The PTM framework: Where do we go from here?

So, the Power Threat Meaning (PTM) framework has burst into my mental health/psychology focussed world. It is rather glorious – outraged, strutting, purposeful: An ideology founded in the certainty (which I share) that something is terribly wrong.

I love the explicit references to power and I love the way it dissolves the boundaries between ‘those who are ill’ and ‘those who are well’. I love the fact that sitting in a large, naturally lit lecture hall in Euston, I was allowed a glimpse of insight into my own fracturing many years ago. I love that I had a moment to think about how the assumed truth, the familiarity and normality embedded into the expectations around me at that time obscured their oppressiveness. For the first time I entertained the thought that maybe it wasn’t solely my idiocy, my youth and my fault that, for one awful year, my mind became my enemy.

The PTM framework is inclusive and bold and impressive and – despite accusations to the contrary – is, in my view, infused with humility. And this is good. It is right that something so ambitious and righteous is also cautious; the authors know that this is just the beginning, they know it needs testing and critiquing and that it will take many people working together to move it forward, to make it work. Like a road map the PTM framework offers us a whole lot of routes but not necessarily the destination. We’re going to have to work out where it takes us and what on earth that looks like.

So, my worry is that we could take a wrong turn. The PTM framework makes it perilously easy to divide the world into those wedded to diagnosis (traditional, unthinking, oppressive) and those who are anti diagnosis (radical, critical, enlightened, empowering).  Or – the other split – those who use diagnostic categories (evidence based, rigorous, scientific) and those are opposed to them (dangerous, emotional, polemical). There is the danger of alienation, division and of little or no progress being made to actually help those who don’t have a voice. There is, I fear, the danger that the the PTM framework could be used to further entrench individuals who should be focussed on creating safe cultures and harmonising care.

I know what I’m talking about…I have been that person. I have been infuriated by the attitudes of my colleagues and I’ve been the one bitching to others (who share similar views to mine) about the ignorance and callousness around me. I’ve viewed the practices around me through a lens of righteous indignation believing that I understand, I know better. I have believed that I’m on the side of compassion whilst my dim witted colleagues are, clearly, the man. I’ve been the person who is speechless with outrage at the decisions made by others. Incandescent and inarticulate with fury….I have been comfortable in my indignation doing nothing positive to bring this shit together.

I’m not stupid. But I have been stupid. Plenty of times.

And the PTM framework is far from stupid but I worry that it may be used in a dumb way to justify opposing views and adversarial positions doing nothing to further debate and put a little compassion out there into the universe.

Which brings me to what I think might be a massive opportunity sat right there in its pages….

The PTM framework, rightly in my opinion, positions the behaviour normally associated with a psychiatric classification as understandable threat based responses. It goes further and argues that these behaviours constitute responses to threat which stem from restricted access to conventional or approved forms of power.

So what if we use the PTM framework to understand the more toxic forms of control and abusive power that  organisations and workers use as responses to threat (or social defences)?  What if the ideological power that infuses coercive care is also understood as organisationally sanctioned responses to fear? How would it be if we understood all those problematic, unthinking, often damaging practices as understandable reactions to aversive emotional events associated with…yes I know how this sounds…with disempowerment, with shame and with anxiety.

I am arguing that workers and, more importantly, organisations are traumatised. I am arguing that these professionals and institutions respond coercively because they often don’t know what to do, don’t know how to help. I’m arguing that they are frightened by what they see and hear and read. They are angry at those who have hurt the people in front of them and ashamed by the impossibility of the task, by their inability to take away the pain.

While we fail to acknowledge our own (as workers) emotional responses to the work, we will continue to oppress, to denigrate, blame and even abuse those who confront us with our inadequacies or make us feel afraid. Whatever words we use, whatever frameworks we have will be weaponised. And while we fail to acknowledge our own emotional responses to the work it will remain easy to accuse our colleagues of stupidity, to fail to understand their struggle and to work supportively, restoratively to create compassionate, therapeutic cultures.

How would it be if we used the PTM framework to look at ourselves first? To notice our own threat responses and the practices which have emerged as a consequence. How about we work collaboratively with service users to examine what we do and find out which practices failed to serve the primary task of alleviating their distress. How about we then ask ourselves why?