A key area has fallen through the cracks in the follow-up discussions to the Romanow Commission on Canada’s health care system: mental health. Thankfully, activist Pat Capponi has been paying close attention to the fate of the psychiatric system’s “consumers,” many of whom struggle to survive on the streets of major urban centres. Often they’re everyday folks – suffering from improperly diagnosed and mistreated common maladies – forced into a system from which they emerge damaged, abused, and terrorized.

Capponi’s first-hand experience of the system’s horrors was documented in Upstairs in the Crazy House, and her trademark brute honesty returns in this look both at her own struggles and those of other survivors. All share an experience of a mental health system that treats them not as battered souls requiring nurturing and guidance, but rather as receptacles for pills, shock treatment, and four-point restraints. Capponi covers such topics as the causes of a “madness” diagnosis, the experience of drugs and hospitalization, substance abuse and self-harm, and organizing among survivors.

At her best, Capponi is a deeply personal diarist who shares some painfully honest revelations about herself and others. But Capponi is sometimes annoyingly self-referential, even quoting herself at a chapter heading; while she has much to be proud of, she needn’t remind us of it as much as she does. It is also sometimes unclear whom the book is aimed at. The text floats between personal reminiscence and survivor testimony to an oddly placed “guide to surviving the system” self-help chapter that appears out of nowhere.

Nevertheless, Capponi’s ultimately hopeful work is a strong contribution to the national dialogue on the future of our collective health.