Reframing psychiatric/psychological illness

Well, I've skimmed through this Mental Elf article.

It is a critical article about a newly published 400+ page document called
''The Power Threat Meaning Framework Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis.''
published by the British Psychological Society.
https://www1.bps.org.uk/system/file...cal Psychology/public/INF299 PTM Main web.pdf

Apparently that long document claims to make a paradigm shift in the way psychiatric disorders are diagnosed and treated. As far as I can gather the general direction proposed is to get rid of current psychiatric diagnoses and anything based on scientific evidence, and base them instead on the patient's narrative about things like childhood trauma and other life experiences that involve imbalance of power. The Mental Elf authors criticlse this approach as not evidence based and making leaps of logic that simply don't stand up.

A concluding sentence from the Mental Elf article:

By contrast, the PTM Framework has opted to take a quite different path, set out by a hybrid social constructionist, anti-psychiatry, anti-science and political agenda. The PTM Framework is more manifesto than scholarly document.
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As far as I can see the 400 page paper is almost unreadable, so I suspect will not be read by most members of the British Psychological Society, and therefore there's no indication of how much influence it will have.

There is no mention of psychosomatic or functional disorders or MUS etc as far as I can see in the Mental Elf commentary, so I have no idea whether this so called 'paradigm shift' will affect us at all. Although the word 'functional' is used in the title of the long article, it seems from the Mental Elf commentary that they are referring to psychiatric disorders such as depression, schizophrenia and personality disorders. I have no intention of even trying to read the 400 page polemic to find out if it includes MUS.

I agree, @Amw66 that it does not bode well if clinical psychology is taking seriously an antiscientific stance.
 
From the blog article:-

near intro
"A position statement critiquing diagnostic frameworks entitled “Classification of behaviour and experience in relation to functional psychiatric diagnoses: Time for a Paradigm Shift (PDF)” was adopted by the Division of Clinical Psychology of the British Psychological Society (DCP, BPS) in 2013. Regarded by many as professionally divisive, it had little impact on clinical practice, not least because it disregarded NHS requirements and pretty much ignored the opinion of many DCP members.

So now we are introduced to the Power Threat Meaning Framework (PTMF) which “is the result of a project for work towards fulfilling that aim”; thus apparently laying claim to the heralded paradigm shift. Although the document (Johnstone and Boyle, 2018) prominently displays BPS and DCP logos, it is not an official position paper. It is the report of a five year project the DCP funded. We were surprised to learn that the DCP spent £15,000 on the PTMFramework launch, implicitly advocating for its adoption without any further review or discussion within the profession.
My bolding

The introduction to the PTM Framework makes it clear that the document is meant to fuel the paradigm shift. Crucial to that is said to be the construction of non-diagnostic stories which will re-integrate reactions presently regarded as disorders back into the range of universal experience. So, the intention is to replace (rather than supplement) diagnoses with personal narratives primarily focused on power issues. Strangely, however, the framework also includes seven “provisional patterns” which have all the characteristics of diagnoses."

Conclusion

"The Framework is hard to understand; the core statement was run through a readability analysis (readabilityformulas.com) and registered as having a Flesch Reading ease score of -9.9 which the site categorised as “Impossible to comprehend”.
It is clearly highly inaccessible to those it is supposedly aimed at. We were urged by one of the authors to read the entire document before commenting, something we have done. The way it is expressed de facto serves to conceal the underlying narrative, something we presume is unintentional. Nevertheless, the effect is to obscure the meaning, which is an ironic and paradoxical outcome.

Spread over more than 400 pages, we consider that the logic claimed to underpin the Framework is not valid. There is quite literally no evidence for the validity of the framework itself, or for the seven provisional patterns proposed as an alternative to psychiatric diagnostic categories. The authors assert that the gathering and synthesis of evidence (positivism) which lies at the heart of psychiatry and psychology should in any case be rejected. We regard the rejection of positivism as the ultimate baby and bathwater situation. Those who seek help from mental health professionals typically need evidence for effectiveness so that they can choose how best to engage with the range of help offered.

