12/11/2025
Lucy Johnstone: 'The aim is to move, in simple terms, away from the “What is wrong with you?” towards the “What has happened to you?” question. To put it at its briefest, we’re evidencing, we hope, the idea that peoples’ distress is understandable in context, but we wanted to think about context in its broadest form.'
"In 2018, Lucy Johnstone, Mary Boyle, and their colleagues in the UK launched the Power Threat Meaning Framework (PTMF). This framework shifts the notion of 'What is wrong with you?' in the DSM to 'What has happened to you?' and by doing so rejects medical process of diagnosing 'disorders' in favour of a narrative response that tells of contexts, power dynamics, and systems.
At a time when the Global Mental Health Movement is exporting the Western biomedical model around the world, Johnstone, Boyle and the PTMF project team, which includes those who identify as service users/survivors, are seeking to promote a radically different way of understanding distress.
Johnstone, a consultant clinical psychologist who has experience working in adult mental health settings for many years, believes that the current mental health system has failed, and we are now in the process of witnessing the crumbling of the medical paradigm of emotional distress.
She believes we need an approach based on fundamentally different principles. The PTMF, which draws on a wide range of evidence and examples of existing alternatives, is an attempt to outline what that might look like. The PTMF project team hopes that it can be a contribution to the much needed revolution.
Lucy Johnstone: 'The aim is to move, in simple terms, away from the “What is wrong with you?” towards the “What has happened to you?” question. To put it at its briefest, we’re evidencing, we hope, the idea that peoples’ distress is understandable in context, but we wanted to think about context in its broadest form.
One of the things we wanted to do was to really make very clear the link between personal distress and social context, social inequality, and social injustices. In other words, to put power on the map. Power is not only missing from psychiatric thinking, but it’s also missing from a lot of psychological thinking, and it’s missing from much psychotherapeutic thinking.
In the Power Threat Meaning Framework terms, one of our core arguments is that instead of understanding distress through biological patterns, patterns that are borrowed from the kinds of patterns that we see when things go wrong in our bodies, we need to understand distress through patterns that are organized by meaning. They’re organized by meaning, not by biology, which is a big conceptual leap, one of the fundamental conceptual leaps I think we made. We need to be thinking about how those patterns are based on or organized by social and cultural meanings, not by biology and something that’s gone wrong with our bodies'."
More info on the book here: https://www.pccs-books.co.uk/products/a-straight-talking-introduction-to-the-power-threat-meaning-framework-an-alternative-to-psychiatric-diagnosis
