The Power Threat Meaning Framework One Year On

The team that developed the Power Threat Meaning framework as a diagnostic alternative reflects on the response to the framework after one year.

Zenobia Morrill
11
2297

The project group that developed the Power Threat Meaning Framework (PTMF) responds to critiques and unapologetically stands by their original vision as they offer reflections, clarifications, and suggestions for future development.

The development of a conceptual alternative to current diagnostic systems in psychiatry is an ambitious goal. Yet, this is exactly what a team of senior psychologists in the British Psychology Society (BPS) and service-users sought out to do when they launched the Power Threat Meaning Framework (PTMF) just over one year ago. The main conceptual difference between the PTMF and dominant diagnostic systems is the view that individuals’ distress is situated within their interpersonal and social contexts rather than biomedical states. They write:

“Our argument – which applies to formulations as well as narratives in a more general sense – is that there is a crucial difference between a system based on diagnosis, and one based on the assumption that people’s experiences and expressions of distress arise out of reasons, functions and meanings, all of which are deeply rooted in their relational and social environments.”

In a new article, the team, led by Lucy Johnstone and Mary Boyle, comments on the responses to PTMF, including its widespread positive reception as well as the critique. An additional feature that sets the PTMF apart from traditional systems is that it was developed alongside service users. This co-production included service users as core team members and project consultants. The team’s perspectives were published in a recent special issue compiled by the Clinical Psychology Forum.

The PTMF has received significant attention. One year following publication, it’s been translated into several languages and has sparked extensive interest and debate across the globe and on social media forums.

“A dozen blogs on the PTMF appeared in the first fortnight, and even in the relatively short time since publication, there are various examples of translating it into practice across a range of different fields, as illustrated in this issue.”

Johnstone and team clarify the purpose of PTMF and stand by their original statements in the face of critique. For example, they respond to criticisms about this sentence in particular, that was featured in the original 2018 publication: “…it can no longer be considered professionally, scientifically or ethically justifiable to present psychiatric diagnoses as if they were valid statements about people and their difficulties” (Johnstone & Boyle, 2018, p. 85).

They write that although this sentence has received a contentious response, they stand by their statement that psychiatric diagnoses cannot be considered valid. They reference Allen Frances and others, who have been involved in the development of current, prevailing diagnostic systems, and have ultimately come out to say that they cannot endorse them as scientifically sound. The team highlights the right for people to know about the dangers and shortcomings of diagnostic paradigms, recognizing that it may be an uncomfortable confrontation. However, they express disinterest in “policing” individuals’ language, and support the right of each person to use whatever terminology they believe best fits their experience.

They go on to address other critiques intended to discount the PTMF for its radicality:

“More subtly dismissive are claims that the framework is ‘sociopolitical’ ‘extremist’ and ‘polemical’. We make no apology for producing a framework which is sociopolitical in the sense that it situates people’s distress firmly in that context and links directly to ideas about social justice and community and social action.”

Further, Johnstone and team write that the PTMF “does offer a critique in a very controversial area, which frequently invites the term ‘polemical’. But it is not unevidenced– although it does question the narrow definitions of ‘evidence’; the separation of fact and value and the assumed neutrality of much mainstream psychology and psychiatry.”

As for the discussion of what counts as “evidence,” Johnstone and team go into this conversation in great detail. They outline the ways in which diagnostic systems are organized in biological and pathological understandings of mental health problems. This reliance on medical-type patterns strips away the possibility that problems have meaning in relation to one’s circumstances. They critique medical frameworks as operating from underlying positivist assumptions. Positivism views data collection and analysis as a neutral, straightforward process that objectively unveils natural facts about the world and people.

“It is exactly this view that the PTMF challenges,” they write, “it arises partly from psychology’s and psychiatry’s reluctance to acknowledge positivism as a philosophy rather than a set of self-evident rules for discovering facts about the world.”

Therefore, while some critics contend that an alternative system is not necessary, the PTMF team believes that the underlying philosophy and assumptions of diagnostic frameworks ought to be questioned and explored for the sake of not just ethics, but accuracy. They continue:

“Asking people to let go of the hope of finding medical-type patterns in distress organised by biology or ‘psychopathology’, and suggesting instead patterns organised by meaning, necessitates abandoning the false hope of finding discrete, universal causal pathways which are a precise fit for any individual, and which are stable across time and cultures. It means moving from clusters based on what people supposedly have or are, towards clusters based on what they do and experience in particular contexts. It means abandoning medical terms such as ‘symptoms’, ‘disorders’, ‘comorbidity’, ‘dual diagnosis’ and even ‘transdiagnostic’.”

