'We are the evidence'--consumers seek shift in research focus. (Special Report: Evidence-Based Practices).

For people who have been diagnosed with a serious mental illness, especially those within the consumer-survivor recovery movement, the term "evidence-based treatment" can inspire both hope and fear.

The hope is that the push toward practices with a scientific base will include the qualitative experiences of people who have moved beyond the limitations of their diagnosis. But the term also brings the fear that an emphasis on double-blind randomized clinical trials, the gold standard for scientific research, will dismiss individual experience as mere anecdote and will entrench mental health in a medical model.

Dan Fisher, M.D., Ph.D., a member of the President's New Freedom Commission on Mental Health, has urged his fellow commissioners to be sure that their recommendations on evidence-based treatment be supportive of consumer-based, self-help initiatives.

"It could go either way," he said. "It really depends on how evidence is defined."

Fisher is co-director of the National Empowerment Center, a consumer-survivor advocacy organization based in Lawrence, Mass., and a staff psychiatrist at Riverside Community Mental Health Center in Wakefield, Mass. He and his associates reject the notion that mental illness is a biological disorder, believing instead that it results from severe emotional distress and loss of social role.