The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling ... to functional psychiatric diagnosis

by Lucy Johnstone, Mary Boyle

The Power Threat Meaning Framework is a new perspective on why people sometimes experience a whole range of forms of distress, confusion, fear, despair, and troubled or troubling behaviour. It is an alternative to the more traditional models based on psychiatric diagnosis. It was co-produced with service users 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 Framework summarises and integrates a great deal of evidence about the role of various kinds of power in people's lives; the kinds of threat that misuses of power pose to us; and the ways we have learned as human beings to respond to threat. In traditional mental health practice, these threat responses are sometimes called 'symptoms'. The Framework also looks at how we make sense of these difficult experiences, and how messages from wider society can increase our feelings of shame, self-blame, isolation, fear and guilt. The main aspects of the Framework are summarised in these questions, which can apply to individuals, families or social
In addition, the two questions below help us to think about what skills and resources people might have, and how we might pull all these ideas and responses together into a personal narrative or

Genres: Psychology

414 pages, Paperback

First published January 1, 2018

Reviews

[Jake · Rating 5 out of 5]

I haven't finished the second half of the book where the descriptive methods of the framework are spelled out, but that's only because the first half of the book, where the outlines of its theory are spelled out, altered the entire path of my interests and thinking so profoundly that I had to go and deal with that for the last three years...

If you have any interest in either the theory of therapeutic psychology, or its practice in contemporary Anglo-America, you should drop whatever you're reading right now and get this book, which the British Psychological Society offers as a free download. If you are over-read in theory (which a lot of the folks I'm connected to on here are, which is exactly why I connected to them), you may not find a great deal that is 'new' exactly. But what you'll find is a rare example of that theory combined with a professional and indeed a social-movement practice that is happening right now, on the ground in our culture.

There are many threads that make up what you might call the left or radical (vs. reactionary) revolt against American psychiatry, with its neoliberal economic order of assembly-line care and mass-produced products of social anesthesis. This book draws a number of them together, but its entry point is the critique of the epistemology and practice of diagnosis.

Most of us were unaware (I certainly was) of a crisis which occurred in the psych professions in 2013 with the publication of the fifth edition of the Diagnostic and Statistical Manual (DSM). That this crisis *should* have been more publicly visible is indicated by the fact that you, gentle reader, already know what the DSM is, what it's used for, and why it's so important not only for head-shrinkers but the culture at large.

The crisis arose from the fact that by the early 2010's everyone -- and I mean everyone -- involved in the psych professions knew that the DSM was basically garbage, a Frankenstinian assemblage of received ideas and questionable categories stitched together in such a way that even its most ardent supporters could no longer claim with a straight face that it passed even a sniff test for validity (in both the general and the technical sense).

In sum, DSM was supposed to address this dire situation with various technical innovations -- all of which got shot down or shunted to an appendix by the top layer of the publication committees of the APA. When, a few months later, someone published a study identifying 73% of those committee members as being lavishly on the payrolls of various pharmaceutical company, no one was surprised really -- y'all do know how psychiatry works, right? -- but it also felt to many like the last straw.

At that point, some *very* heavy hitters in the psych world threw up their hands and walked away, most notably -- on what I would call the 'right' or biologistic wing of the enterprise -- the National Institutes for Mental Health declared the DSM unworkable, it would no longer play any role in federally funded psych research, and that DSM categories would no longer be accepted for funding proposals. Ponder the profundity of that criticism of the entire enterprise for a second.

The problem is that the NIMH, being committed to the scientistic phantasy of biologism and psychiatry as a medicine, doubled down on all the conflicts and errors that sit at the bottom of the mess that is the DSM. They basically reinvented the wheel by cobbling together not a book but a website called the RDOC, which if anything makes the DSM look like the collected works of Shakespeare.

So here we have two steaming piles of garbage, both of which will determine not only the shape of all psych-related policy and research, but what happens to you, gentle reader, when you just can't suck down any more of this plastic culture and feel like you're going to blow, but being a good person not wanting to go full Joker on the scene, you look around for some help.

Enter the (English-speaking) 'therapeutic left', which currently (I've since learned) has basically two nexuses: in America there is a tiny outpost of right-thinking on these issues, built out of the remnants of the consumer/survivor movement in the 7o's, and it dwells in New England, with its center (so far as I have gathered) in what used to be called the Western Massachusetts Recovery Learning Center, recently renamed the Wildflower Alliance. Look it up, you won't be sorry.

Things are much better in the U.K., however, where the survivor movement has a well-educated and resourced professional phalanx in the British Psychological Society and institutions like the University of East London. To get a taste look up: John Read, Joanna Moncrief and Lucy Johnstone. Johnstone is one of the co-authors of the PTMF, and has bunches of talks and interviews in which her cutting and trenchant criticisms can be enjoyed. For my money, Read is the most inspiring of the crew. All of them (and many more) have taken huge strides to deal with the ongoing horrors of e.g. electro-shock therapy, the ill-founded serotonin theory of depression, the dangers of anti-psychotics, etc. etc.

So the PTMF is the product of the efforts of this group of U.K. doctors and academics in the wake of the DSM V crisis, and is an explicitly trauma-informed approach to characterizing the personal etiologies (each one being of course unique, contra the biologismists) of folks who experience psychosocial distress. Being an innovative undertaking, there was also need to provide an argument for its theoretical validity, which is made in the book's first section.

I was personally exposed to the PTMF on entering a course in psychopathology at university -- not because it was taught (heaven forbid) but because I knew -- as anyone exposed to the system ought to know -- that the DSM was garbage, and I wanted to know what else might be out there. In the process of reading the theoretical arguments in the book's first half, I recognized some names from my now-dusty undergraduate philosophy reading (shout out to Eddie Husserl), and for the first time in my adult life actually *wanted* to read something, because I had a reason for reading it.

Pretty much everything in terms of my long list of "hope to read before I die" stuff on this website sprang from that moment. So yeah, I have a personal attachment to the virtues of this book, but yeah I also think that if you're reading this, you should read it.

Appreciate you.

[Jemima Atar · Rating 4 out of 5]

This is one of those books that always stays on my mind – it highlights an alternative way of framing psychiatric diagnoses in a way that emphasises our personal narratives rather than the labels we are given. It is a controversial read that sits on the somewhat extreme end of anti-diagnostic schools of thought, but I enjoyed the alternative perspective and found myself agreeing and resonating with a lot of what was written. This would be a great read for those who have ever received a diagnosis, those who are suffering in any way and wish to make sense of their stories in an empowering way, or those working in the mental health field.

[Kieran Telo · Rating 5 out of 5]

This is now in my “at arm’s length” section. I was introduced to Power Threat Meaning in 2019ish by a student ally. Her impassioned summary lives with me even now. I downloaded and read executive summaries and the like, then let the ideas…marinate?

I picked this up in 2025 at a crossroads in my life and really my only criticism is the split bibliography (by section/chapter). Flicking about then following notes and references has led me to a few interesting new places but, as well, to retrieve some of older texts I’d been toying with, from Szasz to Fromm and Horney and best of all, the most humane, David Smail.

PTM isn’t exactly new, it isn’t exactly news, but my greatest respect to the authors, activists and service users who contributed to the framework.

And thanks Chloe.