Okay, I’ll admit most psychological models won’t have the majority of the public jumping in the aisles but the implications of this one are profound. It calls for the complete and immediate abandonment of diagnosing mental health problems. Yep. You read that correctly. Sound’s like they’ve lost the plot right? I promise all my blogs won't be as heavy as this one, but I have to be serious sometimes! To understand where this model is coming from, I’ll need to do a little contextual explaining. Please bear with me.
In 1955, The Diagnostic and Statistical Manual of Mental Disorders was published. For the first time Doctors could categorise the ‘symptoms’ their patients were experiencing into illnesses with their own names. Back then, many of these symptoms were labelled ‘reactions’ or psychotic reactions, i.e. there was an acknowledgement that these ‘symptoms’ were in response to something that had happened to people. We’ve lost that connection nowadays. Nowadays you’re just sick. There’s something wrong with you if you’ve been diagnosed with a mental health problem. Not only that, but some diagnoses such schizophrenia have also acquired the reputation of dangerousness. Psychologists have always had a problem with this. Lots of our models are on continuums, that is, people vary in where there are on a scale of any given trait. People move up and down multiple scales over the course of a lifetime. In no other field are human beings considered simple. But that’s what the diagnosing of mental illness attempts to do. Simplify human experience down to presence or absence of a disease. It’s categorical - you’re sick or you're not.
This leaves those of us who work for the NHS with a problem. I suspect most practitioners accept that diagnoses are not perfect, and see them as a useful shorthand to describe what is going on for people. They choose to ignore how much damage this labelling people as ‘other’ is doing to both people as individuals and to society. All of society’s ills cannot be cured by medics, if we label reactions to incredibly difficult life experiences as illness then we cause a situation when we expect precisely that. It’s not a coincidence that Britain is issuing more prescriptions for depression than ever before in it’s history. The more the illness model is entrenched the more demand there will be on the NHS.
Throughout my career I’ve struggled with this. As a clinical psychologist I was trained by the NHS for the NHS, and I have to work within this imperfect system. It’s all very well for psychology and our social work colleagues to grumble about labelling, but if we are not offering an viable alternative, then we are just seen as fluffy or ‘unscientific’, (both of which I have been called when arguing against diagnosis.) For the first time we now have an alternative. The power threat and meaning framework offers a new way to view ‘symptoms’. They are seen as intelligible responses to our previous experience. This means mental health professionals should never be asking ‘What is wrong with you?’ but rather ‘What has happened to you?’
The Global Mental Health Movement are exporting a diagnostic model across our planet. In theory, I would support their cause. Alleviating the suffering of those in distress is a noble aim. Unfortunately, they are offering treatment based on diagnosis as the only way to help people with emotional troubles. The cultural difficulties with this are immense, for example shamans regularly hear voices and are feted for it. The very people who have been revered in their culture for generations are being told they are sick as they hear things other people don’t. How can educated people not see how absurd this is?
I was lucky enough to be at the friends Meeting House in London for the official unveiling of this framework. Surrounded by representatives from Psychology, experts by experience (those who have suffered the ignominy of being labelled with a diagnosis) and other mental health professionals. Everyone I spoke to threw themselves behind this model. That is not the norm for a conference. I did not hear one word of dissent. The model is new, it needs a lot of tweaking but the effort to bring together research from so many different fields is only to be admired. It was a privilege to be in a room with filled with such hope. It’s an uphill battle, taking on society, but everyone was up for it!
If you’re not convinced that diagnosis is a strange way to go about things reflect on this. If you were gay forty odd years back you would have been given a diagnosis by DSM. You were sick, deviant and needed to be made well again. This clearly demonstrates that the construct of illness and disorder, ‘mental’ or otherwise is purely a social one. Shifts in the concept and nature of disorder reflect wider social, political and economic forces more than scientific advancement. And don’t get me started on Asperger’s. That doesn’t even exist as a diagnosis anymore, confusing individuals, their families and society alike. How can a person ‘have’ something one day, and it be abolished the next?
It’s time we all started rejecting this powerful story of individual weakness/deficit and medical illness. If you take a moment to think about this, really think, you’ll see that there are massive numbers of vested interests which serve to preserve the medical illness model. Not only personal interests but family, organisational, professional, community, economic, and political.
The whole of society is contributing to maintain this fiction. For too long, these interests have deprived people of a socially shared framework which they can use to make sense of their own experiences. It’s time for change.
If you are interested in reading more about power threat and meaning, you can access the link to the British Psychological Societies Division of Clinical Psychology below:
You can read the full Power Threat Meaning Framework here, or a shorter overview.
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