The Framework relies on empirically unsupported claims regarding the “cause and function” of psychological distress. This is something which has eluded the field for its entire existence. All is not lost, however. Progress in psychological interventions at every level has been made by efforts to understand why, for some people, distress becomes particularly severe and particularly persistent to the point that they need help and support to deal with it.

The range of effective psychological treatments we have are all based on such an understanding and this has been the emphasis of the applied science of clinical psychology and increasingly in psychiatry over the last four decades. There are real and exciting possibilities of understanding causes and therefore developing primary and secondary prevention interventions. These are almost entirely complementary to the demonstrably effective strategy of helping people to deal with factors which maintain their problem in ways which empower them to be able to bring about changes towards their preferred goals.

By contrast, the PTM Framework has opted to take a quite different path, set out by a hybrid social constructionist, anti-psychiatry, anti-science and political agenda. The PTM Framework is more manifesto than scholarly document. What is needed is evidence such as that in the excellent recent paper by Perkins et al (2018). These are complex matters not best dealt with by polemics."

authors bolding
 
As the Mental Elf is noted for unbalanced discussion, I'll leave an explanation of the new framework for people to judge for themselves.

https://www.madinamerica.com/2018/0...framework-new-perspective-on-mental-distress/

“The philosophical position outlined in this document suggests a more sophisticated view of human beings and human emotional distress, within which we are active agents in our lives at the same time as facing many very real limits and barriers to the changes we can bring about. Those limitations may be material (money, food, transport), biological (physical disability), psychological (fear, anxiety, self-doubt) and/or social (gender expectations, isolation, discrimination). More subtly but perhaps most damagingly, they may take the form of the meanings, beliefs, expectations, norms and values that we absorb, often unconsciously, from wider society.” (p 17)
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Thanks for that @Luther Blissett, I agree the Mental Elf is not a reliable source and it's good to get a completely opposite perspective on the long paper being discussed in the Mental Elf article which I read earlier today.

I have skimmed through this article - it's a very readable positive commentary on the long paper that the mental elf article was so negative about, and seems to make many valuable points from this perspective:

The fact that psychiatric “diagnoses” are routinely used to obscure and divert attention from deep-rooted social and economic problems is addressed.
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It does however, concern me that they may be swinging too far in the opposite direction, suggesting all psychiatric disorders that don't have a proven biological basis like dementia, must therefore be explained in these sociological terms. Some of it, if you slotted in MUS instead of psychiatric disorder reads uncomfortably like what we are fobbed off with.

Take this section quoted from the long article being reviewed:
“The identity of ‘mentally ill’ has mixed consequences. It may represent relief from guilt and uncertainty, and hope for expert guidance and effective intervention. At the same time, the ‘sick role’ identity has been theorised as facilitating passivity and a reduced sense of responsibility for one’s recovery. Diagnosis has been shown, overall, to incline the person diagnosed to have less optimism about recovery, make less effort to recover, and be more likely to use alcohol to cope, as well as to have lower perceived control over their difficulties and undermining the effects of therapy. Conversely, rejecting one’s diagnosis has been linked to better outcomes. However, this may lead to conflict with professionals, and the need to access services and benefits rules out this option for most people.” (p 221)
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How would we see that paragraph if we substitute ME or MUS for 'mentally ill' in the first sentence?

I've just re-read that last bit, and I think I've confused myself. I hope someone with more functioning brain cells than I have at the moment will elucidate.
 
I think that ME or MUS would be rejected from the first sentence for the simple reason that there is no such thing as a disease of the brain that you can point to and say "that is ME, that is MUS". The paragraph is about the way psychiatry labels a person, tells them that the only thing they can do is take medication and do exactly as the psychiatrists says. Any views the person then has that do not go along with the psychiatrist's is then viewed through a prism of a manifestation of the 'mental illness' and not a rational response to their circumstances.

