed. It means a designation such as LGBTQ, despite its differences and tensions, can still serve as a shared banner in collective action.
The identity basis of Mad Studies is less stable. "Survivor" and "service user," for instance, aren't merely different names. They often carry different understandings of psychiatry, diagnosis, treatment, and institutional experience. Some call themselves survivors to emphasize having survived harm from mental-health systems, and may strongly oppose those systems. Some call themselves service users while continuing to recognize the need for certain services, treatments, or professional support. These identities can therefore involve real political disagreements, not just stylistic differences. To become a powerful field of knowledge and action, Mad Studies has to face that tension: it can neither force one word to represent everyone, nor lose its shared critical direction because internal differences are so great.
Consider, too, its delicate relationship with disability movements and disability studies. Many people oppose medicalized accounts of "mental illness" and emphasize how social relations, poverty, isolation, stigma, violence, and institutional harm shape distress. Yet they may not want a "disabled" identity. Some worry that adopting it would reinforce their own pathologization. Others feel disability carries another layer of stigma, or doesn't accurately describe their experience.
This puts Mad Studies in an awkward position. Its experiences, identities, and language are more fractured. It can't simply copy the social model from disability studies, or pretend all qinlizhe want to understand themselves through the same language of identity.
The second challenge is the contested word "mad" itself. Mad Studies chooses mad to refuse psychiatric language, refusing the constant description of suffering and difference through illness, disorder, and symptom. The word is resistant, an attempt to reclaim stigmatized language. But for many people, mad isn't easy to reclaim. It may mean humiliation, danger, ridicule, exclusion, even violence. Beresford notes that some service users find mad/madness empowering, while others feel strongly that the words carry too many negative associations. Others worry about romanticizing suffering or creating division through a word with no clear, shared meaning. If Mad Studies grounds its radicalism in reclaiming a word, it must face the fact that the reclamation doesn't work for everyone.
The third challenge is academicization and elitism. Mad Studies grows from the work of people organizing, survivors, and experiential movements, but increasingly enters universities, journals, handbooks, courses, and conferences. Compared with more established fields such as gender studies, it is, of course, only beginning. Universities provide resources, visibility, and routes of circulation, but also risks. Beresford notes criticism that Mad Studies relies too heavily on Western academic spaces and values. A field intended to challenge psychiatry and professional authority might gradually become another professional discourse: those who can publish in English, enter universities, attend conferences, and get cited become more able to represent it.
Beresford's 2020 article explicitly mentions the criticism that Mad Studies is elitist, mainly located in academia, with many prominent writers holding or pursuing PhDs. That's quite specific. Elitism doesn't only mean authors come from the Global North or white societies. It means entry requires familiarity with English-language theory, complex academic language, publishing channels, institutional backing, and the resources to sustain participation.
I feel uneasy about this myself. I have never thought of myself as an elite. But I have entered academic knowledge production; I can't claim to be outside it. I do have more access to reading and writing in English than some people, and more opportunities to attend international conferences. Yet calling all this "elitism" can be glib. There is tension here. I entered academia precisely because of my prolonged powerlessness as a qinlizhe. With little social capital, academia was the place I could most readily stretch up and reach. From what I know, many people in disability and gender fields have followed similar routes.
One possible consequence is that the qinlizhe who become visible are those closest to academic institutions. Those without doctoral status, stable jobs, English writing skills, or the time and money for international conferences may be excluded from knowledge production.
This affects how Mad Studies understands qinlizhe, or whatever term is used. We aren't a homogeneous group. People living in poverty, homeless people, criminalized people, including those convicted or imprisoned, migrants, refugees, non-English-speaking people involved in action: they occupy very different positions from qinlizhe researchers in universities. If the field's central texts and representatives mainly come from universities, one relatively resourced kind of experience may stand in for experiential knowledge itself.
Of course this isn't insurmountable. Staying connected to different communities, avoiding "armchair anthropology," paying attention to news and online discussions, using community-based research approaches, sharing one's power: I think these are all ways to push against it.
The fourth challenge, which could be joined to the first, is a philosophical basis with both potential and instability. Beresford and Rose argue that Mad Studies has made greater efforts than earlier survivor movements to develop theoretical foundations. It opposes biomedical models, values rights and social and holistic understandings, centres first-person experiential knowledge and collective action, and seeks alliances beyond mental health. But they also acknowledge that it is less a complete, unified "model" than a set of conditions, principles, and open practices. That openness can be a strength, allowing different forms in different places rather than another universal template. It can also be a weakness. Without sufficiently clear shared philosophical commitments, a field may be absorbed, transformed, and neutralized by mental-health systems. Their article discusses how the lack of a unified philosophy left survivor movements vulnerable to co-option by the psych system. To avoid that fate, Mad Studies must find a balance between openness to difference and a continuing critical core.
The fifth challenge concerns the Global South and decolonization. I don't much like "Global South," but haven't found a better term for now. In their critique of global mental health, Beresford and Rose point out that Western psychiatry often enters the Global South in the name of expanding services and access to treatment. This may reproduce colonial relations: the North defines the problem and provides the solution; the South becomes the object of intervention.
I'd rather understand Mad Studies as an opening for discussion. Through that opening, Global South voices can become more present and, in turn, reshape Mad Studies itself. We don't need to translate something into Chinese or another language only to use it to "educate" or lecture local qinlizhe and people doing the work. It's precisely because I see this potential that I want to think critically about the field. I find it more worth this kind of critical attention than more established disciplines such as psychiatry or psychology.
These criticisms don't mean Mad Studies has no value. Precisely because it matters, we should take its limits seriously. Its refusal to let psychiatry monopolize interpretation is powerful. To keep that power, it can't allow English-centred academia, the Global North, or academic elites to monopolize the interpretation of Mad Studies in turn.
Texts discussed
Beresford, P. (2020). 'Mad', Mad studies and advancing inclusive resistance. Disability & Society, 35(8), 1337-1342. DOI
Beresford, P., & Rose, D. (2023). Decolonising global mental health: The role of Mad Studies. Cambridge Prisms: Global Mental Health, 10, Article e30. DOI
This essay also develops thoughts from my earlier piece, A Question for Mad Studies: What About the Non-English-Speaking World?.