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

101 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.

        • Thanks, Fiachra, I’m glad to hear this speaks to you. Yes, our “systems” do just that, they argue with themselves, helps no one in the end and only causes chaos for everyone, the Great Divide. Starts with the “leaders,” they are the examples. Ultimately, we have to lead ourselves if we have only divisive leadership, which is what creates a society/social system divided.

          It’s what I write about in the article which just got posted on Mad in Italy. Please check it out! Part 1 of 3. My original version is posted in English and Marcello translated it to Italian. It’s nicely laid out I think and I appreciate being published in 2 languages.

          I’d be so interested in your feedback, of course, which I always find to be very heartfelt and meaningful, if you feel compelled to comment so far. It’s a new site, so not much commentary at all for now.

          Who knows? This might lead to a book eventually, so much to write about! That’s a big undertaking, though, and not sure I’m prepared at this time. I’ll see how this flies, first, one step at a time.

          https://mad-in-italy.com/2019/07/larte-dellessere-umani-parte-1/

  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.

    • My supposition is that the PTMF idea is probably influenced by the writings of David Smail. It does away with the presumption of ~mental illness~. Its like trying to cure people of their exposure to the ~mental health~ system.

      Its not bad for a first critique of psychotherapy. But it still comes down to confessing your affairs in the therapist’s office, instead of fighting to end this colonization. It does nothing to address the actual assaults on social and civil standing, as those require a political solution, not ~therapy~.

  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.

    • 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.

      There currently are no other economic systems, as there are no truly socialist countries other than perhaps Cuba, and that’s iffy. So I think this has to be considered speculative. Certainly rape, for example, predates capitalism; however in the current day it is part of the capitalist mentaliity — just as racism and male supremacy may have predated capitalism but are now part of its support system. Moreover, capitalism is not just one form of oppression among many, but is “the mother of all oppression” in this day & age. So overthrowing it would not be a “merely,” it would change how people perceive the world and themselves and how they relate to one another.

  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.

  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.

          • Therapist does not obtain punishment for perpetrators and reparations for survivors.

            They just get survivors to live in the very small social space which the abusers have left.

            Therapy is an opiate.

          • Posting as moderator: It is important not to make generalizations about large groups of individuals, even based on profession. I’m not going to publish any more comments that make negative generalizations about therapists.

          • Since psychotherapy does not refer to anything specific it’s hard to generalize about “psychotherapists.” However there are perfectly accurate generalizations that can be made about psychiatrists.

          • I would agree that psychiatry is an organized system with a specific purpose and a political apparatus to support it, including mass funding through the drug companies, and it is much easier to make accurate generalizations about psychiatry. I would still maintain that saying that “all psychiatrists” are the same is inaccurate, but in the case of psychiatry, the defectors from the status quo are much fewer and much more exposed to blackballing and other punishment from the powers that be.

          • All psychiatrists are not the same as everyone is an individual. However all psychiatrists submit to the same basic belief system, the one which believes in “mental illness.” If not they are heretics. I imagine there are also Christians who don’t believe in Christ, but this is not sufficient to invalidate the generalization that Christians believe in Christ. Same here.

            “Psychotherapy” on the other hand has no consistently shared principles other than counseling for pay.

          • I will agree that some therapists are worse than others, but I still say that the underlying premises of the whole thing are always wrong. And if we promote psychotherapy, then most clients are going to end up with the crumby therapists. And I have also noticed that those who are not paying but are being provided with a therapist at public expense, they get the worst. It is not just because these are bad therapists, it is also because there is a presumption that the job of the therapist is to regulate and reform the client, so that they don’t use up so much tax payer resources.

            But having said all of that, I still say that therapy is based on a con, and it tries to get people to reformulate their self narrative into something consistent with the con.

            So really it has a lot in common with something I loathe, Scientology. But it also is like versions of religion.

            People say that Freud and Psychoanalysis took hold early on because they appear to be more liberal than religion, seeing us as being animals and having lots of drives to sex and violence.

            In his native Vienna Freud watched troops mobilizing for WWI and he lamented about all the kinds of darkness that are in men’s souls.

            But he seems not to understand that it is not darkness in men’s souls which make war.

            What makes for war is injustice, things like monarchy and capitalism.

            And fighting for one’s country is not necessarily a bad thing.

            Freud was taking people’s experiences and turning them into a moral defect. Still too much like religion. And today, Psychotherapy is still like this, they just use different terminology. And this Richard Schwartz, as I see it is one the worst.