This mirrors the way we are treated if we refuse to do GET for example. It is viewed as us using avoidance behaviour that must be treated, with threats for non compliance, including the loss of civil rights, the right of consent to decline treatment. The fact that refusing GET is a perfectly rational response to the symptoms we experience, is not considered, because GET was not designed for us, but to do something to us.

The psychologists who are pro the new approach seem to be very aware of why such creations happen. They say that the whole concept of something like MUS is created for the benefit of psychiatrists and not for patients. One of the most important points they have is that you must listen to what the patient is telling you, and consider what impacts wider society has on the patient.

Its' philosophy is about using your power to work with the patient, instead of using your power to do things to the patient.
The first is empowering, the second is dis-empowering.

Groups of psychologists have been very vocal about institutions such as the DWP. They refuse to accept that things like unemployment are a failing of the individual, but a failing of society, in direct contrast with the DWP view. They were against placing mental health support workers in jobcenters for example, as they did not want to be part of any coercion.
 
I'm familiar with some of the names of the secondary authors on the 400-page article, and some, like Peter Kinderman, I've already heard of in connection with this strong anti-psychiatry perspective. He is (or was) the BPS chair, and when he came into that position, was quite vocal in his pronoucements on the evils of medicalisation of psychological distress, and even made analogies between modern psychiatry and Nazism.

@Luther Blissett, the Mad in America review is useful, as it can be taken as probably the most positive interpretation of the (unreadable) 400-page document.

What I read there would suggest this model places some weight on the limitations that society imposes on a person, but also a lot of weigh on the limitations a person imposes on themselves, through their beliefs, etc.
“The philosophical position outlined in this document suggests a more sophisticated view of human beings and human emotional distress, within which we are active agents in our lives at the same time as facing many very real limits and barriers to the changes we can bring about. Those limitations may be material (money, food, transport), biological (physical disability), psychological (fear, anxiety, self-doubt) and/or social (gender expectations, isolation, discrimination). More subtly but perhaps most damagingly, they may take the form of the meanings, beliefs, expectations, norms and values that we absorb, often unconsciously, from wider society.” (p 17)
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While the document seems to make some important acknowledgements - that we tend to underestimate the role of social factors iin many types of psychological distress - it is also kind of paradoxical, in that it views psychologists are uniquely placed to alleviate these problems.

(edit: I reread the article, and don't think the above statement was entirely fair. They do also call for changes at the societal level).

The document also takes some very extreme views, like the view that even schizophrenia is best understood not as a biological disorder, but as a mental construction formed from a particular set of experiences and beliefs. In fact, they recognise biology as a having a significant causal role only in diseases where it simply cannot be denied - like when dementia results in severe brain atrophy that any fool can see, etc. In all other instances, absence of consistent evidence of biological causation is interpreted as evidence of absence.

Chapter 6 was quite interesting, as it talks about what people need in order to have a distress-free life.

There seems to be a mix of some quite interesting insights and some really potentially dangerous bullshit.
 
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I'm wondering what they would make of ME, and given that the evidence for biological causation of ME isn't in-your-face obvious, I suspect it would fall into the category of an expression of distress, which arises due to the interaction between the individual and the limits and expectations society places on them.
 
Woolie said:
I'm familiar with some of the names of the secondary authors on the 400-page article, and some, like Peter Kinderman, I've already heard of in connection with this strong anti-psychiatry perspective. He is (or was) the BPS chair, and when he came into that position, was quite vocal in his pronoucements on the evils of medicalisation of psychological distress, and even made analogies between modern psychiatry and Nazism.

@Luther Blissett, the Mad in America review is useful, as it can be taken as probably the most positive interpretation of the (unreadable) 400-page document.

What I read there would suggest this model places some weight on the limitations that society imposes on a person, but also a lot of weigh on the limitations a person imposes on themselves, through their beliefs, etc.

While the document seems to make some important acknowledgements - that we tend to underestimate the role of social factors iin many types of psychological distress - it is also kind of paradoxical, in that it views psychologists are uniquely placed to alleviate these problems.

(edit: I reread the article, and don't think the above statement was entirely fair. They do also call for changes at the societal level).

