Discursive of Tunbridge Wells
John McGowan
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Anne Cooke, Rachel Terry and John McGowan discuss whether there is a viable alternative to psychiatric diagnosis.
The beginning of February saw the launch of an ambitious document aiming to offer a new way of thinking about human distress. The Power Threat Meaning Framework (published by the British Psychological Society) emphasises the role of adverse experiences in emotional suffering. The PTMF also offers an alternative to more traditional psychiatric diagnostic categories. The panel discuss the how useful the document may be, and some of the criticisms which have been made of it.
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Links to things we talked about on this show:
The main Power Threat Meaning Framework is available here, along with shorter summaries, slides from the launch.
A short piece by Richard Bentall and Mary Boyle covering some of their main criticisms of the use of diagnostic categories in mental health is available here.
A recent talk by John on suicide prevention is available here.
Please note The views and opinions expressed in this article are those of the contributors and do not necessarily reflect the official policy or position of any of the contributors employing organisations.
Producer: John McGowan
Assistant Producer: Saul McGowan
Music: http://www.bensound.com/
Thank you for your thoughtful reflections. I will make a few brief points in response:
Accessibility. In order to attempt to meet its ambitious aim of offering a sound, evidence-based conceptual alternative to diagnosis, the Framework did have to be rather dense…. but the link you have provided will take people to the FAQs, a two page summary, the Guided Discussion about the ideas, the slides from the day, and in due course, a video of the main talks, plus other planned blogs and journal articles. All of these are intended to offer an easier way in, and we hope people/groups/services will want to develop their own versions too.
The title! Yes, the subtitle of the main document isn’t exactly snappy (see above) – but we hope that the main title, ‘The Power Threat Meaning Framework’, is sufficiently concise to grab people’s attention and indicate roughly what it is about. So far it seems to be working.
The Framework and psychology. We have discussed the limitations of some psychological models at length, given that the target of our criticisms is the assumptions underpinning a whole range of approaches – ie positivist, reductionist, individualising and so on. At the same time, we have pointed out that if adequately contextualised and offered sensitively within the vehicle of a trusting relationship, ideas and strategies from CBT and all kinds of other sources can be useful.
The Patterns. We acknowledge this is the part of the Framework that needs most development, and the current suggestions are put forward as an ‘in principle’ starting point. We are sure that their names, descriptions and contents will evolve over time, and we have some ideas about how to support this. However, we do want to emphasise the ways in which they are different from medical patterns. They are not ‘clumping people in groups.’ Rather, they are attempting to outline very broad patterns of, in a key phrase, ‘embodied, meaning-based threat responses to the negative operation of power.’ Not an easy concept to grasp, but in a way, that is the point – challenging dominant ideas can be so deeply rooted that it is actually quite hard to stand back and see what is different about new proposals (which is a separate issue from whether you agree/think it works, etc..) In essence, we are proposing patterns organised by meaning not by biology. These are necessarily overlapping, contingent, probabilistic, and varying across time and across cultures. To state this is not to identify a weakness of this very different kind of pattern. It is to say – This is how things are. This is how human emotional distress is experienced and distressed. This uncertainty is something to embrace, because it also gives us hope that things can be different – at all levels – individual, group and societal.
As we have emphasised, we see the Framework as a first stage – not a finished product or a policy document, but a conceptual resource which is free to use, adapt or ignore This includes adapting any of the language that seems unhelpful in particular settings or for particular individuals. We welcome further feedback.