The PTMF perspective can be summarized in the words of the survivor slogan: ‘Instead of asking what is wrong with me, ask what has happened to me.’ The PTMF expands this into the following core 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?) • ‘What are your strengths?’ (What access to power resources do you have?) • … and to integrate all the above: ‘What is your story?’
In fact, these are overlapping questions.
Below is a more detailed description of the PTMF key ideas that were listed in Chapter 1. We can see that they are fundamentally different from those underpinning the diagnostic model. We will draw out their implications in the rest of the book and show how they can lead to very different ways forward.
• Emotional distress, like all human experiences, is experienced and expressed partly through our bodies. The PTMF main document has a detailed overview of relevant biological and evolutionary factors. But, while all our experiences have physical aspects, not all distress is best understood as a medical illness with mainly biological causes and treatments. This is particularly true of the effects of the traumas and adversities that occur in many people’s lives.
• We will never be able to make simple links between ‘This happened to me’ and ‘This is the result’. This is because, when things go wrong in our lives, the outcome is shaped by a multitude of factors, including the support we get and the sense we make of the situation. No one is doomed to long-term emotional distress or ‘mental illness’ because of difficult life experiences.
• The origins of the experiences we call ‘mental health problems’ are, when traced back to their roots, social and political, which is why the PTMF has implications far beyond one-to-one therapy and support. Judgments about how we ought to think, feel and behave are based on values, not on objective medical criteria, and those values draw on deeply held assumptions about the kinds of people we should be and the kind of lives we should be living. Feeling that you are unable to conform to or live up to these expectations can cause great distress, even if you have not experienced obvious traumas or adversity.
• Expressions and experiences of distress will always be shaped by the culture in which they arise. Rather than exporting the diagnostic model across the world, Westernised societies have much to learn from non-Western understandings of distress and healing.
• Human beings are fundamentally social beings, not separate individuals making their own purely personal journeys through their lives. Distress arises within and can only be healed through our personal and social relationships and our wider communities.
• Human beings have ‘agency’ – in other words, they are not just passively acted on by outside forces, as in the case of an infection that (say) attacks your lungs and makes you cough. Of course, we may face very severe constraints, such as not being able to afford good housing or enough to eat. At the same time, we still retain the ability to make some choices in our lives, even if our options are very limited.
• The responses described in psychiatry as ‘symptoms’ are actually our best attempt to survive difficult situations, both past and present. They represent what people do in the face of hardship, consciously or otherwise, not an illness that they have.
• Human beings are meaning-makers, and these meanings arise out of our experiences, our relationships, and our social and cultural contexts. We all try to make sense of our circumstances, good and bad, and this shapes how we are affected by them and how we respond.
• One of the most damaging effects of psychiatric diagnosis is to obscure personal meanings. If hearing voices, having mood swings or starving yourself are seen as ‘symptoms’ of an ‘illness’, then there is not much reason to explore your life experiences and the sense you made of them. The PTMF, in contrast, argues that we need to move away from the medical approach and place the central focus on meaning, narrative and personal experience.
• One of the implications of these core principles is that stories and narratives of all kinds can replace psychiatric diagnosis.
Lucy Johnstone, The Power Threat Meaning Framework, 2020