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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.
Series introduction – Richard Bentall and Pete Sanders
1. What this book aims to do
2. The problems with diagnosis and why we need a different approach
3. Introducing the Power Threat Meaning Framework
4. ‘What has happened to you?’ (How is power operating in your life?)
5. ‘How did what happened affect you?’ (What kind of threats does this pose?)
6. ‘What sense did you make of it?’ (What is the meaning of these situations and experiences to you?)
7. ‘What did you have to do to survive?’ (What kinds of threat response are you using?)
8. General patterns in distress
9. What is your story?
10. How did we get here? Questioning some basic assumptions
11. Further implications of the Power Threat Meaning Framework
Further reading and resources
Appendix: General patterns
Plus a one-page Appendix containing the Guided Discussion template?
Subject index
Name index
References
‘Our understanding of mental health has long been waiting for some fundamental rethinking. This book sets out a new framework that achieves the rare combination of being both revolutionary and eminently sensible. People have been complaining of ‘the medical model’ for years but have rarely had anything to replace it with. Now we have an approach carefully worked out over several years by a group of senior psychologists and users of psychiatric services. ‘Chemical imbalances’ have been replaced by a deeply social and experiential view. As the arguments about it go back and forth over the coming years, this book will be essential reading for anyone who takes a serious interest in the field.’
Richard Wilkinson, Emeritus Professor of Social Epidemiology, University of Nottingham, and co-author of The Spirit Level and The Inner Level.
‘We found the book to be self-explanatory, gripping and with good flow. The way in which it unravels is engaging and each paragraph leaves you wanting to know more. The added dimension of examples throughout makes this book relatable and also further supports learning. We believe that this book leaves people with no option but to think about change, not only within themselves, which in itself is empowering, but also within different cultures and the system as a whole. The knowledge it shares left us feeling empowered and we strongly believe it holds potential to have the same impact on others.’
SHIFT recovery community, Portsmouth
‘This is a welcome and much needed contribution to current thinking in mental health. I couldn't put it down and will continue returning to it repeatedly. It is thoughtful, thought-provoking, engaging and refreshing. The Power Threat Meaning Framework has been a game-changer for many and this book synthesises it into everyday, jargon-free language, not only making it more accessible to a wider audience but also bringing the concepts alive and allowing the reader to apply it to their own experiences and/or to their practice. It offers an alternative to diagnosis and medical explanations and invites the reader to consider and reflect on other possibilities and avenues to make sense of emotional distress. There are also incredibly useful references to literature and research throughout, as well as real-life examples and powerful vignettes.’
Dr Karen Treisman MBE, clinical psychologist, organisational consultant, trainer, director of Safe Hands and Thinking Minds, and author of 11 books including A Therapeutic Treasure Box for Working with Developmental Trauma
‘This is a ground-breaking text on the impact of painful life experiences and trauma. It makes a huge contribution to the study of the human condition per se. The authors powerfully evidence their argument that emotional distress and the troubling behaviour and mental states that often ensue should no longer be seen as stigmatising mental illnesses, but rather as a part of life. The Power Threat Meaning Framework is a non-medical model of human distress (people with problems not patients with illnesses) offering real hope through collaborative conversations and narratives, and consideration of social contexts, the influence of power and the meanings the person has taken from their experiences. Beautifully articulated and totally accessible to professionals and lay people alike, the book presents a radical shift from the expert narratives of the psychiatric model. This is a persuasive and commanding exhortation to review our fundamental assumptions and attitudes about mental health.
Dr Margot Sunderland, Director of Education and Training at the Centre for Child Mental Health, London and Co-Director of Trauma-Informed Schools UK
Mary Boyle has worked mainly in clinical psychology education and training and in clinical posts in adult mental health and women’s health. She is a long-time critic of the medical/diagnostic approach and of individualistic approaches more generally in the health field. She is the author of Schizophrenia: A scientific delusion (2002) and Rethinking Abortion: Psychology, gender, power and the law (1997), as well as many articles and chapters on feminist approaches to women’s health and on problems of and alternatives to diagnostic models. She is Emeritus Professor of Clinical Psychology at the University of East London.
Dr Lucy Johnstone is a consultant clinical psychologist, author of Users and Abusers of Psychiatry (Classic editon, 2022) and co-editor of Formulation in Psychology and Psychotherapy: Making sense of people's problems (Routledge, 2nd edition 2013) and co-author with Mary Boyle of A Straight Talking Introduction to the Power Threat Meaning Framework (PCCS Books, 2020) along with a number of other chapters and articles taking a critical perspective on mental health theory and practice. She is the former Programme Director of the Bristol Clinical Psychology Doctorate and was the lead author of the 'Good practice guidelines on the use of psychological formulation' (Division of Clinical Psychology 2011.) She has worked in Adult Mental Health settings for many years. She is an experienced conference speaker, lecturer and trainer.