        • Steve McCrea, can you offer anything which psychotherapy does, besides being an opiate and telling people that it is morally superior to live in the very small social space which the abusers have left?

          “The practice of Psychotherapy is wrong because it is profiting from another person’s misery.”
          https://www.amazon.com/Jeffrey-Moussaieff-Masson-Emotional-Psychological/dp/B008WDKKHK/ref=sr_1_2?keywords=jeffrey+masson+against+therapy&qid=1564536210&s=gateway&sr=8-2

          Any alternative view to:

          “Psychiatry and Psychotherapy turn your experience of injustice into a medical problem and a self-improvement project”.
          https://www.amazon.com/Anti-Social-Family-Radical-Thinkers/dp/1781687595/ref=sr_1_1?keywords=anti+social+family&qid=1564536271&s=gateway&sr=8-1

          • I am saying that it depends very much on who the psychotherapist is and what they’re about. I would say that it is true that most therapists these days are fully indoctrinated into the DSM system and see people’s problems as “mental illnesses.” But as Bonnie points out, there are therapists who take a very different view of what therapy is or should be, and there are many people, including myself, who have had very positive therapy experiences themselves. I can pretty much guarantee you that I would not have become an antipsychiatry activist and advocate for stopping the mass drugging of kids in our society (and adults, of course, but kids were my specialty) without having gone through that experience myself. You have talked about Alice Miller and the need for people to get in touch with, feel, and validate their own experiences in order not to perpetuate the same offenses on the next generation. I agree totally with Alice, and I would also submit that most therapists haven’t done this work and are either useless or dangerous. But not all.

            So my objection is not to making generalizations about the practice of therapy as a profession, but to generalizing that all THERAPISTS have the objective of removing someone’s honor and having them accept themselves as inferior beings. That was not at all my experience, and others report finding therapists who have helped them gain new and helpful perspectives on how to live their lives without worrying about how “the system” or “the middle class” would judge them. I think this is very valuable when it happens, even if it is rare, and I don’t want folks who have had that kind of experience or who have provided that kind of experience to be invalidated by sweeping generalizations about what “all therapists” are intending to do.

          • Well some have said that Psychotherapy works well when the therapist lives in more non-conformist ways than the client.

            But this is usually not the case though because the clients tend to be more socially marginalized, whereas the therapist enjoys a good degree of wealth and legitimation.

            I imagine that when David Smale did therapy sessions that they were more like Philosophical Counseling, and that this new Diagnostic Manual is intended to steer it more that way.

            Please tell me if I am correct.

            Okay, but do we really want people making appointments with counselors of any type? How about peer relationships and political activism?

            If John Brown had consulted with a therapist, would he have raided Harper’s Ferry?

            If Huey Newton and Bobby Seale had consulted with therapists, would they have founded the Black Panther Party for Self Defense, and then approached Oakland Police while carrying fire arms?

            Would suffragettes in jail have gone on hunger strike and had to endure the feeding tube, if they had first consulted with therapists?

            Would Michel Foucault have gone on to be what he was, if he had submitted to the national renowned psychoanalyst his parents had sent him to in the 30’s?

            Here Shari Karney, she did see a therapist, but only for a while. Then she committed herself and worked tirelessly to find a way around SOL’s, finally just having to get the laws changed. This took about 10 years and involved much conflict. But as she said on her web page, this is why the US Roman Catholic Church has had $2 billion in judgments against it.

            Excellent made for TV movie:
            https://www.imdb.com/title/tt0108110/

            I believe that if she stayed in therapy, or was the sort of person who would stay in therapy, then her legal fight never would have proceeded.

            Karney is a survivor of early childhood familial sexual molestation. And she never was able to sue her own parents. But she opened the door to all such suits, though most have been against large institutions. Seems to me that people are still not ready to deal with abuse within The Family.

            But no one would ever accuse Karney of just doing nothing, or of aiding the perpetrators. She is ferocious.

            So I put this forward as a question, and please tell me if I am wrong or right. Seems to me that a universal among therapists is that they are not interested in political fights over anything other than therapy. They are certainly not interested in revolutionary activities. Their view is that the issues and the solutions exist between the client’s two ears. While they won’t anymore do like Freud and call the client’s liars, they still see the client’s basic complaints as being unimportant. Rather, their objective is to help the client learn to live with things as they are.

            So I ask this as a question, and it is the basis of my claim that all forms of Psychotherapy revolve around something like Original Sin.

