Last year, Lucy Johnstone, Mary Boyle and their colleagues in the UK launched the Power Threat Meaning Framework (PTMF), a set of ideas that represented a sharp departure from the biomedical conceptions that animate the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). This framework shifts the notion of “What is wrong with you?” in the DSM to “What has happened to you?” and by doing so rejects medical process of diagnosing “disorders” in favor of a narrative response that tells of contexts, power dynamics, and systems.

At a time when the Global Mental Health Movement is exporting the Western biomedical model around the world, Johnstone, Boyle and the PTMF project team, which includes those who identify as service users/survivors, are seeking to promote a radically different way of understanding distress. Responses to the PTMF have ranged the gamut from criticism to gratitude.

Johnstone, a consultant clinical psychologist who has experience working in adult mental health settings for many years, believes that the current mental health system has failed, and we are now in the process of witnessing the crumbling of the medical paradigm of emotional distress. She believes we need an approach based on fundamentally different principles. The PTMF, which draws on a wide range of evidence and examples of existing alternatives, is an attempt to outline what that might look like. The PTMF project team hopes that it can be a contribution to the much needed revolution.

Johnstone described the PTMF in an earlier MIA interview. In this interview, 18 months after the launch, she reflects on the reaction to the PTMF, and the impact it has had so far. How are the ideas being used? Does it stand a chance of becoming more widely adopted? She also describes how her own life experiences have influenced her work.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.


Zenobia Morrill: To begin, why do you believe we need an alternative diagnostic framework? In other words, what’s the problem with the DSM?

Lucy Johnstone: We don’t think we need a new diagnostic framework, we think we need a new framework that is nondiagnostic. So that’s what we attempted to provide. But you and anyone who visits Mad in America will be well aware, as many other people are, that the current diagnostic framework is facing a lot of problems.

Of course, experiences of distress are very real. People really do feel suicidal and desperate and anxious and hopeless and hear hostile voices and have mood swings and so on, but it’s never been demonstrated that these very real experiences are best understood as medical illnesses that need diagnosing. There is also a great deal of evidence that people are ultimately responding to events in their lives when they go through these very difficult experiences.

We clearly need something different (from the DSM). Now, of course, people have varying ideas about what that different system should look like; whether it should be in some sense a better, more effective diagnostic framework, or whether it should be something completely different. But it’s obvious I think to everybody on every side of the debate that the current diagnostic system is not working. We do need at least something different and it’s our view that the big difference needs to be a fundamental shift away from the assumption that these difficulties and these forms of distress are best understood as medical illnesses.


Morrill: How would you respond to people who say that the DSM or ICD are helpful in that they group together people with like symptoms for research purposes, provide a common language for practitioners, or even helpful for reimbursement purposes and categorizing different treatments for people with similar symptoms?

Johnstone: Legitimate diagnosis, medical diagnosis, does do those things. That’s why we have it, so we can group symptoms together and suggest the best treatments or interventions. I would actually challenge that language, first of all. The language of “symptoms” and “illnesses” and “treatments” all implies the same unproven model. Actually, I think it’d be very hard to maintain that psychiatric diagnoses perform any of the functions that diagnosis does in what I would call legitimate branches of medicine.

We do need ways of grouping different kinds of experiences together so that we can think about the best way forward and all the rest of it, but the diagnostic system doesn’t do that. We are claiming that we’ve come up with something that does that better. Equally, it’s true that in the current system, diagnosis is needed for some practical purposes, like access to welfare and benefits, and for the foreseeable future, probably will be. We want to claim that we found that there are more effective ways of doing that that don’t require you to subscribe to a label, which is actually not valid and is experienced by many people as very damaging.


Morrill:
Do you feel that the DSM has helped form societal and professional thinking about psychiatric difficulties in a way that has been harmful?

Johnstone: The DSM and its European equivalent, the ICD, have certainly had a profound effect on forming societal and professional thinking, and it’s chicken and egg isn’t it? It’s arisen out of a certain way of thinking about things. It’s had a profound effect. I would certainly argue, as would many other people, that the overall effect has been very damaging.