In addition, the project group clarifies and responds to numerous questions. For example, some responses reflect the question: “Is the framework meant to replace all current practice?”

The team shares that they have attempted to describe what a conceptual alternative might look like. However, whether it is fit to operate and be implemented as a complete alternative is a decision that is out of their hands. Rather, this decision would be reached by stakeholders and those who dictate practices within particular settings. They respond that, in the short term, it is realistic to expect that the PTMF may be used alongside dominant frameworks or to encourage alternatives within current practices.

The team also responds to questions about whether the PTMF is meant to be trauma-focused. Although the framework is inclusive of considering the impact of experiences that may be described as “trauma,” the team holds reservations about the medicalization of this term. Trauma, through a medical lens, can be a misleading term that implies extreme, life-threatening events that are discrete. Alternatively, the PTMF is intended to also capture continuous negative experiences that are “embedded in people’s lives and relationships.”

The team goes on to address responses in nuanced ways. They express their wish to emphasize and address the role of professional power in influencing practice and mental health legislation, as well as its ideological influence in the production of “theory, research and cultural narratives of distress.” Moreover, they encourage discussion about the implications of rejecting diagnostic categories. Recognizing that formal diagnoses can provide access to services, they validate the argument that “dropping diagnostic categories could be used to promote a neoliberal agenda of withdrawing support.” However, they also assert the following:

“. . . it is also true that diagnostic labels have not prevented the current dire situation in which welfare recipients have been driven to destitution and even suicide. For all these reasons, the PTMF aims to start an important and necessary discussion about ways in which the benefits system might start to move.”

Finally, in staying true to their vision that the PTMF can be step toward re-conceptualizing diagnosis to provide contextualized and socially just responses to distress, the team speaks to increasing involvement of service users and a diverse group of stakeholders in the framework’s future development. In addition to this, they highlight the production of accessible versions of the framework, the importance of continuing to validate its evidence base through research, and working to promote alternatives to diagnosis “in the area of benefits, the law, and other statutory agencies.”

Overall, the team comments that the PTMF is “a considerable conceptual leap, but we argue that it reflects and allows for the indefinite complexity of human agentic, meaning-based responses to their changing circumstances.” They conclude:

“While we have at no point claimed to have produced a ‘paradigm shift’, we do feel that widespread interest in PTMF is a sign that people are actively looking for alternatives.”

 

 

****

Johnstone, Lucy & Boyle, M & Cromby, J & Dillon, J & Harper, David & Kinderman, P & Longden, E & Pilgrim, D & Read, John. (2019). Reflections on responses to the power threat meaning framework one year on. Clinical Psychology Forum, 47-54.

11 COMMENTS

  1. The value for me of the PTM framework is the emphasis on context. We cannot attempt to understand ourselves or explain our behaviour independent from our life context and that is a good starting point. I also like the focus on needs such as positive identity, connection to others, belonging, control/agency, meaning and purpose and safety that can be threatened and how we react and adjust to, overcome, avoid or tolerate this as possible explanations for our distress and behaviour. It can obviously never be an all-encompassing account of our diversity, individuality and complexity, but the PTM framework just made a lot of intuitive sense to me.

  2. The academic jargon and kowtowing to the academic world creates walls to those in mh systems, those survivors of said systems, and the general folks on the street.
    They need to honor and boldly hold the voice of the survivors in their circle or it will all be lost. All together or not.
    They also before doing this need to recognize, accept ,hear the damages inflicted on those who sought help or were forced or prodded to “seek help.”
    One cannot change until the elements of abuse and neglect and violations are acknowledged and amends made.
    One way to look at the system is a ritual gone rotten. This takes on the whole history of caring for others.
    “ It takes a ritual to repair a failed ritual. It also takes a person directly responsible for the failure to right the wrong. Acknowledgement of error is not error…….”
    Ritual
    Power, Healing, and Community
    Malidoma Patrice Some

  3. Thanks for this update Zenobia. In trying to comprehend my horrible experience with a psychiatrist during cancer treatment I bought Lucy Johnstone’s book “A Straight Talking Introduction to Psychiatric Diagnosis” last year. It was very informative and validating as to how there is NO consideration given to causation or context surrounding a person’s circumstances that could lead to stress, insomnia etc. I have great respect and admiration for Lucy Johnstone and her team for putting forth the PTMF and standing by their framework, which is a voice of reason, moral ethics and intelligence that is egregiously lacking in the DSM and psychiatry.