            Other’s knowing more than me have said this about Freud, that it is all based on a religious world view, and that it comes down the client being the one who is wrong.

            I see Life Coaching as wrong or foolish for the same reasons. But Life Coaching is likely to be shorter term and of more narrow focus, and it is not government endorsed.

            In the 70’s feminist groups would meet and discuss things like Incest, Rape, and other horrors of a life restricted to domesticity. They saw these rightly so as political issues.

            But in the 80’s concern of these issues spread to a broader and hence more conservative portion of the populace.

            Hence, it all became fodder for Therapy and Recovery.

            Susan Faludi
            https://www.youtube.com/watch?v=fIC4uKSFpL0

            https://www.amazon.com/Rocking-Cradle-Sexual-Politics-Happened/dp/0201624710

            Today I read that psychotherapists say that the number one concern of millennials is that they will not be able to save enough money to retire.

            Okay, so is their therapist going to change anything about this?

            Why are they not at political meetings and in political protests and writing political articles, to try and bring this country to Social Democracy, and to end this politics of private wealth accumulation and of inflating the stock and real estate markets?

            When one emerges from the office of their therapist, what objective circumstance of their life has changed?

            I say, only if you believe in Original Sin, would you say that something has changed.

            Yes, the clients are part of the problem, they seem to always be attached to reactionary social and political views, and to me this is the real source of their problems.

            But you don’t find therapy clients leading the charge for legal redress. In a civilized society wrongs are redressed by law suits. And most other industrialized countries do not even allow disinheritance. But try to talk about this with therapy clients and they are mortified. They don’t want to even look at such ideas, because that would mean breaking out of the fantasy which therapy has created with its bad models of cognition, and seeing just how abusive this world really is.

            I talk online to people who believe in therapy, from other countries, and they talk about how their parents abused them. I ask them about their country’s more favorable inheritance laws, and they have zero knowledge of such. And I am talking here about even civil law countries where the client will not even need a lawyer to collect. Therapy has put them into this film representation type world, created by reflected memories made into a story line, and this is not how cognition works.

            Where you find people who want to fight, its in those like Shari Karney and in those like the Munchausen’s Survivor Julie Gregory, people who very early on excused themselves from Psychotherapy and Recovery.

            Gregory ends her book, not in therapy, but dialing Montana CPS, because her mother has got a foster child, and a whole new pile of medical books, and she seems to be doing the same stuff all over again.

            So I feel that the basic premise of therapy is that it is better to keep it within the therapist’s office. If this were not true, then therapists would have vast experience and knowledge about legal and political fights.

            We want people hooking up with political comrades, people who are willing to take to the barricades.

            What does the therapist think their sessions do, unless they believe in Original Sin or otherwise have a low opinion of the client?

            Jeffrey Masson says that virtually all of the stuff discussed with a therapist would be better discussed in some other venue. I have yet to see anything myself which contradicts this.

            Deleuze and Guattari say that Psychoanalysis, but meaning Psychotherapy too, have been created by Captialism and that they are completely parasitic.

            There is this 4 hour BBC documentary, Century of Self. It is a deep and cutting critique of all forms of Psychoanalysis, Psychotherapy, and Psychology, and its effect on politics.

            They start by showing this Psychoanalysts Ball held annually in Vienna. People say that because of Psychoanalysis, people can speak freely. Example, say someone is a maid. If they tried to complain about this they would be rebuked for not accepting their social position.

            Whereas with Psychoanalysis they are free to say what they feel.

            Well, is this really true? A most basic area will be the exploitation and abuses which are the middle-class family. So the client starts to speak. But does the therapist really side with them? Usually the therapist will say things which tend to exonerate the parents, and which tend to excuse what happened as being of the past, the old pedagogy manuals.

            And Jeffrey Masson writes that it is part of the training to at a certain point stop listening and shift to trying to get the client to accept what has happened and to forgive.

            And isn’t it true that Psychotherapy is just Pedagogy Round 2? It promotes the ideology of the family.

            Try to get the client to kneel down and worship the Holy Family, while acknowledging that there have been mistakes and errors, and that the old pedagogy manuals were worse than the new ones.

            But the client must not see that the entire system is rotten, and all Pedagogy Manuals are just lessons in how to abuse children and get away with it. The angry client is to be turned into a helpless neurotic.

            In D and G’s Anti-Oedipus they have a very funny little skit which Jacques Lacan had published, making fun of psychoanalysis over this.