The document also takes some very extreme views, like the view that even schizophrenia is best understood not as a biological disorder, but as a mental construction formed from a particular set of experiences and beliefs. In fact, they recognise biology as a having a significant causal role only in diseases where it simply cannot be denied - like when dementia results in severe brain atrophy that any fool can see, etc. In all other instances, absence of consistent evidence of biological causation is interpreted as evidence of absence.

Chapter 6 was quite interesting, as it talks about what people need in order to have a distress-free life.

There seems to be a mix of some quite interesting insights and some really potentially dangerous bullshit.
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It is the fact that dangerous bullshit seems to be positioning as the way forward and growing at the rate of a farm midden that worries me.
 
Appreciate the responses.

It's not my area really, but on the whole, I feel that one group is more aware of history, past failings, falliability and capable of self reflection than the other. In other words, more an heir to the humanist tradition.

It would be interesting to ask about ME and MUS and see what their views are.

---

I came across this tragic story a few months ago that seems a perfect illustration of the problem, a man with a fungal scalp infection was diagnosed as having delusional psychosis despite having a medical reason for his problems.

He lost his freedom and most of his life, seemingly because it was decided he should not be listened to or respected as a rational person. One he was labeled as deluded it took a lot of money and a specialist to prove that he was not. Any mental illness was probably caused by the way he was treated.

It's seems a perfect story to highlight the dangers of not listening and refusing to consider that a doctor could be wrong.

https://www.bristolpost.co.uk/news/bristol-news/bristol-man-reveals-five-years-1264209

I haven't been able to find out what, if anything, was done about the whole mess.
 
Luther Blissett said:
Appreciate the responses.

It's not my area really, but on the whole, I feel that one group is more aware of history, past failings, falliability and capable of self reflection than the other. In other words, more an heir to the humanist tradition.

It would be interesting to ask about ME and MUS and see what their views are.

---

I came across this tragic story a few months ago that seems a perfect illustration of the problem, a man with a fungal scalp infection was diagnosed as having delusional psychosis despite having a medical reason for his problems.

He lost his freedom and most of his life, seemingly because it was decided he should not be listened to or respected as a rational person. One he was labeled as deluded it took a lot of money and a specialist to prove that he was not. Any mental illness was probably caused by the way he was treated.

It's seems a perfect story to highlight the dangers of not listening and refusing to consider that a doctor could be wrong.

https://www.bristolpost.co.uk/news/bristol-news/bristol-man-reveals-five-years-1264209

I haven't been able to find out what, if anything, was done about the whole mess.
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We only have to look at Bob' s experience to appreciate the position people find themselves in.
Unfortunately the bullshit brigade are coming to a place near you soon.....
 
Amw66 said:
We only have to look at Bob' s experience to appreciate the position people find themselves in.
Unfortunately the bullshit brigade are coming to a place near you soon.....
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This shit show is a long way from over yet. The BPS cult have made it abundantly clear that they are not for the turning, are going to redouble their efforts, fight to the bitter end, and that we patients are merely expendable pawns in their crusade.
 
I still cannot comprehend how it is allowed (legally, morally, rationally) for a group of people to decide that once people are labelled "mentally ill" in some way, they somehow magically can never have any sort of medical condition or needs that might require treatment?

It is so nonsensical and so immoral that it is difficult to imagine that this occurs in 2018, yet it is only growing as a concept and practice.
The medical community needs to speak the fuck up about this medical negligence that is irrational beyond belief.
 
Allele said:
I still cannot comprehend how it is allowed (legally, morally, rationally) for a group of people to decide that once people are labelled "mentally ill" in some way, they somehow magically can never have any sort of medical condition or needs that might require treatment?

It is so nonsensical and so immoral that it is difficult to imagine that this occurs in 2018, yet it is only growing as a concept and practice.
The medical community needs to speak the fuck up about this medical negligence that is irrational beyond belief.
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Or that everything the person says is not to be believed. They are reduced to knowing nothing about themselves and their experience.

It's the stuff of nightmares.
 
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