A Straight Talking Introduction to the Power Threat Meaning Framework: An alternative to psychiatric diagnosis

by Mary Boyle, Lucy Johnstone

The current mainstream way of describing psychological and emotional distress assumes it is the result of medical illnesses that need diagnosing and treating. This book summarises a powerful alternative to psychiatric diagnosis that asks not ‘What’s wrong with you?’ but ‘What’s happened to you?’The Power Threat Meaning Framework (PTMF) was co-produced by a core group of psychologists and service users and launched in 2018, prompting considerable interest in the UK and worldwide. It argues that emotional distress, unusual experiences and many forms of troubled or troubling behaviour are understandable when viewed in the context of a person’s life and circumstances, the cultural and social norms we are expected to live up to and the degree to which we are exposed to trauma, abuse, injustice and inequality.The PTMF offers all of us the tools to create new, hopeful narratives about the reasons for our distress that are not based on psychiatric diagnosis and find ways forward as individuals, families, social groups and whole societies.

Genres: Psychology, Nonfiction, Sociology

291 pages, Kindle Edition

First published November 12, 2020

Reviews

[Harriet · Rating 5 out of 5]

Excellent book. The PTMF content was not new to me although still very helpful and I will continue to refer back to it. The chapters critiquing psychiatric diagnosis were so good and so important in a culture that increasingly focuses on mental health/illness from the medical viewpoint rather than thinking about distress more holistically. I also like that the Framework makes more space for spirituality.

[Cian Aherne · Rating 5 out of 5]

Such an inspirational book about understanding mental distress and how we have evidence to embrace a better framework for this understanding. Scrap “mental disorder” diagnoses, it’s time to change the system please!

[V · Rating 1 out of 5]

This book and by extension the Power Threat Meaning Framework (PTMF) as a whole is ideology masquerading as psychology. Of all the books I've read so far, this has to be the worst. To put this book in the overarching topic of psychology is an affront to real psychology books.
Throughout the book strawmen are erected and then subsequently burnt, such as neoliberalism, medical diagnosis and wide swathes of psychological research.

The authors of this are hardly qualified to write about psychology, nevermind the descriptions and false assumptions regarding economy.

The PTMF as a whole is touted as some sort of cure-all, while oversimplifying complex diagnoses and being overall reductive - both in terms of misrepresenting therapy approaches as being one-dimensional and reducing agency from the individual.

"Our highly individualistic culture also promotes the belief that we can meet many, if not all our
core needs through our own efforts and inner resources – by ‘selfmanagement’ or ‘self-improvement’. All of this can result in feelings of failure or self-blame in the face of adversity (see Chapter 4)." P65

"For example, we can replace ‘symptom’ with ‘problem’ or ‘difficulty’; for ‘schizophrenia’, ‘bipolar disorder’ or ‘depressive illness’ we can substitute ‘hearing voices’, ‘having extreme mood swings’, or ‘feeling desperate and suicidal’. We can turn the conditions that people are said to ‘have’ into what they ‘do’: for example, ‘experiencing the effects of trauma’ rather than ‘having a personality disorder’. Sometimes we may need a range of alternatives to draw on: for example, replacing ‘mental illness’ with ‘emotional distress’, ‘mental distress’, ‘severe mental distress’, ‘extreme state’, ‘psychological distress’, ‘troubled or troubling behaviour’ and ‘emotional suffering’." P171

To say that the above is an oversimplification would be hyperbole. In the ICD-10 Schizophrenia (F20) is delineated into eight different types, all with different criteria. The authors repeatedly lament a dehumanisation of individuals that are diagnosed, yet at the same time in broad strokes reducing entire established lived experiences into single words. Persons that are diagnosed with schizophrenia have a rich lived experience, and it deserves better treatment than 'hearing voices', this belies the authors lack of knowledge and experience in terms of practical therapy and practice.


