The Power Threat Meaning Framework was published in London on January 18, 2018 by the Division of Clinical Psychology of the British Psychological Society. According to one of its’ lead authors, “The Framework is an ambitious attempt to outline a conceptual alternative to the diagnostic model of mental distress, unusual experiences, and troubled or troubling behaviour.” The Framework is an evidence-based, non-medical approach to identifying patterns in distress, including those that are called “psychosis”.
The “core principles” of the Framework identify the roots of psychological distress as arising from human relationships, not brain chemistry or dysfunction. For example:
- “Humans are fundamentally social beings whose experiences of distress and troubled or
troubling behaviour are inseparable from their material, social, environmental, socioeconomic,and cultural contexts. There is no separate ‘disorder’ to be explained, with context as an additional influence.”
- “Experiences and expressions of emotional distress are enabled and mediated by, but
not in any simplistic sense caused by, our bodies and biology.”
From the PTM Overview:
“This broad PTM Framework is derived from a wide range of theory and research, across disciplines and research methods. It comprises four interrelated aspects:
- The operation of POWER (biological/embodied; coercive; legal; economic/material;
ideological; social/cultural; and interpersonal).
- The THREAT that the negative operation of power may pose to the person, the group
and the community, with particular reference to emotional distress, and the ways in
which this is mediated by our biology.
- The central role of MEANING (as produced within social and cultural discourses,
and primed by evolved and acquired bodily responses) in shaping the operation,
experience and expression of power, threat, and our responses to threat.
- As a reaction to all the above, the learned and evolved THREAT RESPONSES that
a person, or family, group or community, may need to draw upon in order to ensure
emotional, physical, relational and social survival. These range from largely automatic
physiological reactions to linguistically-based or consciously selected actions and responses…
“In summary, this PTM Framework for the origins and maintenance of distress replaces the question at the heart of medicalisation, ‘What is wrong with you?’ with four others:
- What has happened to you?’ (How has Power operated in your life?)
- How did it affect you?’ (What kind of Threats does this pose?)
- What sense did you make of it?’ (What is the Meaning of these situations and experiences to you?)
- What did you have to do to survive?’ (What kinds of Threat Response are you using?)
Translated into practice with an individual, family or group, two additional questions need to be asked:
- What are your strengths?’ (What access to Power resources do you have?)
- …and to integrate all the above: ‘What is your story?”
The early response to the PTM Framework has been mixed. A writer in The Critical Mental Health Nurses’ Network is full of praise, stating, “… no other framework or explanation of distress in individuals/society I have ever read has the scope and rigour of this one…it is no kind of exaggeration to say that it exposes the intellectual bankruptcy of psychiatry.” On the other hand, a “critical psychiatrist” writing in Recovery in the Bin raises issues with the lack of evidence for reliability and validity of the model. This author also expresses doubts about the applicability of the PTMF in certain situations, saying, “The feasibility of using the PTMF in short appointments (of 15-30 minutes) or in emergency work including overnight when time / cognitive resources are under pressure and many issues such as risk or excluding medical causes of problems is limited.”
Although approaching the point from different, almost “half-full/half-empty” perspectives, both authors point out that the PTMF does not fit within our current social services system, which has been constructed and operates within the architecture of the traditional biomedical model, extending even to such matters as insurance reimbursement and legal processes. As the psychiatrist points out, “…the legal system is geared towards making categorical judgements which fit well with diagnostic constructs.” The nurse is more optimistic: “It is going to take a lot of time and discussion to understand The Power Threat Meaning Framework and plan next steps, but how could that be otherwise given that this is not a few tweaks but a revolution in mental health?”