            And they quote Antonin Artaud saying something which shows the neuroticism which Psychoanalysis and Psychotherapy are predicated on.

            D and G call this “Oedipalizing”. And the schizo is someone like Artaud, who cannot be Oedipalized. So of course this is where the mental health system would really bear down.

            Alice Miller writes about artistic representations of the Sacrifice of Isaac. Why is Isaac always mute and compliant?

            She says that if Isaac were to raise his hand against Abraham, then “that would start the war that we all fear.”

            Well this is where we see the limitations of Alice Miller. Its her Psychoanalytic training, its the effects of religion, and I say that also she was weakened by her experiences in the Warsaw Ghetto.

            She finally wants Isaac to just ask “Why?”

            I say that we have to strike back, we have to bring on a revolution, whether we fear it or not. I do not fear it in any way at all.

            Paul Mones says that most of what we know about familial child abuse comes from the Richard Janeke patricide case from Cheyenne Wyoming.

            People learn when thing happen, and they happen regularly. And we all learn when we act. I learned a huge amount from being intensely involved in a child sexual molestation prosecution.

            I say that it never will be like this in the therapist’s office, and that someone is a therapist because they have committed themselves to the view that it is better to keep it in the therapist’s office. And I see this as being a universal truth.

          • Well, I still think you’re making generalizations that aren’t true for every therapy relationship. My therapist didn’t specifically suggest that I do anything or not do anything in particular, because she saw her role as helping me process those unconscious feelings you and Alice Miller talk about, and then to decide FOR MYSELF what I should do about it. It certainly did involve confronting family members about how I had been treated, and seeing roles that other family members had been thrust into and helping protect them against the (mostly unconscious) tyranny of my mom and my brothers. There was also a raising of social consciousness regarding the plight of others who had experienced similar family dynamics and were suffering. This led me eventually into social work, and then when I observed what social work systems were doing to people, into advocacy. She most definitely helped me move from being angry at myself to being angry about social injustice, not because she told me to feel that way, but because she helped me find and connect with my own sense of righteous indignation. And as I said before, without this experience, I would never have gotten to advocacy as a career and life path.

            So my therapist did not fit your model of “teach you to adjust to injustice” or “accept your lot in life.” It was much more about, “If you have an issue, what are you going to DO about it?” Which certainly fits into your framework of encouraging people to take action against their oppressors.

            Now this was in the 80s, and I fully acknowledge that such therapists have become more and more rare as the DSM has taken hold. But to pretend that there is some generalized agreement among therapists that their job is to prevent people from holding their oppressors accountable is to me simplistic and not supported by the fact. Therapists are not lawyers, nor are lawyers therapists, but there’s nothing to prevent a therapist from making referrals to lawyers for class action suits and the like, and I certainly have done that with many a person in my social worker days.

            As a wise man once said, “Generalizations are always wrong.”

          • Why would someone opt to be a psychotherapist if they did not see the locus of problems as being between the patient’s ears, and that the place to handle this was to be their office?

            And they must be able to see that no amount of therapy helps the client restore their public honor. In fact, the more weeks for which their life revolves around therapy and recovery, the further advanced becomes the narrative of defect and disorder. Makes it look like the client does not even understand the concept of honor and that they do not want honor.

            And why can’t these interpretations be generalized about therapists?

            Working shoulder to shoulder with comrades on the barricades is a good place to start when one wants to restore their honor.

          • Because not all therapists are the same, and saying they are is inherently insulting to people who either provided or received care that conflicts with your generalized assessment.

          • Psychotherapy, like Psychanalysis, runs of the premise that all you have to do is surface that which is unconscious.

            Well first of all, this is a rotten model of cognition.

            Second, is the therapist paying office rent, or are they out fighting on the barricades and in the court rooms to make the sorts of legal changes which will restore the social and civil standing of survivors, and will end this interminable “healing project”?

  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

  17. Money spent to develop this PTMF Manual, money spent sending survivors to Psychotherapists so that they can talk themselves out and thus be reduced to a highly vulnerable state so that they can be pressured into accepting an honorless vegetative existence.

    This money would be far better spend sending survivors to law school.

    And I am not the originator of this idea.

  18. Lucy Johnstone is quoted above “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.”

    Why on earth would anyone want a psychotherapist to be even knowing their affairs, let alone planning the “best way forward”. Diagnosis simply means that a survivor of abuses is being tarred as having something wrong with themselves. Where as the real problem was always the destroyed social and civil standing. Diagnosis, even of this PTMF sort, just further compounds this.

