The Power Threat Meaning Framework By Anne Scott

  • 6 March 2018

In January this year, a new report was published online by the British Psychological Society which presents a radically new way to think about the diagnosis of functional mental illnesses, or mental illnesses which are not rooted in brain damage or neurological disorder. It is called The Power Threat Meaning Framework (PTMF), and it replaces the extremely problematic process of categorising people with labels such as ‘schizophrenia’; ‘generalised anxiety disorder’ or ‘anorexia’, with an alternative approach, based on a narrative process which looks at people’s life history, and the meanings they have made of it. 

The Power Threat Meaning Framework replaces the diagnostic question: “What’s wrong with you?” with four new questions:
1. What has happened to you?   (e.g. how have negative power relations impacted your life?)
2. How did it affect you?  (e.g. What were the resulting threats to your survival, safety and general wellbeing?)
3. What sense did you make of it?  (e.g. what were the meanings you created out of your experiences?)
4. What did you have to do to survive?  (e.g. how did you respond to these threats with coping/ protective behaviours that ultimately became ‘symptoms’ of mental illness?)

Seven general patterns have been provisionally laid out, which hinge on particular dilemmas faced by children, young people and adults, such as ‘surviving entrapment and defeat’ or ‘dealing with emotional abandonment’. For each of the patterns, there are experiences of negative or coercive use of power; typical threats that result; and common meanings that people may make of those experiences. As a result, certain threat responses, or ‘symptoms’, become characteristic of each pattern, but these cut across a number of the standard DSM or ICD diagnoses. 

The report is weighty! It comes in two forms: the full report, which is 400 pages in length, and lays out the problems with standard diagnosis procedures, the reasons for drawing on narrative, the ways that social adversities can impact on wellbeing, and the new approach. There is also a shorter overview document, which just looks at the new approach, and finishes with a number of case studies looking at alternative ways of approaching mental illness in practice. The full report also discusses how the PTMF can replace the standard uses for diagnosis, such as insurance requirements, research needs, and clinical processes. 
I found this report quite exciting to read!  As a sociologist of mental health, I am intimately familiar with the failures of our current, reductionistic, system of labelling people, often with a number of ‘disorders’, and then attempting to treat these disorders in a decontextualized way that doesn’t take account of their histories of adversity or trauma, or the meanings they have made out of their lives. The Power Threat Meaning Framework has an approach that is still in its infancy, but it offers a fresh new direction in mental health with real possibilities for the future!

To download the open source report, go to the British Psychological Society’s website. Here are the full references and the weblinks:
Johnstone, L., Boyle, M., Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D., and Read, J. (2018) The Power Threat Meaning Framework: Towards the Identification of patterns in Emotional Distress, Unusual Experiences, and Troubled or Troubling Behaviour, as an Alternative to Functional Psychiatric Diagnosis. Leicester: British Psychological Society. 
Link to full document. 
Johnstone, L., Boyle, M., Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D., and Read, J. (2018) The Power Threat Meaning Framework: Overview. Leicester: British Psychological Society.
Link to overview document.

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