What are your thoughts about psychiatric diagnoses?

Did you know that a psychiatric diagnoses are not scientific facts? Although widely used in the treatment of psychological difficulties, they are simply medical labels that describe patterns of experiences or behaviours that are causing you to feel distressed. This includes terms such as: “depression”, “obsessive compulsive disorder”, and “psychosis”. They are not the only way of helping someone construct a more meaningful narrative of their difficulties.

I fully acknowledge that diagnoses can have immense value, for example, in providing a patient with the most appropriate treatment. However, a part of me remains averse to them. This is because words like “personality disorder” suggests that there is something inherently wrong with someone. It locates the problem in the individual and does not consider the wider socio-cultural factors that contributes to a person’s suffering.

I believe that psychiatric diagnoses can be damaging if they are not delivered with sensitivity and compassion. Without the proper explanation, a diagnosis can cause an individual to believe that they are mad or bad for doing the best that they can to cope with life’s challenges, and this is something that we must discourage with all our power.

For all these reasons and more, I was absolutely delighted to learn about the Power Threat Meaning Framework (PTMF). Have you heard of it?

The Power Threat Meaning Framework (PTMF) was developed, over the course of five years, by a group of clinical psychologists, to serve as an alternative to more traditional models based on psychiatric diagnosis. The framework offers a more holistic way of thinking about mental health because it “highlights and clarifies the links between wider social factors such as poverty, discrimination and inequality, along with traumas such as abuse and violence, and the resulting emotional distress or troubled behaviour…. It also shows why those of us who do not have an obvious history of trauma or adversity can still struggle to find a sense of self-worth, meaning and identity.”

In traditional mental health practice, threat responses are sometimes called ‘symptoms’. The PTMF instead looks at how we make sense of our threat responses (example: self-harm, acting out, dissociation, hearing voices, purging etc.) and how messages from wider society can increase our feelings of shame, self-blame, isolation, fear and guilt.

Threat response v.s. personality/social anxiety/eating disorder. Which sounds like a more humanising way of talking about someone’s challenges? Isn’t it funny how two different set of words can evoke such different feelings? De-stigmatizing mental health and mental health illnesses starts with how we describe and think about this universal human experience

The framework is based on four questions that can be applied to individuals, families or social groups. These four questions are a great way to construct a more balanced and less self-judgmental narrative around any trauma or threat you have faced. Why not give this four questions a go yourself? Personally, they have helped me to re-frame some of the most challenging times in my life in a more compassionate, empowering, and curious light.

The Power Threat Meaning Framework can be used as a way of helping people to create more hopeful narratives or stories about their lives and the difficulties they have faced or are still facing, instead of seeing themselves as blameworthy, weak, deficient or ‘mentally ill’.

Dr Lucy Johnstone

Click here to hear Dr Lucy Johnstone speak more about this framework.

The language we use to describe mental health matters a great deal. It influences the way we perceive someone who is suffering and the way they view themselves. Calling someone ‘psychotic’, ‘bulimic’ or ‘crazy’ just because they are doing their best to cope with their pain is not cool, it is shaming and discriminating.

Rather than assuming that a person is ‘mad’ or ‘bad’, we can understand their symptoms or their ‘challenging’ behaviours as a response to acute (short-term) or on-going threat/trauma.

No one goes through life without facing some of kind of threat or trauma (See below). May we be kind to each other and toward ourselves as we make sense of our unique responses to painful and challenging life experiences. This is how we can heal collectively.

As mental health professionals, we must be patient, and take the time to explore whether a diagnosis makes sense, and is a helpful way of referring to a patient’s difficulties. We must be open to exploring new ways of talking about their difficulties if they choose not to subscribe to a medical label.

I’m really sorry if you’d ever received a psychiatric diagnosis in a way that was painful or highly unpleasant for you. A diagnosis is not a fact, and they are not permanent. You have the power to make sense of your difficulties in a way that is meaningful to you.

Unsubscribe from any labels that perpetuate the belief that you are broken. You have the choice to create your own version of understanding what happened to you, how you made sense of what happened, what you had to do to survive, and how you overcame your struggles and emerged as the warrior that you are today.

Read more about the power threat meaning framework here.


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