    And we must organize and fight for redress, including Universal Basic Income, which does not further tar survivors or require acceptance of a diagnosis.

  19. I should probably ignore this comment, and the many others like it, but I do find it frustrating when people who apparently have not read the PTMF make blanket statements about what it says, which are actually the opposite of its arguments, and then state that it should be arguing for X,Y and Z instead, which in fact it already does.

    The PTMF does not support any kind of psychiatric diagnosis, or variation on the diagnostic system, whatsoever. It is not about psychotherapy except in a very indirect sense. It is about all of us, whether labelled as ‘mentally ill’ (a grouping which it does not accept) or not. It promotes non-professional support and help and activism as much as, or more than, professional interventions. It is centrally concerned with issues of social and civil rights. It argues that we need a fundamental re-think of our welfare systems, including, possibly, UBI – and it includes a detailed discussion of the pros and cons of UBI and other alternatives.

    I am not sure what document PacificOcean has been reading, but it is not the PTMF. The PTMF is an imperfect, evolving project, which may not be to your taste, but it bears no resemblance to the version that is assumed by several MIA commentators.

  20. lcjohnstone, you seem not to have read what the promoters of the PTMF are themselves saying.

    “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.”

    The mental health system exists because most people, including most of us here, have cooperated with it and gone along with its rationalizations.

    Those of us who have been effected by it will only regain our social and civil standing, our biographies, when we totally reject it and punish perpetrators and seize reparations for survivor.

  21. lcjohnstone, why to you think anyone would consent to having this new manual used on them?

    Could it be because the mental health system has already gotten power over them?

    And then what of the trashing of this persons biography, their social and civil standing? Don’t you think this was a person once with ambitions?

    If the mental health system has impacted them, then they no longer have a legitimated biography. This will hurt them in the development of a career and with intimate relationships. ~Healing~, ~Recovery~, and ~Therapy~ do not make for a biography.

    This changes though when survivors start organizing and fighting back.

  22. Icjohnstone, maybe the ideas behind the PTMF are like those of David Smail. But he was talking about how power is used in order to help people see through the fallacy of ~mental illness~.

    This PTMF turns it around. Making up a new system for classifying people.

    And your therapist is not going to get up out of their chair, ride down in the elevator, and solve problems for you. An attorney would try their best to being other parties into line. But a psychotherapist, no. So at the end of the day, it is still the client who has a ~problem~. Not described in DSM terms anymore, but in these new PTMF terms, so it still undermines their public honor. And loss of public honor, as I see it, is always going to have been the problem in the first place.

    If we want to take down the Mental Health – Psychotherapy – Recovery System, then we must not ever cooperate with it in any way.

  23. What the PTMF people say,

    “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.”

    It’s not a genetic, medical, or brain chemicals approach anymore. Its a moral and character defect approach.

    It is true that what has been called ~mental illness~ is really just about ways power is being wielded. And being shown that gives one a chance to resist the ~mental illness~ interpretation.

    But this PTMF is yet different again, turned back around. It’s a new manual, but the one wielding it is still the therapist. And your therapist is not going to venture outside of their office to solve your problems.

    If you hired an attorney, they would do their best to solve your problems. By mediation, court orders, or a lawsuit, they would do their best to force other parties to yield so that you could win.

    But the therapist, no way. You are the one who comes to their office, and so you are the one they try to influence. So no matter what they pick out of this new PTMF manual for you, it is still you’re problem. You are the one who has not learned how to solve it, you are the party whom the label is being recorded as attached to.

    The analysis of power which could have been used to dismantle the ~mental health~ system, is now being used to turn it into a ~moral health and hygiene system~.

    • This scenario is nonsense, and more or less the exact opposite of what the PTMF advocates for. It is not a manual. It is not particularly aimed at therapists. It argues strongly that problems are not located within the individual or their ‘character’, and that real life solutions are what is needed. Further more, it questions the whole idea of therapy, mental health services, and the rest of the current system. I won’t be responding further.

      • But it is still coming out of a ~mental health~ or ~therapy~ context. And it assumes that people will be discussing their affairs.

        Where as for example, if the party went to an attorney, the first thing the attorney would say is “Stop Talking About It”.

        And it is being called a “Conceptual Alternative to DSM.”

        Well the conceptual alternative to DSM is a lawyer to bring the matters into civil court.

