The author, a long-time activist in the psychiatric survivor movement in the United States, gives a brief historical overview of the movement’s development in the U.S., describing its expansion and the development of a factions which rejected the medical model as oppressive and another that sought rights expansion while embracing the medical model. She describes her own disillusioning experience trying to push a survivor agenda from inside a state mental health bureaucracy and discusses the co-optation of the idea of peer support as the system created “peer staff” roles within a medical model framework. The author assesses the current lack of influence of the survivor movement on mental health public policy issues, described the lack of a Mad Studies movement in academia in the U.S., and suggests that such a movement is needed.