Recent years have seen increased pressures on psychiatrists to work closely with user/survivor and carer groups. We argue that although many groups are happy for this to remain at the level of consultation, there are growing demands from more radical elements of the user/survivor movement for moves towards a more collaborative framework. A number of these groups challenge some of the central assumptions of psychiatry. for productive engagement and collaboration to take place, psychiatry will have to be able to react positively, not defensively, to these challenges. We suggest that this raises questions about how we should think about the nature of science, truth and expertise.