"This ambitious project was co-produced by a group of psychologists and service
users and published in January 2018. It is called a ‘framework’ because it is broader than any particular theory or model, although it shares features with some approaches you may already
be familiar with. A framework is a kind of lens that guides how we think about and study a particular area – in this case, the various forms of troubling feelings and behaviour that are usually called ‘mental illness’. For example, the medical framework is based on a set of ideas that suggests that we should look mainly to our brains and bodies to explain these experiences. The PTMF, on the other hand, unpicks these ideas and comes up with a very different set of principles that apply to every area of the field that we call ‘mental health’, including research, training, service design, mental health charities, peer support, welfare and housing agencies, the media,
and policy-making at all levels." Page 2

I have not met many therapists which hardline represent solely a bio-behavioural approach, as they usually change their tune once they practice. More often than not, a succesful therapist will pursue a holistic approach to therapy, this means mixing psychoanalytic, depth psychology, existential psychology, behavioural psychology (Such as CBT and DBT), and logotherapy. This list is not exhaustive. A quick glance at the references in this book shows a distinct lack of variety - why is Erich Fromm not cited? His work present excellent deconstructions of capitalism and consumerism, and this already since the 1940s.
Other perspectives which would have been relevant are also strangely absent. In no particular order, where is the existential-humanistic approach? Where is a citation of Logotherapy and Viktor Frankl?
How about James Bugental? Irvin Yalom? Rollo May? Sullivan? Carl Rogers? Karen Horney? All of these do not follow a strictly 'medical' diagnosis reductionist approach, all of them include holistic approaches to meaning, narrative and empowerment of the individual. All of them focus on the whole person. Most modern therapists do too.
Edit: Also why not quote and cite Szazs? He presents some significantly better arguments against the coercive aspects of psychiatry and was a staunch defender of patient freedoms.

We stand on the shoulders of giants today - Freudian theory might be yesteryear's melted snow, but the therapy, the practical application is not vastly changed from when Freud worked.

The purpose of this book and the entire framework around it is not to bring therapy forward, but to push a political narrative. It is wholly unsuited to what it purports to do.

I quote Page 167: " The PTMF therefore aims to open up a much-needed discussion about hypothetical alternatives, all of which have their pros and cons. A personal narrative is obviously not suitable for these purposes, but another possibility is using straightforward problem descriptions such as ‘hearing distressing voices’ or ‘feeling suicidal’ or ‘experiencing severe anxiety’. A GP signing you off work might say you have ‘stress’ or ‘exhaustion’; in the same way, these are non- Medical terms that do not need to include personal details but are acceptable if confirmed by a
professional.
More radical solutions such as Universal Basic Income, in which everyone is guaranteed a basic living wage regardless of their employment or health status, are also worth considering, although a lot depends on how they are implemented. A universal right to income has been found to be popular with service users as an alternative to the humiliating requirement to demonstrate enough impairment to access essential financial support (Beresford et al., 2016)."

As such it does far more damage to its alleged cause by presenting abysmal arguments as to the abolishment of diagnosis, thereby strengthening its grip.

I have to repeat, the therapists that are being presented here, the entire 'medical system', is a strawman.
Most therapists have holistic approaches and are in pursuit of establishing an authentic connection with their clients/patients.

If you want to actually get a holistic overview of psychology and therapy approaches, I recommend reading "The Will to Meaning" by Viktor Frankl. Unlike this book, it contains substance.

[Martin Vallis · Rating 5 out of 5]

If you’ve been through the Psychiatric system like me and been given a diagnosis, then this book if you want an alternative view, is well worth the read.

Having been a service user and inpatient at various times in my life, this presents another way of viewing my experience.

It’s not so much that I wasn’t aware of some of the process raised in this book, it’s just that, when in a vulnerable position and environment ones voice is often not heard because of the ‘Power and Authority’ that’s been held over me and not only that, that I’ve given up to, those who may or may not be better informed.

This book has really changed my thinking, well done, Mary Boyle and Lucy Johnston.

[Ceri Paterson · Rating 5 out of 5]

Looking for an alternative to modern psychiatry? Here it is, fully explained & detailed.