I think it’s almost impossible to overestimate its influence and to grasp how deeply it’s infiltrated in all sorts of areas of our lives. It’s not just services, but the legal system, the welfare system, and it’s to the extent that people are actually coming along having diagnosed  themselves. This language is everywhere–it’s in campaigns, like anti-stigma campaigns, it’s on Google, it’s in the media, it’s in people’s training programs. It’s become something that Mary Boyle, in her useful phrase, calls “the DSM mindset.”

There’s an awful lot of evidence, and you will know this of course, but people like Robert Whitaker have shown, I think quite conclusively, that this kind of approach coupled with the psychiatric drugs that it invites, does not, over the long term, on average, help people or make them better. In fact, levels of disability across countries rise in tandem. The fundamental model clearly isn’t working, and we clearly need something different.


Morrill: You’re noting that this system has done harm, it lacks validity, and it’s not working. And, that the Power Threat Meaning framework (PTMF) offers something else. What are the core aims of the PTMF?

Johnstone: The Power Threat Meaning Framework is a ridiculously, ludicrously ambitious attempt—an ongoing attempt, not a complete answer—that we hope will start to outline a conceptual alternative to the diagnostic model of distress.

We already have a number of different ways of approaching distress, that aren’t diagnostically based, and we’ve drawn from a lot of those. An awful lot of what is in the framework isn’t new. We chose the word “framework” deliberately. It’s kind of an umbrella that supports, centers, and gives some more evidence and credibility and support for the many nondiagnostic ways of working that already exist, as well as suggesting new ways forward.

We’re intending it as a major step away from not just a particular use of language, a particular use of labels, but a whole way of thinking—getting away from the whole DSM mindset. That’s partly why it had to be so long, dense, and detailed because we didn’t really want just to tweak the existing system. We didn’t just want to say, “Well, here’s an extra way of doing things that might be helpful.” We wanted to go beyond that, which required us to really dig quite deeply into the philosophical and conceptual principles of the DSM approach and do a massive overview of all the relevant research.

The aim is to move, in simple terms, away from the “What is wrong with you?” towards the “What has happened to you?” question. To put it at its briefest, we’re evidencing, we hope, the idea that peoples’ distress is understandable in context, but we wanted to think about context in its broadest form. One of the things we wanted to do was to really make very clear the link between personal distress and social context, social inequality, and social injustices. In other words, to put power on the map. Power is not only missing from psychiatric thinking, but it’s also missing from a lot of psychological thinking, and it’s missing from much psychotherapeutic thinking.

Along with that, we wanted to have a framework that supports people to help tell their stories, narratives of all sorts. So the simplest answer to “What do you do instead of diagnosis?” is “you listen to people’s stories.” This is a framework, we hope, that both validates the idea that narratives are an alternative to diagnosis and supports the construction or co-construction of particular narratives and looks at patterns in those narratives.

Finally, the third important thing to say is that the framework applies to all of us. We really wanted to get away from this whole idea that there’s a group of people who are somehow mentally ill or different in some fundamental way. We’re all subject to the negative influence of power. We all suffer distress at times. The framework is actually about all of us.

One of the key things about the framework is actually giving people the knowledge, the information, to make up their own minds about how they want to describe their own experience. That’s a really important form of restoring people’s power: the ability to make their own meanings. Ultimately, to create new narratives that make more sense.

Biomedical model psychiatry is a prime example of the use of ideological power because it is a worldview that does not have any evidence to support it, that never has had evidence to support it, that clearly operates in the interests of people who are already quite powerful—professionals, drug companies, and so on—clearly operates to the disadvantage of people who are already less powerful, or else they probably wouldn’t be in services in the first place. It clearly operates by imposing a form of meaning on people, which goes along the lines of: you have a mental illness of X, Y, or Z sort. If you start to challenge that, you will quickly find out that the power lies elsewhere. You’re not allowed to challenge it. All sorts of consequences may follow from challenging it.


Morrill: How has your personal and professional background influenced your participation in and construction of the PTMF?

Johnstone: I’ve always believed that madness has meaning, but also I think probably all of us in the project group would say the same thing. In a way, the framework is the culmination of our life experience both personally and professionally. We, all of us, brought a range of experience to that task which covered research, clinical practice, training, and personal experience. Together, I think it made a rich mix whereby all of us, those aspects of our experiences, were able to feed it into the production of the document.

