Many are of the view that too much of what people feel and do is being pathologized and labelled as a mental illness when, in fact, it should be seen as a natural response to negative life experiences often involving being adversely affected by the misuse of power by others, social deprivation, and political, philosophical, cultural, sociological ideologies.
POWER THREAT MEANING FRAMEWORK (PTMF):
In relation to this, a new framework has been recently developed called the Power Threat Meaning Framework (PTMF) which aims to explain psychological and emotional distress in an alternative way to the traditional method of medicalizing/pathologizing signs of such distress, calling them ‘symptoms’ and placing the bearer of those symptoms in a diagnostic box (which, although sometimes helpful, can also be stigmatizing and traumatizing).
One of the great advantages of the PTMF is that it was developed not only by clinical psychologists but also by service-users.
A fundamental aspect of the PTMF is that it emphasizes how social factors can contribute to our feelings of psychological and emotional distress, including:
- economic deprivation
- social exclusion
It also takes into account the effect trauma has on our lives, including:
IDEOLOGICAL POWER AND CONTROL:
The PTMF also recognizes the various ways in which ideological power and control (which forms the basis to all other forms of power and control) can psychologically harm us. Ideological control can be defined as the way in which people in positions of power and influence seek to persuade people to develop particular values and norms about what is important in society as well as what is ‘good’ and worthy of praise through the assumptions they make, the language they use and the meanings they create.
For example, in the 1950s in the UK homosexuality was assumed to be immoral and criminal and men were sent to prison because of this particular form of ideological control. Many, too, committed suicide as they internalized the implicit meaning those in power had associated being homosexual i.e. that they were ‘sick’, ‘dirty’ and ‘perverted’ and, tragically, could not cope with the guilt and shame they felt as a result. Perhaps one of the best-known examples of such a tragedy is Alan Turing, the mathematical and computer genius who significantly contributed to the Allied victory in World War Two by breaking German code. He was taken to Court and given the choice between prison or taking hormones that would reduce or eliminate his libido. He opted for the second option which had the side effect of causing him to develop breasts and he killed himself by injecting an apple with cyanide and then eating it. (This is why the computer company Apple have an image of an apple with a bite taken out of it as their logo).
Religion is another example of an institution that can create ideologies that cause psychological harm. For example, indoctrinating children that they are ‘born in Sin,’ instilling them with needless feelings of guilt and shame, and telling them that that without redemption from Christ they will suffer eternal agonies in Hell. (Psychiatrists have given the fear of Hell a name – hadephobia – and you can read my article about it here; you may, too, wish to read my article entitled: ‘ The Use Of Religion As A Weapon Of Abuse.
And let’s consider, as another example, childhood depression. Depression is another diagnostic label that has been increasingly attached to children in recent years. However, rather than just categorizing children as ‘mentally ill’, medicalizing their behaviours and emotions and ‘ treating them with ‘medication it is necessary to understand why the behaviours and emotions (leading to a diagnosis of depression) may be emerging at an increasing rate over recent decades in relation to cultural changes in attitudes and ideologies including which have manifested themselves, for example, as:
- increased rate of separation and divorce of children’s parents
- a reduction of close-knit communities and community spirit
- increase in the amount of time parents spend working
- the decrease in time children spend with parents
- reduction in exercise
- the targeting of children as consumers by the pharmaceutical industry (the more children diagnosed with conditions that require the medications they produce the greater their profits)
There has also been an explosion of children diagnosed as having ADHD. This is another example of a diagnosis that has been heavily influenced by cultural attitudes, ideologies and the resultant meaning attached to children’s behaviour. For more on this, see my previously published article: Reasons Why ADHD Might Be Being Over-diagnosed.
We may also consider racism. Indeed, black people are more likely to be diagnosed with schizophrenia than white people in the UK which may be attributable, at least in part, to the distress induced by having to endure living in a society in which the racist ideology, and the potential social exclusion and unfair treatment that goes with it – a cancer that is yet to be entirely excised from our culture (even though, thankfully, racism is not as bad as it was, say, forty years ago).
The final example I shall provide is the use of the diagnosis of borderline personality disorder (BPD) which many find highly stigmatizing and which can detract from the fact that the signs a person displays leading to such a diagnosis are often entirely understandable responses to extreme early life trauma and abuse of power by parents and others. Indeed, many are still diagnosed with BPD even though the psychiatrist making the diagnosis has asked nothing about the individual’s childhood or life story in general. The same is true of people diagnosed with ‘clinical depression’ or ‘schizophrenia’,. both of which, research now clearly demonstrates, are more likely to be diagnosed in people who have experienced significant childhood trauma and/or live in areas of social and economic deprivation.
Why Is The Traditional Approach Of Medicalizing And Pathologizing Human Distress And Unhappiness Still So Prevalent?
Even though the medical labels used to describe people in distress are essentially just social constructs, they persist. This is for a variety of reasons including: hiding the real reasons for this distress (e.g. depression is far more frequently diagnosed in areas of economic deprivation but rather than solving the problem of inequality it is easier for certain elements of society to dish out antidepressant drugs), the profits they bring the pharmaceutical industry and the keeping of psychiatrists in business.
The Fundamental Power Threat Meaning Framework Questions:
Central to the PTMF is the idea that abuse and misuse of power can cause people to feel under threat. The behaviour and feelings individuals undergo as a result of such threats are termed symptoms by those who base their understanding of human distress on the medical model.
The central idea behind PTMF, which is interested in people’s lived experience, their interpretations of this experience and resultant personal narrative and how these affect the meaning we attribute to their distress can be summarized by the questions ‘What happened to you?’ (How is power operating in your life?); ‘How did it affect you? (What kind of threats does it pose?); ‘What sense did you make of it?'(What is the meaning of these experiences to you?); ‘What did you have to do to survive? (What kinds of threat response are you using?).
According To The PTMF, there are also two key questions those in distress can ask themselves which might provide them with a more optimistic personal narrative that does not involve diagnostic labels that might imply weakness, blame or a sense of being in some way flawed. These two questions are:
- ‘What are your strengths?'(What access to power resources do you have?)
- ‘What is your story?'(How does all this fit together?)’
David Hosier BSc Hons; MSc; PGDE(FAHE).