  4. I do agree, all who do not understand “that people’s experiences and expressions of distress arise out of reasons, functions and meanings, all of which are deeply rooted in their relational and social environments” are insane or stupid.

    But, of course, that does mean that all who believe in the DSM “bible,” which ignores people’s real life psychosocial concerns, in favor of the bio-only believing idea that all distress is caused by “chemical imbalances” in people’s brains, are insane or stupid. And that is an insane belief system, really, and now it’s been confessed to be “invalid,” too.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    Good luck with your much needed attempts to change our “mental health” industries’ misguided, “invalid,” to the point of being insane, current DSM psychiatric paradigm.

    It’s shameful our government, which was founded on the knowledge that separation of power is mandatory, has given these insane DSM deluded psychiatrists the power to play judge, jury, and executioner, to innocent human beings. Since these “omnipotent moral busy body” “mental health” workers are now waging yet another, undiscussed in the mainstream media, modern day psychiatric holocaust.

    https://www.naturalnews.com/049860_psych_drugs_medical_holocaust_Big_Pharma.html

    Psychiatry just repeats the worst of history over and over and over again, never learning. Let’s pray this time God judges them all as the unrepentant murderers, attempted murderers, torturers, and defamers that they are, not to mention systemic child rape cover uppers.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

  5. Thanks for these comments. The article Zenobia describes can be accessed here, along with others on some of the ways the PTMF is being used: https://shop.bps.org.uk/publications/clinical-psychology-forum-no-313-january-2018.html

    There are also 2 blogs on introducing the PTMF in New Zealand and Australia here:
    https://www.madintheuk.com/2019/02/crossing-cultures-with-the-power-threat-meaning-framework/
    https://www.madintheuk.com/2019/03/crossing-cultures-with-the-power-threat-meaning-framework-australia/

  6. Thanks, Lucy, I went to read one of your articles in MITUK and found that to comment, i had to create a separate account over there. I am too lazy to do this, I suppose. I wanted to say that for whatever reason, when reading your story about journeying into the Maori cultures and realizing the importance of story, I started thinking of the stories of my own people. I cannot help but realize (yes, I happen spell it with a z…) that my own story parallels the Passover story, and funny, too, we’ve just finished our Passover celebration.

    Why did we leave Egypt? Because we had to. We had no choice. It was like we were not only forced to escape, but we also fled in absolute terror. Me too! I was so scared when I left the US, scared they’d stop me at the airport, or they’d find a way to put me away before I could leave. Afterward, I was criticized by ignorant people who said I ran away because I had a personality disorder, that I would never be satisfied and that any of these consequences I surely brought upon myself. The only thing I could do was to shake my head and walk away.

    We live in such a sick society that turns against anyone they do not like and will blame that person for every problem they ever had. I kept wondering why that kept happening, why, for instance, fat people turned against me because I was thin and they had to struggle, hated because I was smart and others resented it, hated for so many reasons that were not something I had myself created, but they had created. I had to run away from the hate.

  7. It took me a long time to read through the PTMF. It didn’t speak to me but I imagine it would speak to a lot of people that have fallen into the clucthes of conventional mental health approaches who feel unhelped or harmed.

    Certainly it’s a big boost in furthering the status of people who are the victims of abuse. And that’s long overdue. Even if it will also encourage those who are not in actual fact the victims of abuse, but who claim that they are.

    Incidentally, I hear nearly 80,000 voices simultenously, about 7000 of them are very hostile, 30,000 I would say are reasonably kind, and the other 43,000 are febrile and unpredictable. I was lucky to find a very understanding psychotherapist who hired out Wembley football stadium over a number of off-season summer weekends and we did probably the most extensive chair-work ever seen in the history of psychobabble.

    An utterly exhausting process but nonetheless transformative. And, ultimately I have attained a very workshoppy recovery.

    Good luck to the PTMF-crew, I say. As with all the other crusaders, some of whom self-promote on here from time to time, lots of travel to new and interesting places, all expenses paid. What is it about Australia and New Zealand and their never-fading need for workshops from people from the USA and UK? Strange phenomena. Do they have no survivors or thinkers of their own? What do they do all day other than receive visitors from the UK and USA on all-expenses workshop tours?

    • Don’t know about NZ, but in Australia psychologists are dictated to by the Medicare system to get paid. This requires an assessment and diagnosis of a GP first in order to be referred to a psychologist. Financial considerations will then get in the way of independent thinking by professionals