Despite three major reform movements over the last 300 years, the mental health system has been remarkably resistant to change. Today, another period of reform is underway, only this time, new players - dissatisfied ex-psychiatric patients - are organizing to affect the process of change. This paper discusses characteristics of previous movements and examines their similarity to and difference from the present consumer and psychiatric survivor movement. It appears that the new participants have shaped the rhetoric of reform but it (...) remains to be seen if they can affect the reality. (shrink)