If I think about myself, I would certainly say it’s not an accident I went into mental health work and developed the views that I do have. I’m an unremarkable person. I come from an ordinary UK middle class background, my parents are both school teachers, I have a brother and a sister, I went to a decent school. . . I mean, in one sense nothing awful happened to me. In another sense, there were a number of ways that I was always very unhappy as a child, as a teenager, as a young woman, and I spent a lot of time thinking about that. It’s clear to me that there were reasons for that.

I come from a generation that was still quite influenced by the so-called antipsychiatry movement. When I started training as a psychologist, there were still people around, some of whom were very inspiring to me, who had worked with Laing, for example. Those ideas were still around. It all fitted for me. The personal thread of experiences, that distress or madness has meaning, very much chimed with some of the currents that are still around in the culture. I’ve always believed that, I’ve always followed that thread through.


Morrill: What was the intellectual process like of constructing the PTMF?

Johnstone: In one sense, the starting point is the position statement that the Division of Clinical Psychology issued in May 2013 at exactly the same time as DSM-5 was published, and I was  part of that position statement, as were a couple of other people who were in the group. In essence, it was a whole professional body calling for the end of the disease model of distress, which is quite a brave and challenging thing to do.

One of the recommendations was that if we’re going to call for this, then we need to be able to work out what an alternative would look like and join with survivors and other stakeholders to see what that might look like.

It kind of evolved from that, without any plan. Mary and I were the project leads. I’ve never been involved in anything as ambitious as that before. I think it helps that the core group, we’ve all known each other for years, if not decades. We all knew where we were coming from and I don’t think any other group would have been able to take on such a task nearly so easily. There was a large degree of shared trust and friendship and shared ideas and understandings.

We started to meet regularly. We started to firm up some of our ideas. We started to assign different aspects of the document to different people to take a lead on it. We started to draw in other members and people to give advice and consultation. We had set up an advisory group of service users and carers. About three years down the line, Mary and I realized that unless we devoted some really solid time for this, it’s never going to happen. We essentially spent two years unpaid in front of our computers, each of us, putting it together, and then it came out.

It was very stressful at times. I think it’s fair to say that for about two years I think I felt, and I know Mary felt, and I think probably the others felt, that we’re kind of thinking, “What the hell have we done here? It feels like we’re wandering in an intellectual wilderness.” Firmly as we believed that the existing model is not fit for this purpose, it’s actually a much bigger task to put together something that is going to hold together and something different to put your money where your mouth is, as we say in the UK. So it was very stressful and difficult at times, but we’ve emerged at the other end with an imperfect, evolving document, but one I think that we overall feel very proud of.


Morrill: What do you believe the PTMF has accomplished? How do you wish it to be used, and how would it change societal and professional thinking if it were to be adopted?

Johnstone: We had no idea how it was going to develop and it’s still an evolving thing. I don’t know how far it’s going to go or what it’s going to look like. If it is really fully implemented, then the landscape would look so different. I think it is actually quite hard to conceptualize because you’re bringing up some really fundamental questions, like, “Do we need a mental health system?” Not all cultures and countries have had, or do have, a mental health system. Do we even need one? That’s a very big question.

At a more immediate level, we deliberately haven’t set out specific answers about, “How might I work differently with this person?” or “How might services look differently?” because we wanted this to be a conceptual resource, a set of ideas. It’s really up to people themselves to think about how they might put it into practice. We want to be collaborating, letting it go so other people can do what seems helpful because they will be the experts in their setting and their position. The second stage of the project is for that to happen as much as it happens. We hope to get feedback on that.

We hope to learn from how people are using it, what’s worked, what hasn’t worked, and so on. I guess what we mainly wanted to accomplish is some sense of support for people who do want to think and do things differently or see their lives differently–some ideas for them to put into practice to take them further down that road. That is how it seems to be working out. That’s great. It’s an ongoing journey, so we’ll see.


Morrill: How do the core aims of the PTMF fit in or clash with the movement to globalize mental health?

Johnstone:  One of the biggest scandals of our age, I think, is not only that the diagnostic model is comprehensively failing in the largely Western industrialized countries within which it was developed, but it is that at the same time— and this may not be a coincidence—it is being exported across the world.

