Mar 5, 2018
This week, we interview Dr Lucy Johnstone. Lucy is a clinical
psychologist, trainer, speaker and writer, and a long-standing
critic of the biomedical model of psychiatry. She has worked in
adult mental health settings for many years, alternating with
Lucy has authored a number of books, including 'Users
and Abusers of Psychiatry’(Routledge 2000), and ‘A
Straight-talking Introduction to Psychiatric Diagnosis’
(PCCS Books 2014) as well as a number of articles and
chapters on topics such as psychiatric diagnosis, formulation and
the role of trauma in breakdown. She has a blog on Mad in
Lucy kindly took time out talk to me about the new Power
Threat Meaning Framework, an ambitious attempt to outline a
conceptual alternative to psychiatric diagnosis which was published
on January 12th this year by the Division of Clinical Psychology of
the British Psychological Society.
In this episode we discuss:
- Lucy’s background and what led her to be interested in mental
health work, particularly in terms of being critical of current
- The importance of acknowledging the reality of people’s
experiences of distress along with questioning the dominant
explanations for that distress.
- The fact that the diagnostic model has never been supported by
- How imposing a diagnosis often can be very damaging to people,
by turning ‘people with problems’ into ‘patients with
- Why we need to move towards the survivor slogan of “Instead
of asking “What is wrong with you?” ask “What has happened to
- The inception of the Power Threat Meaning Framework, which was
funded by the Division of Clinical Psychology of the British
Psychological Society, and the five-year journey to its release
earlier this year.
- The composition of the core project team: Lucy, Mary Boyle,
John Cromby, Jacqui Dillon, John Read, Peter Kinderman, Eleanor
Longden, Dave Harper, Dave Pilgrim and a research assistant Kate
Allsopp. The core team consists of psychologists and
survivors/campaigners, many of whom are well known to MIA readers.
Also involved were a consultancy group of service users/carers; a
group of critical readers with a particular focus on diversity; and
a number of others who contributed to particular sections or
supplied good practice examples.
- How the Framework itself is not an official DCP or BPS position
or policy document, nor is it a plan for services or for any other
specific form of implementation. Rather, it is offered as a
co-produced academic and conceptual resource to anyone who wishes
to take on these ideas and principles and develop them further or
translate them into practice.
- The Framework is necessarily dense because of its aim to move
right away from the “DSM/ICD mindset” which is deeply
rooted in Western culture. However, there are various accessible
summaries of its core principles (see below.)
- How we already have a number of ways of supporting someone
non-diagnostically, but what we didn't have before was a sound,
evidence-based alternative to what diagnosis claims, but fails to
do, which is to outline patterns in distress.
- How the Framework acknowledges the irreducible complexity of a
person’s responses to their circumstances.
- The derivation of the title: The Power Threat Meaning
- The four main questions, which are:
- What has happened to you? Translated as “How is Power
operating in your life?”
- How did it affect you? Translated as “What kinds of Threats
does this pose?”
- What sense did you make of it? Translated as “What is the
Meaning of these situations and experiences to you?”
- What did you have to do to survive? Translated as “What
kinds of Threat Response are you using?”
- Finally “What are your strengths?” or “What access to Power
resources do you have?” and to pull it all together, “What is your
- These are not separate questions, since each of them implies
and arises out of the others.
- That the aim is for people to be able to use these ideas and
questions for themselves, not necessarily through an interaction
with a professional.
- How the PTM Framework does not recognise a separate group of
people who are ‘mentally ill’ but describes how we are all subject
to, and affected by, the negative impact of power in some aspects
of our lives.
- How it is particularly important to recognise the role of
ideological power, or power over language, meaning and
- How the PTM Framework includes the concept of formulation,
which is a semi-structured way of putting together someone’s story,
but is much wider in scope and for that reason uses the preferred
term “narrative” – which may be individual, group or
- How diagnosis often obscures someone's story, and how the
Framework aims to help create narratives that restore the links
between personal distress and social injustice.
- What the PTM Framework says about DSM and ICD attitudes to
conceptualisations of distress in non-Western cultures.
- That since we are meaning-making creatures, at a very basic
level the principles of power, threat, meaning and threat response
apply across time and across cultures, although all expressions and
experiences of distress are culturally-shaped.
- The regrettable exporting of Western psychiatric models across
- How the Framework does not exclude or deny the role of biology,
but integrates it as a mediator and enabler of all human
experience, although not something that is always accurate or
helpful to view as a primary cause.
- The reaction to the Framework, both positive and negative. The
team very much welcomes feedback, much of which has been very
helpful. Some of the more extreme reactions can be understood as
predictable responses to the threat posed by the Framework to
- How the reaction outside social media has been overwhelmingly
- Emphasising again that the Framework is (unlike diagnosis)
presented as a completely optional set of ideas, and a work in
progress. The project team is very pleased that there is such
widespread interest in taking these ideas forward in people’s own
lives and settings.
- People are encouraged to explore these ideas for themselves via
the links below. More resources will be added in due course.
PTM Framework Introduction and Frequently Asked Questions
The above link will take you to the following:
Power Threat Meaning Framework Main document
Power Threat Meaning Framework Overview
PTM Framework Guided Discussion for applying these ideas to
your own life or someone you are working with
Presentation slides from the PTM
The Power Threat Meaning Framework 2 page summary
You may also be interested in these articles and blogs
on the Framework:
Publication of the Power Threat Meaning Framework: Mad in America
A mental health nurse’s first response to the launch of the Power
Threat Meaning Framework
My mother took her own life – and now I know a different mental
health approach could have saved her
An Alternative to Psychiatric Diagnosis?
The PTM Framework,
where do we go from here?
I’ve Been Waiting for this Since I Was a Child
Threat Meaning Framework: a radically different perspective on
Lucy’s interview on Let’s Talk Withdrawal can be found
Lucy’s interview on Let’s Talk Withdrawal (April 2017)
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© Mad in America 2018