The Power Threat Meaning Framework
An alternative basis for the identification of patterns in mental distress, unusual experiences, and problematic behaviour - from the UK
With the latest changes in the DSM as they relate to the diagnosis of autism, we (as a community) are left wondering at next steps. It’s one thing to pound upon the walls of the APA and demand an equitable path forward. It’s quite another to suggest what that path might be. Understanding the position of the self-diagnosed, the system simply won’t accept autism as an identity at the moment. Thus, we need a new framework to replace what’s been foisted upon us.
In researching this topic, I came across the Power Threat Meaning Framework in the UK. The Power Threat Meaning Framework (PTM) has been developed as an alternative to more traditional models based on psychiatric diagnosis, and applies not just to people who have been in contact with the mental health or criminal justice systems, but to all of us.
The principles and practices, theory and evidence are synthesised herein from the source documents in order to describe the alternative framework in more detail. Because of their importance, the key features of the framework are noted here, and it is argued that any attempt to outline alternatives to the psychiatric diagnostic system should have the following characteristics:
Be based on the identification of broad patterns and regularities in the expression and experience of distress and troubled or troubling behaviour, as opposed to specific biological (or psychological) causal mechanisms linked to discrete disorder categories.
Show how these patterns are evident to varying degrees and in varying circumstances for all individuals across the lifespan.
Not assume ‘pathology’; rather, describe coping and survival mechanisms which may be more or less functional as an adaptation to particular conflicts and adversities in both the past and present.
Integrate the influence of biological/genetic and epigenetic/evolutionary factors in mediating and enabling these response patterns.
Integrate relational, social, cultural and material factors as shaping the emergence, persistence, experience and expression of these patterns.
Account for cultural differences in the experience and expression of distress.
Assign a central role to personal meaning, emerging out of social and cultural discourses and belief systems, material conditions and bodily potentialities.
Assign a central role to personal agency, or the ability to exercise influence within inevitable psychosocial, biological and material constraints (especially if supported within healing relationships and communities).
Acknowledge the centrality of the relational/social/political context in decisions
Provide an evidence base for drawing on these patterns in order to inform individual/family/group narratives.
Offer alternative ways of fulfilling the service-related, administrative and research functions of diagnosis.
Suggest alternative language uses, while arguing that there can be no one-to-one replacements for current diagnostic terms.
Include meanings and implications for action in a wider community/social/political context.
The main publication* collectively summarises evidence on fundamental aspects of the emergence of mental distress, unusual experiences and problematic behaviour as follows:
The operation of POWER (in its various forms of biological/embodied power;
coercive or power by force; legal power; economic and material power; social and cultural capital; interpersonal power; and ideological power). These manifestations of power, both negative and positive, operate through social structures, institutions and organisations; through our physical environment; through the media and education; and through social and family relations.
The kinds of THREAT that the negative operation of power may pose to the individual, the group and the community, with particular reference to mental distress.
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.
The evolved and learned THREAT RESPONSES, mediated through meaning-based bodily capabilities, that any individual (or family, group or community) experiencing threat arising within the Power Threat Meaning process, may need to use to protect themselves. Rather than being ‘diagnosed’ as passively suffering biological deficits, we suggest that service users (and all of us) can be recognised and validated as activating threat responses for protection and survival. The experiences that are described as ‘symptoms’ are therefore better understood as reactions to threat, or ‘survival strategies’.
In line with these analyses, a conceptual framework for the origins and persistence of distress, unusual experiences and troubled or troubling behaviour is now proposed, and is described as the Power Threat Meaning Framework.
To put it at its simplest, the PTM Framework replaces ‘What is wrong with you?’ with four key questions:
‘What has happened to you?’ (How is Power operating 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 evidence cited in the publication supports the contention that humans are social beings whose core needs include:
To experience a sense of justice and fairness within their wider community.
To have a sense of security and belonging in a family and social group.
To be safe, valued, accepted and loved in their earliest relationships with caregivers.
To meet basic physical and material needs for themselves and their dependants.
To form intimate relationships and partnerships.
To feel valued and effective within family and social roles.
To experience and manage a range of emotions.
To be able to contribute, achieve and meet goals.
To be able to exercise agency and control in their lives.
To have a sense of hope, belief, meaning and purpose in their lives.
…all of which will provide the conditions for them to be able to offer their children…
Secure and loving early relationships as a basis for optimum physical, emotional and social development and the capacity to meet their own core needs.
Anything that prevents these core needs being met may be experienced as a threat to emotional, physical, relational and/or social safety and survival. As a result, human beings have evolved to be able to employ a range of threat responses which serve the function of protection from core threats.
The PTM Framework therefore fulfills the following main purposes:
Highlighting the common meaning-based threats posed by various manifestations of power.
Highlighting the evolved and acquired strategies commonly employed to counteract these threats.
Highlighting the links between threats and protective threat responses that have been obscured by the use of diagnostic labels.
In the place of traditional psychiatric models, providing a basis for identifying broad, evidence-based patterns that synthesise the influences of Power, Threat, Meaning and associated Threat Responses.
Utilising these patterns to generate personal, group and/or social narratives that help to restore meaning and agency, in line with the relevant cultural assumptions, and along with this, have the potential to create hope, rebuild relationships, and promote social action.
I encourage you to leave a comment below. Let me know what you think about this brief summary. Take a visit to the PTM web site and explore it’s contents. Does this seem to you as though it could replace the current paradigm?