This is generally seen to be a good thing and I’m sure people are well motivated, well, most of them, in doing it—not quite so sure about the drug companies—but I think we’re too close to see what a scandal this is. It reminds me quite a lot of how a hundred years ago, 80 years ago, this would have been missionaries exporting Christianity, dutifully and well-motivated, but actually this is in some sense similar, but I would say more damaging. It’s a form of colonization and it’s an insidious one because it’s about taking over people’s minds and actually persuading people that this is what they want, these wonderful, new Western scientific ways of treating so-called illnesses. One of the strong messages of the framework, we hope, is a message of respect for the many, many different culturally specific and culturally appropriate ways of understanding, expressing, and treating distress across the globe.

This is very different from the DSM perspective because the DSM perspective has a great deal of trouble in trying to accommodate culturally specific expressions of distress. Because if these are medical illnesses, they would look roughly the same, wouldn’t they? Diabetes, a broken leg, malaria, or whatever looks roughly the same wherever it happens. Expressions of distress could look extremely different. They can look extremely different across time as well as cross culturally. In the Power Threat Meaning Framework terms, that absolutely makes sense because one of our core arguments is that instead of understanding distress through biological patterns, patterns that are borrowed from the kinds of patterns that we see when things go wrong in our bodies, we need to understand distress through patterns that are organized by meaning. They’re organized by meaning, not by biology, which is a big conceptual leap, one of the fundamental conceptual leaps I think we made.We need to be thinking about how those patterns are based on or organized by social and cultural meanings, not by biology and something that’s gone wrong with our bodies.

As soon as you get your head around that, you realize, from a framework point of view, of course, expressions and experiences of distress are going to look very different cross-culturally because they’re different cultures with different meanings, norms, and assumptions. That sets the scene for saying, well fantastic. If that works, that’s great. Actually, to go further than that and say there may be things we can learn from non-Western non industrialized cultures rather than the reverse “We’re going to impose our ‘modern’ views.”


Morrill: What criticisms have you received and how has psychiatry responded to the PTMF?

Johnstone: Well, psychiatrists vary. It’s been kind of interesting because there is a group of psychiatrists in the UK called the Critical Psychiatry Network who are very outspoken critics of the way psychiatry works. I was invited to speak at their annual conference this year. They were very supportive, very interested, very welcoming. Other psychiatrists, of course, have viewed it rather differently and, as expected, have, well, I like to think that the usual line of defense goes ignore, attack, assimilate.

Any approach that challenges the status quo you tend to see: ignore, let’s pretend no one has said this, attack, let’s tear this apart, assimilate—in some ways, the most dangerous stage, because it’s like “We’ll take some bits and pieces of this, but we’ll ignore the fundamental message” and the whole road show continues much as before. We’ll have psychiatry as before, but we’ll have a hearing voices group for half an hour once a week on the ward, where we give people a few coping strategies and otherwise, everything will go on as before. Although, interestingly, we seem to have gone straight to the attack phase with the framework. I don’t know what that means, but I do want to say that it’s really much bigger than, as it’s sometimes unhelpfully phrased, psychiatry versus psychology. This is about a way of thinking that is deeply embedded in all of our minds, in every professional of any background.

I think it’s important to listen to everything that comes back at you—but some of it strikes me as quite odd. For example, one of the big criticisms we’ve got is that “Your framework isn’t evidenced.” Well, the diagnostic model isn’t evidenced, that’s for sure. We have actually got 70 pages of references and a massive overview of the evidence. Some of the less constructive criticisms are saying “You’re antipsychiatry,” which, in the UK, is a kind of all-purpose way of dismissing you.

The system isn’t going to change easily, and by the system, I mean all the professionals who are involved in it. But, as I said, that’s not mainly where we’re aiming. I think the time has come to, as much as we can, step aside from all that stuff and promote good practice and different practice where we can and where there are people willing to listen and try out new things.


Morrill: There has been a critique of service user and survivor involvement in the PTMF project. Can you discuss those critiques as well as your responses to them?

Johnstone: We’ve had some really, really heartwarming feedback from particular people who said, “I see my difficulties in a very different way, I don’t have to feel so different or guilty or ashamed,” and so on. And we’ve had some very fair criticism, particularly that it’s not very easy to read it in most of its current form. I think that’s fair. I think we want to think about more accessible forms and we are doing that.

