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This paper provides a philosophical analysis of the Power Threat Meaning Framework (PTMF). I offer a critique of the underlying unexamined foundations in its proposal to provide an alternative to classifying mental disorders. The PTMF is a non-pathologizing approach to understanding mental distress that attempts to transform our comprehension of what it terms "emotional distress, unusual experiences and troubled behavior" (Johnstone & Boyle, 2018, p. 5). Fundamentally, the PTMF argues that a framework of medical understanding and diagnosis leads to a reductive, biological approach to mental distress that frames experience as disorder. Against the idea of disorder the PTMF constructs a concept of mental distress as survival with an overarching message that a person is:
experiencing a normal reaction to abnormal circumstances. Anyone else who had been through the same events might well have ended up reacting in the same way.(Johnstone & Boyle, 2018, p. 18)1
The main PTMF document was launched in January 2018 and written by psychologists and survivors/campaigners who work in research and training. It aims to reframe understandings of mental distress away from pathologizing questions that attempt to identify what is wrong with a person, toward an understanding of how negative experiences of "power" produce threat-based responses that are understandable as survival mechanisms rather than mental illnesses. This proposes a hermeneutic framework that aims to have a fundamentally different orientation from traditional psychiatry. Rather than asking what is wrong with a person, the PTMF structures its understanding through the following questions:
What has happened to you? (How is power operating in your life?) How did it affect you? (What kinds of threats does this pose?) What sense did you make of it? (What is the meaning of these experiences to you?) What did you have to do to survive (What kinds of Threat Response are you using?).(Pilgrim, 2022, p. 90)
My focus in this paper is on three philosophical issues that are raised by the PTMF: the questions of illness, meaning and power.
First, is the question of mental illness. The PTMF unfolds a broadly Szaszian critique of the concept of mental illness but, like Szasz and his many followers, it fails to distinguish between concepts of illness and disease or discuss the ways that illness and disease...