Session 9 - The Power Threat Meaning Framework

The dominant view of “mental health issues” is that, if someone behaves “abnormally”, they are treated as ill and presumed to have something wrong with them. A medical professional will find out their symptoms, provide a diagnosis and then they will be treated. Treatment may involve medication, therapy, or other interventions. This is known as a Medical Model.

However, this model is flawed. Who gets to decide what is normal? And what if the behaviours that are deemed “abnormal” or seen as “symptoms of mental illness “are actually a normal response to abnormal circumstances? Mostly, the Medical Model is not particularly focused on what may have led to the supposedly abnormal behaviours.

This is where a different model may be more helpful: the Power Threat Meaning Framework. Rather than presuming something is wrong with people, this model assumes that something wrong has happened, and that most cases of mental and emotional difficulty are the results of situations where someone is negatively affected by power in their life and relationships

This framework asks four questions instead of “what’s wrong with you?”:

1. “What happened to you” is a question about how power was taken from us. This might be ideological power, where we’re given messages by others, or by society, about how we should think, feel or behave. It may touch on us being excluded, marginalised or punished for failing to live up to societal expectations and standards, perhaps as a result of our race, sex or class. It could be because we have a disability, or because of our sexual orientation, religion or gender identity. It could include being stereotyped or ignored, threatened or discriminated against, disbelieved or denied access to services or support. This could also be about circumstances, such as childbirth, job loss, cancer, a car accident, the death of a close friend or relative, poverty, or a natural disaster like an earthquake. It could be when someone chooses to hurt us: abuse, violence, rape, or neglect.

2. “How did it affect you” is about what was threatened when power was taken away from us. We might be overwhelmed by isolation, injury, exhaustion, a lack of justice, a lack of safety, confusion, fear of being completely destroyed, or the threat of being unable to feed our family.

3. The question “what sense did you make of it” deals with how we dealt with what has happened to us or been done to us, our body, mind and emotions. The unrealistic beauty standards women are subjected to may leave women believing they’re ugly. Homophobia may leave a gay or lesbian person thinking they’re perverted. The messages in society that state that people have to be able bodied to have value may leave disabled people believing they are worthless. Racism may leave a black person feeling that they’re inherently wrong. We may decide that the actions of others are our fault to avoid feeling powerless. We might presume that the person who hurt us didn’t mean it, or make sense of our pain by deciding life isn’t worth living. We may conclude that we're unlovable, dirty or worthless. Humans have a deeply in-built need for justice. When there is no justice in a situation, we might rationalise the injustice by believing that it must be our fault, or that we've failed.

4. This question looks at what the Medical Model would call “abnormal” behaviour or “symptoms”. In order to survive an assault on our power, and overcome a threat, we do things that our body, mind or feelings deem helpful for survival. Most of the time these threat responses are physiological, not something we can control: the Five Fs of fight, flight, flop, friend and freeze. We might also experience, anger at ourselves or others. Or panic and high levels of fear. Our mind might wipe the memory of the situation. We might hate our body and self-harm. We could throw ourselves into work to avoid thinking too much or use dissociation to stay disconnected from the pain. We might end up with stomach problems, be impulsive, begin hearing voices or have severe mood swings.

The first question is about power, the second about threat, the third about meaning and the fourth about threat responses. Hence, the model is called the Power Threat Meaning Framework.

Let’s take shame as an example. Writer Rana Awdish says, “Shame doesn’t strike like a fist. It rots its way in. Shame unravels us at our most fragile seams…It’s unique in its devastating ability to make us feel exposed and worthless.” Shame may feel deeply personal and internal, but it’s a social emotion, a sense or fear of being judged negatively by others, not just for what we do, but for who we are.

In the Medical Model, shame might be treated independently, by trying to build up feelings of worth and value. While this can be helpful, the Power Threat Meaning Framework would seek to know what power issues were operating prior to the shame. Let’s take humiliation as an example.

Maida’s husband Gilbert humiliated her by mocking her at a dinner party. After sex, he made her watch him wash himself because he said she was so dirty he had to wash her off him. Gilbert’s humiliating acts leave Maida feeling powerless. Her deep need for justice is threatened as she can’t make sense of why Gilbert would be so horrible.

His actions exclude her from feeling part of a world with people who have not been humiliated. His unpredictable behaviour leaves Maida feeling helpless. The idea of telling people what Gilbert has done horrifies Maida: she fears she will be seen as pathetic and that people will judge her. When she was at school, boys mocked girls’ genitals and she’s heard plenty of jokes about them. Maybe Gilbert is right - maybe she is disgusting?

In order to deal with these threats, Maida’s brain, body and feelings will seek to make sense of what Gilbert has done. Deciding the world is not safe, Maida becomes distrustful of others and may become paranoid about her body, who she is and what people think about her. In order to overcome powerlessness, Maida becomes sure that she made Gilbert do it. If she could MAKE him treat her badly, then that makes her incredibly powerful. To deal with the overwhelming injustice of Gilbert’s behaviour, Maida concludes that his behaviour is fair, because she is so bad that she deserves to be treated horribly. To make sense of Gilbert’s rejection, Maida concludes that Gilbert didn’t mean it. She creates a new narrative where he was joking or he didn’t know that it would be hurtful. To make sense of living in a world where female genitals are denigrated, Maida accepts that she is dirty and bad.

The social messages she has received leave Maida feeling disgusted at her own body, while Gilbert’s behaviour, and the sense Maida’s brain has made of it, leaves Maida feeling alienated from herself and others. She may feel resentful and angry, or totally mentally defeated. She may shut down, leaving her feeling numb, and self-harming to try and feel again.

Under a Medical Model Maida would be asked “What’s wrong with you?” But there is nothing wrong with Maida. What’s wrong is how Gilbert has treated her and how society has damaged her. By recognising this, Maida can begin the process of moving forward.

In the Power Threat Meaning framework, the process of moving forward is shaped by two questions:

1. What are my strengths?

2. What is my story?

Accepting that we’ve been powerless, subjected to injustice, and rejected by someone is a LOT to deal with. So too is realising we live in a world where we are demeaned and devalued because we are female. But this acceptance is the first step forward. We can begin to make new meaning, writing a new narrative for our lives and identifying our strengths.

In her new narrative Maida may realise that she is not disgusting, dirty and to blame. She may recognise that shame was a way of coping and making meaning. By placing responsibility on Gilbert for humiliating her and on society for making her feel that her genitals are wrong, she can rewrite her narrative. Maida can reject the shame, instead placing it on Gilbert and the wider society, and she may be able to begin viewing herself as powerful and strong.

We can all begin making new meanings and writing new narratives for our lives, identifying the strength that we have and how extraordinary we are to have made it through.

We are not the problem and we can create a new story.