There are people who say, “It doesn’t really seem to fit or describe me.” That’s absolutely fine. And people who are happy with the diagnostic model that does fit and suit them, and that’s absolutely fine too because it is really not our aim, nor is it within our power, to go imposing this framework on people. It’s for people to pick up if they want.

We’ve had some quite angry criticisms that I think are based on misunderstandings and I can’t blame anyone for not reading through the whole document—it is long—but the risk is you pick up ideas that aren’t actually what we said. One of the regular comments we get is, “I need my diagnosis for welfare and service access, so you’re going to take away my diagnosis.” Also, “The system is going to leap on this and say ‘oh these people aren’t ill, we don’t need to give them support,’” and so on. Actually, we’ve very clearly said, at a number of points in the document, the first priority must be to protect people’s access to benefits and services. Of course, it must be. This is a discussion document. It’s not a plan for services or benefits offices, it’s a way of discussing ideas.

I would still maintain that the current benefits system is not working now and the same people who are, understandably, anxious about “Will this make life even more difficult?” I think would be the first to admit that the system is appalling in the UK, not just in the UK. Diagnosis is very often used to exclude as well as include people, and most people are really struggling and they have to go through a humiliating process of describing themselves on their worst day and accepting a label that they may not be happy with in order to have the bare minimum to live. This system really does need changing. It needs changing in a way that doesn’t put people more at risk. But I think we have to have these discussions.

There are other people who I think have understood it or misunderstood it as saying, “We’re going to go around the country tearing people’s diagnoses off people and saying, ‘you’re not allowed to use this language.’” Again, we’ve clearly said people have to have the right to describe their experiences in a way that makes the most sense to them, but people are very rarely offered that choice. They are very rarely offered that choice.


Morrill: Where do we go from here? The world of psychiatry still seems to be mostly governed by the DSM. Does the PTMF feel like a lost cause if that’s the case?

Johnstone: It doesn’t feel like a lost cause because my view is that we are actually witnessing the crumbling of an entire paradigm. With or without the framework, the days of the diagnostic paradigm are numbered. If you read that stuff, the Thomas Kuhn stuff, the “Structure of Scientific Revolutions,” we’re seeing all the signs of the crumbling of a paradigm. We’re seeing massive contradictions within the paradigm, desperate attempts to shore it up, a mountain of evidence that is not correct, or that other ways are a better way forward.

One of the things that Thomas Kuhn says is that all these things can happen and yet, the paradigm won’t fundamentally shift unless or until there’s somewhere else to jump. Well, I think there are actually a number of places to jump, and I think the trauma-informed perspective, which we’ve drawn on to quite a large extent in the framework, is one of them, but I think the framework itself, I hope, can also be seen as additional support for that kind of approach, and as a place to jump to in itself. If it becomes a small part of that inevitable process, and I do think it’s inevitable, then we will be pleased and proud.


Morrill: That’s heartening to hear.

Johnstone: You can see I’m a total optimist.


Morrill: Anything you’d like to add?

Johnstone: I don’t think so. I’d encourage people to read the links you’re going to put at the bottom to find out more. Make of it what you will.

**

More about the PTMF

The British Psychological Society: Introducing the Power Threat Meaning Framework

Lucy Johnstone discussing the primary features of PTMF

Presenting the PTMF in Australia

Presenting the PTMF in New Zealand

39 COMMENTS

  1. Ok, if I understand correctly, the PTMF is an attempt by (some)
    psychologists to gain a bit more power, now that psychiatry and the pharmaceutical industry (biological model) has the upper hand. From what I can gather as to what psychology does, it is to alter the “meaning” for the individual in order to make him / her more amenable to the power structure (or framework, if you prefer).

    I find it interesting there is no mention (at least in the text above) of the influence current and future technology has / will have. It’s actually key, as it’s meant to cement the power disparity most of us experience.

  2. Apollonian ego fundamentalism is the main sickness. Rationalism and theology/religion in medical disguise. Where is psychology? We need the real image of the psyche. Because we do not even know about what we are talking about.

