We now have a new kind of psycho-politics; a brutal and destructive alliance between neoliberalism and an expanding psychiatric empire. This article will explore how mental health service users/survivors and other mental health campaigners can connect with the critical analysis and action embodied in the work and values of Peter Sedgwick at a time of crisis and reaction. They have seen ideas like ‘user involvement’ and ‘recovery’ co-opted and undermined, and both their experiences and aspirations individualised and devalued. Emerging interest in mad studies, it is suggested, offers a way forward that challenges both the marketisation and medicalisation of people’s distress. This discussion will explore the continuities and discontinuities with Peter Sedgwick’s pioneering work and highlight, as he did, the importance of making explicit the political and ideological relations of survivors’ struggles within and against the psychiatric system.