  24. Oh but Lucy, this has been great! So please do not drop out of the conversation. It is despite the uncomfortable feelings raised extremely important.
    Do not give up and I would say the same to PD but breathe and process and think on this and think on that and if something rises up please share.
    My reaction was visceral and it wasn’t I skimmed for the sake of skimming – some of it way to close to my trauma core.
    And the other issue is please please please say life is trauma. Do not create walls and barriers where they really Do not need to exist.
    Social Work/ Parenting 101!!!!!!!
    The fact that your kid is angry does not mean the kid or you are bad the fact is kid or adult fill in the blank is SAFE enough to get angry!
    This is huge!
    Because of our human history of trauma the emotions are twisted tangled and come out in a variety of health and unhealthy ways. And if one has been majorilly traumatized just getting to the point of recognizing I need to contain this emotion or well yeah These Emotions can be life long or some never are able to identify and it comes out in abuse of some sort.
    So glad you are trying glad to see multisysyemic thinking, glad to see you dialogue but for me and possible others
    Be Includive we not we as professionals but we as humans on this fucked up earth. ( And Yes Alex – not total and places of green) Then maybe an opening through the walls and barriers of now. Capice?

  25. Look, I will concede that this PTMF is a kind of attempt at anti-psychiatry, similar to David G. Cooper.

    And he did still seem to have an anti-consulting office, do anti-sessions, and collect anti-fees.

    And it does sound similar to David Smail. His web site and online book are being rebuilt right now.

    Okay, but this stuff is all coming from way back. And PTMF does sound more like Philosophical Counseling, or Life Coaching.

    But we don’t need any alternative to DSM. All we need is the middle finger.

    Right now in the US we have a burgeoning underclass. For the most part it has been created by Psychiatry, Psychotherapy, and by the Autism and Neurodiversity industry. It plays into the needs of the middle-class family too, the need to find ways to medically abuse children.

    So you can write a book about power, and teach classes about power. No objection to that. But the problem arises when it becomes psychotherapy, taking advantage of naïve people who will confess their affairs to a therapist sitting in the arm chair across the room from them. That therapist is not a comrade, not in anyway. They are a state licensed thought enforcer.

    We need people to reject drugs, psychotherapy, and recovery programs. Otherwise we will continue to make no progress.

  26. Once people finally see the con which psychotherapy always is, then they can move into the realm of legal and political action. Just look at the new Child Victims Act in NY, 500 lawsuits already.

    And in British Columbia those who have survived a ~dysfunctional family~ to a lawyer, to make sure that they are not disinherited, not a therapist or a recovery group.

    And then Civil Law countries, it is not even necessary to have a lawyer.

  27. The focus on trauma as being about “memories” is very misleading. And this largely comes from the conjunction of conjunction of Psychotherapy and the Recovery Movement. And unfortunately this is still being stalked about in connection with this new NY Child Victims Act.

    A better understanding would be found just by looking at how someone’s life has been shaped, the lost social opportunities, and then just at the degree of betrayal involved. If you just talk about memories, that makes it sound like physical pain and trauma. Better is just to see it as the entire context of one’s life being undermined by exploitation and betrayal.

    And of course in saying this I am aware that childhood sexual abuse is the worse, the closer the child is to the abusers.

    Exposing this requires legal redress, not just a psychotherapist who has promised confidentiality. It is not a personal issue, it is a societal issue.

  28. PacificDawn’s Elixir of Health, Wealth, and Happiness!

    All it costs is $300 per treatment. But each treatment does as much good as a whole year of weekly psychotherapy sessions.

    This is how a treatment works, I drill a 1/16″ diameter hole in your skull, and then I inject 2 fluid ounces of my magical elixir, which is derived from citrus juices.

    *******************************************************

    Do you find the above scenario implausible?

    Do you think my treatments would do as much good as a whole year of weekly psychotherapy sessions? And do you consider your position to be based a rational or an irrational belief?

    Do you think my treatments are non-harmful? And do you consider your position to be based on a rational or an irrational belief?

    Do you consider psychotherapy to be beneficial to the client? And do you consider your position to be based on a rational or an irrational belief?

    Do you consider psychotherapy to be non-harmful to the client? And do you consider your position to be based on a rational or an irrational belief?

    CA Gov. Gavin Newsom, Attorney General Xavier Becerra announce legal action on immigration
    https://www.youtube.com/watch?v=J3volw6DXXw