    We need “Re-Visioning psychology”,psyche is a mythic imagination. We need Jung and Hillman not false empiricism and biological model of psyche. Psychiatry is psychopathy.We do not control psyche.Our small ego participate in it. We are imagined by things we do not control, that is why we need phenomenology of the psyche, not science. We need to learn to accept psychological truths, and now all we have is theology (rationalism materialism) which condemned the real human psyche. And apollonian ego thinks that psyche is a mental illness, not psychological truth.

    Psyche is a mythic imagination, not science/ false empiricism. That imagination is not a property of our small arrogant ego or science.

    Psyche is a mythic imagination.Psychiatric imagination is apollonian ego fundamentalism (rationalism, theology) and psychiatry without psyche is a form of stubborn stupidity. We can’t have psychology on the left, and psychiatry without psychology on the right side.

    We do not have psychology. We have egology. We think that psychological reality belongs to small apollonian ego.

    We are wrong.

  3. I don’t exactly understand the PTMF, but that’s okay!

    Originally the question the Talk Therapists asked me was NOT “..what’s happened to you..” BUT “…What’s going on for you, and how can we help you….” and “..lets talk about things, and we’ll see if we can help you..”. Talk Therapy did help me.

    Successful Talk Therapy for people “diagnosed” “with” “Schizophrenia” and “Bipolar” I would imagine, would be like Dr Terry Lynch s friendly and encouraging Approach.

    From hindsight I understand my problem to have been “Neuroleptic Withdrawal Syndrome”, or as Robert Whitaker has coined it, Neuroleptic Withdrawal “High Anxiety”.

    Ultimately I was able to find effective longlasting solutions to my “obstructions” through a “Buddhist Approach” .

    • I felt the reality of my past time issues surface all at once when I withdrew. The drugs had not allowed natural shifting to occur so I was repeating the same dynamics in my life rather than evolving away from them. That’s where I had to work on shifting and streamlining my process, so that I could move forward with greater ease, which was life-altering.

      Getting off the drugs alerted me to the inner changes I needed to make so that I could create my life with higher awareness in present time. New reality emerges from this and anxiety subsides because there is no toxic interference with the process. It is natural now and I am clear on what is good for me and what drains me or simply does not speak to me, so I follow this discernment as my life guidance now, rather than based on what is expected of me or will garner me “approval.”

      Feeling badly about oneself for not meeting standards for social approval is what tends to lead many people to psych drugs in the first place. And we all know what Krishnamurti said about being well adjusted to a sick society not being a measure of health and well being. Quite the opposite is true, I believe– that seeking approval from a dysfunctional society makes us be dysfunctional on our own way. If we don’t comply and instead stand our ground and protect our well being and challenge the system, then we won’t fit in. Get used to it. I’d rather be healthy and functional rather than to fit in where it is not a healthy environment. That just means big change is on the horizon, which is a GOOD thing, imo.

      Getting off the drugs allows consciousness and self awareness to expand as we heal from the toxins, which are part of the reason for the anxiety. Big part of healing is detoxing, followed by coming into balance, experiencing relief, and achieving new clarity. That is change and transformation.

  4. Thank you Zenobia for this interview podcast with Dr. Lucy Johnstone and the transcript.

    To Dr. Lucy Johnstone and your team: I don’t have words to describe how outstanding and impressive I find your work and whole concept of the PTM Framework to be. As I watched the video of your presentation (Oct 2018) I was going to jot down a few important points but by 20 minutes into the video I was pausing to jot down everything you said because it’s all important points and truly pearls of wisdom!!
    i.e. “a formulation is NOT based on a diagnosis but on a personal story and what has gone on in someone’s life” and “Instead of diagnosing people listen to their stories”. “You are dealing with people with problems not patients with illnesses” and “what they are experiencing are not ‘symptoms’ but reactions to trauma” and it is “normal reactions (survival responses) to abnormal circumstances” and “it is about what happened to someone and their struggles – but also about their strengths”.
    Yes, yes, yes!!

    The PTM Framework makes so much good sense. I hope the medical paradigm of putting damaging labels on people who have endured trauma, emotional suffering, social injustices and problems in life will crumble very SOON!! It can’t come fast enough!
    Thank you for all your incredible work!!

