Session 9 - The Power Threat Meaning Framework Part 1

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: this model is called 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 result 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?

2. How did it affect you?

3. What sense did you make of it?

4. What did you have to do to survive?

“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 serious ill health, moving to an unfamiliar place, 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, sexual assault, or neglect.

“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 not having enough food to eat.

The question “what sense did you make of it” deals with how we coped with what has happened to us or been done to us, our body, mind and emotions.  The unrealistic beauty standards girls are subjected to may leave girls 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.

What did you have to do to survive? Is a question that 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 school or college 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.  Which is why the model is called the Power Threat Meaning Framework.