One of the newer tools being promoted within the mad movement is the Power Threat Meaning Framework (PTMF). You can read about it in detail via the link at the end of this post, but for the purposes of brevity here is a summary from the PTMF overview document:
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?)
The purpose of the framework, as I understand it, is to offer an alternative to the diagnostic culture which pathologises suffering by affixing diagnostic labels onto individuals. It offers one the authority to describe and define one's own experience and to maintain that actually, the problem lies in the situation, not the person.
Yet what of situations in which the PTMF is used as a mandatory part of ‘treatment’?Ironically, the power dynamic itself between 'professional' and 'patient' belies the self-determination of the PTMF.
The temptation then is to shine the spotlight on professionals and the untoward power they wield, particularly when their work involves vulnerable people. My idealistic nature asks, why can we not just be humans together? Surely the baggage of professionalism – the conventions, the dogma - is too heavy and unwieldy to serve us well? But I think even this is too much a shortcut. It is a piece of the puzzle, perhaps, but not a solution in itself.
Again I am drawn to say: finding a solution is beside the point. What is needed is a radical shift in paradigm which transforms the very foundation of how we approach problems. Applying the PTMF to the mental health system is like sticking a plaster onto a gaping wound.
Two thoughts. The first is to acknowledge that change happens in mysterious ways. I like the seed metaphor: to sprinkle new ideas and efforts into the wind and see where and how they may take hold. I think of our civilisation as a heavy slab of cement, with small cracks in it that these seeds lodge themselves into and take root, pushing the cracks open wider and creating gaps of new culture which may emerge. I think of the mad movement this way, and appreciate the diversity within the movement which resists the settling of a single goal or objective. If the PTMF is one of these seeds, then it lands in different environments and sometimes thrives, sometimes wilts.
The second thought is that the new paradigm is already emerging; we can see it at the frontiers of science, philosophy, politics, economics and all the different fields which are shifting us into a looking-glass world of quantum physics and liberation theology and post-capitalism. My own term for this new paradigm is madreality, but the matter of mental health is just one aspect of it. And we're still very much in the messy middle, within the process of collapse.
So is it worth introducing these new ideas into an old system? The PTMF is suggestive of a new paradigm, one in which people have the power over their own narrative. But it is being used within the structures of the old paradigm, in which professionals 'know best.' Do we throw our seeds at the old system? My gut feeling is yes, because we cannot control where and how those seeds will take hold. In the instance of this acquaintance, the seed was the PTMF and the cement was the psychiatric system whereby professionals rule and patients obey. It's not that the seed itself is flawed, but rather that it didn't land on a crack – it landed on the cement.
Yet even the seed metaphor falls short, because change is not as binary as yes-it-landed or no-it-didn't. We don't control change, it is a messy process within complex systems. Change is not a mechanical on/off switch; it is a smear, a flutter, a sprinkling, a shift and sometimes even a great orgasmic roar. Change is happening, always.
And a single framework is also itself just one way of approaching complexity. A framework is not set in stone; it is not a set of instructions or a prescription to dose oneself with. It is conceptual, optional, and there to offer help only if the help is useful and wanted.
You can read more about the Power Threat Meaning Framework here.
Photo by Karsten Winegeart on Unsplash
Julia, I remember talking with you about Judith Rich Harris's work back in the day. I think what I eventually drew from her challenges to the prevailing psychodynamic, psychiatric models was that all models are just coat hangers to hang our cultural coats on... (sorry for the mixed metaphors!!). We can learn from the seeds that germinate and grow, but also from those that don't. It seems to me that PTMF can be a more nuanced alternative to the straight line 'trauma' causes everything, or parents fuck up their kids (Rich Harris's nurture assumption), as well as a counter to the lazy biochemical brain balance assumption. Like you say, it's fine to throw seeds at the old system, but is that also a recognition that there are things of value to be retained? Having said all that, it's always good to keep an eye on where the power really is... and where it might be shifting to. Great piece as always...
Hi Julia. Thanks for your interest in the PTMF. As one of the lead authors, I would like to clarify that it isn't about MH services, and any use of it 'as a mandatory part of treatment' or to endorse or support professional power (which, of course, the authors cannot prevent) would be a serious travesty of its intentions. It is a set of PRINCIPLES about our understanding of the experiences described as 'mental health problems' - and as such, raises exactly the issues you have mentioned. Do we need professionals, or indeed a MH system, at all? Many of those who have taken up the PTMF are survivors and peer groups who decided to use it without any input from professionals at all - which is exactly as we had hoped. Some are using it within services - and if it can help to reduce some of the damaging impact of services, then we welcome that - but of course it is true that there is a fundamental incompatibility between services and PTMF principles. As you say, 'Why can't we all be human together?' Why indeed? That is the core message of the PTMF - 'We are all story tellers and meaning-makers.'