  5. good luck to the team in making such important changes – how mad to think power is more of less missing from the picture – I’ve worked in the mental (ill) health system for years and its deeply frustrating to daily hear the language of disorder pouring out from just about everyone – I think in the land of psychological therapy especially with the dominance of CBT this language has exploded and it always seems to me that many therapists actually like the language – I think the language helps provide some with a sense of professionalism and expertise when it is anything but.

  6. The aim is to move, in simple terms, away from the “What is wrong with you?” towards the “What has happened to you?” question.

    How about “WHY has this happened to you?” and “HOW do we rid the world of these forces which have done this to you?”

    This PTMF thing befuddles me, as there are credible people who like it. But it still defines distress as a personal matter, to be dealt with on an individual level, rather than a collective problem to be approached collectively and politically. Rather than truly moving away from the idea that there must be “experts” to define and “treat” our (system generated) misery, even the name PTMF sterilizes the nature of what’s going on, and categorizes what should amount to fighting and defeating oppression as some sort of “helping profession.” However, pursuing revolutionary transformation (which is really what we’re talking about) is not a profession; it is a responsibility shared by all who are conscious and motivated enough to take it up.

  7. My sense is that it is ultimately a red herring dialogue because if money were not involved in the process no diagnosis would ever be needed because it would only be a transaction between the helper and helpee.
    Money makes the MH world go around and some folks have figured out how to game the system bigly.
    Ida foundation or government agency would just offer salary and not require payback part of the false dichomity would be leveled.
    Title I Social Workers were paid that way as well asHospital Social Workers but that was long ago and now far away.
    By doing eliminating payment for services more time and energy could be used for addressing real mumtiststemic needs like say our earth and housing? As just two of a flood of needs.
    Think of all the time energy these folks put in and still in a quagmire.
    I appreciate the efforts but eliminate all payment entities and beucracies and go back to small clusters or one to one. Even bartering would be better than all the interference set up to block humans in need of whatever fill in the blank to get the help they need or want or desire.
    And if folks were educated on the how to for taking care of ethics they could in many cases be a umbrella. Perps use oeople’s ignorance and fear in any power situation- take away the ignorance and fear and there is a less chance of abuse.

    • Sort of skimmed over this before but I think we’re maybe reacting to the same things — don’t know if they’re intangible or just hard to define. But real people don’t talk about “frameworks” unless they’re psychologists or “mental health” professionals, so to me this seems like more of an “in-house” discussion which seems to be calling for more enlightened “practitioners,” rather than more revolutionary consciousness among the people.

  8. I think we have had this conversation before, Oldhead… you do not have to like the PTMF, but its strongest message is that distress is NOT simply a personal matter; that we must make the links between personal distress and social injustice/inquality; and that the main changes must happen at that macro level, collectively and politically, and mostly outside the MH system. Not quite sure how you managed to read it differently…?

  9. Bad things happened and the message you gave to your subconscious was, I don’t like this and I don’t want it to happen again. Your obedient mind then formed parts which were dedicated to protecting you in the future, and the feelings they produce are interfering with life, so the feelings get labeled as the problem. If you came up with a way to look at the whole picture, really describe reality, then you could have a diagnosis. It wouldn’t be just a simple label thing, it would be longer. They just need to stop side stepping reality, and it would work a lot better, so they could have some way to classify problems because that is the need for officialdom and bureaucracy.

  10. And as long as there are financial and status incentives, we will continue trying to replace the Biomedical model with the Morally Superior and Self-Improvement model.

    Our state licenses Psychotherapists and Recovery Programs to keep survivors from ever trying to fight back.

  11. PTMF is one of the most important undertakings of the century.
    An ethical, timely and necessary challenge to the utter “bullshit” the DSM et al has spewed across the globe.
    Deep respect for Dr. Johnstone, the core team and everyone dismissing the limited medical model thinking harming the planet.

  12. I’ve been very slow to embrace the PTMF as well as other models like the psychological injury model – partly because with trauma, we’re talking about actual physical injury to the body. My mind isn’t damaged but my nervous system clearly is. That’s a really big distinction to make.

    I think I agree in spirit with the pushback against all of these new models because it feels like ever more resources are going to fix the problems the system generates rather than to changing the system. (Which system? Psychiatry? Capitalism? Government education? Conformity itself?) But I think it’s shortsighted to suggest that this is a black and white issue and that merely ending capitalism or psychiatry or pick your oppression will end traumas like child abuse, rape, spousal abuse, drug abuse etc, all of which thrive under other economic systems. So, to keep beating the war drum that all we need is collective action feels just as disingenuous as suggesting that trauma-informed communities are any sort of panacea.

    I’m very glad to see this shift in thinking about distress being pushed from within the professional community, and I think activists need to stop lecturing professionals about changing their language and telling them to make changes on the inside, and then shitting on every effort the professional class attempts to change the language of mental distress and to make those changes from the inside.

    Thank you Dr. Johnstone for your efforts and to Zenobia for the interview. I hope to see more collaboration with survivors rather than the current methods of philosophizing about or studying distressed populations. But I think this is a really good start and is certainly leagues better than the current disease model of psychological distress, which most of the emerging “trauma-informed” approaches really don’t sufficiently distance themselves from, well meaning as they seem.

    • I think activists need to stop lecturing professionals about changing their language and telling them to make changes on the inside, and then shitting on every effort the professional class attempts to change the language of mental distress and to make those changes from the inside.

      Why should there even BE a “professional class”? Or an “inside”? Why do we need a “model”? What happened to revolution as a model??? I’m surprised at this response.

  13. Promoting a Moral Improvement – FYOG model, over the Biomedical model is just a way of continuing to target survivors for more abuse.

    Survivors need to learn to fight back in the here and now, and accept none of these models of defect, and to settle for nothing other than penalties for perpetrators, and reparations for survivors.

    The PTMF is just the latest in an ongoing campaign to press survivors into life without public honor. And we have already seen so many cases where this results in suicide.

    We must organize survivors into teams who will fight back.

    • Thanks, Gerard.
      PacificDawn – I’m all in favour of survivor action, alongside professionals (as in the PTMF development) or separately. The PTMF is not a ‘model of defect’; rather it tries to show how all of us (not just those labelled ‘mentally ill’) use survival strategies in the face of the negative operation of power of all kinds.

  14. Hi Lucy,

    I’m so glad you’ve taken such a nuanced position here and in the PTMF. And I’m glad that ‘carers’ are recognized as a group worthy of being heard. I’ve given the last 11 years to my wife’s healing and we’ve seen amazing things using attachment theory and other things we’ve learned along the way.
    I’m working my way thru the PTMF. It seems like you welcome responses and reactions to the document, but I don’t see any where to send them.
    Wishing you the best.
    Sam

  15. Psychotherapy is based on teaching people that their evolutionarily developed instincts to fight back and protect themselves are wrong. And then when someone does not go along with that, they obviously are mentally ill, and so the power of the state can be used against them.

    Not much more to it than that.

      • Psychotherapy is always about getting people to yield. The psychotherapist is a government licensed Thought Enforcer. Makes no difference if any diagnosis is being used, its simply because the therapist is encouraging the client to make disclosures. This will mean that the client will have to yield because they are compromising themselves.

        • I respectfully disagree, based on personal experience. You appear to be committed dogmatically to a viewpoint that is not supported by the reported experiences of many people. I agree that the run-of-the-mill therapist is likely to be supportive of the status quo, and that there are certainly a significant number who are married to diagnoses or other client-blaming theories, and that such “help” is not very helpful. However, to say that all psychotherapy has the client yielding as the goal, or the client putting all problems in the past, is simply not true, no matter how many times that idea is repeated. It feels very disrespectful both to people who have found counseling/therapy beneficial and to those therapists (admittedly a minority these days) who work very hard at helping the client meet his/her own goals in an empowering way.

  16. PTMF
    https://www.sochealth.co.uk/2018/03/15/the-power-threat-meaning-framework/

    This is still based on Thought Policing, the reason why the state licenses psychotherapists.

    It is still based on getting people to confess their feelings to non-comrades, until they have no further defensible boundaries.

    Fortunately attorneys now are suing for “Transference Abuse”

    We don’t need this new manual or its concepts, any more than we needed DSM. I urge everyone to fight the use of both models bay any means necessary