I had the luxury of a spare Saturday yesterday (12th February 2022) that coincided with an online festival of presentations and discussion on all manner of things from philosophy to science, all the way around culture and back again. It was the Winter Revel brought to us by How The Light Gets In.

I’ve been to one of their online festivals before and loved listening to people who were new to me and people whose books I’d read. They have some ‘heavy hitters’ on the bill. 

I was so pleased to listen to Lucy Johnstone’s (left) take on Mental Health…. a radical take, as she put it, in many ways. Lucy is is a UK clinical psychologist, trainer, speaker and writer, and a long-standing critic of biomedical model psychiatry. She has worked in adult mental health settings for many years, alternating with academic posts.

She said a number of interesting things that critique the current professional and public perception of mental health that I am still thinking through for myself but I felt were worthy of getting out there for further exploration. You can comment below or join the chat at our Social Work Shorts Discord server – you’ll need to download the app or desktop version and then follow this link. 

So what did she say!?

She started by quoting Dr Allen Francis the chair of the DSM IV Committee (the mental health diagnostic manual) as saying ‘there is no definition of a mental disorder ….it’s bullshit.’ Johnstone was keen to point out in saying this and the other things she said she wasn’t denying the very real and problematic experiences that people have. She was simply suggesting that we are approaching it in the wrong way ….and she did offer a solution which I’ll get to later. She confirmed the view of Francis stating that diagnosis is not scientifically valid saying that diagnosis is circular. You’re hearing voices – you have schizophrenia – how to we know you have schizophrenia – you’re hearing voices etc. This points to the fact that mental health diagnosis is social not medical. The person doesn’t fit with what society perceives as ‘normal’.

She went on to suggest that psychiatry rarely helps people. She wasn’t saying that it sometimes didn’t help but that mostly it doesn’t. In fact she suggested that psychiatry can sometimes reinforce the stigma that goes with having a mental health problem. She suggested also that well intentioned anti-stigma campaigns often do quite the opposite and reinforce the ‘othering’ of people with such ‘problems’. They are based, she feels, on an illness model rather than a model that centres emotional suffering. She noted that the mantra ‘we all have mental health’ elevates the normal range of emotions and feelings to a higher level and problematises or medicalises a range of feelings that sit within a ‘normal’ range. Again she was not saying that people with emotional difficulties should not be supported but rather that the elevation is inappropriate for many. Self diagnosis is unhelpful and also so is the over medicalisation of a range of emotions.

The problem with diagnosis and the diagnostic manual she suggests is that 9 out of 10 of us at some point will meet the criteria for one or other of the ‘mental illnesses’ so eventually it will be 10 out of 10 so then we all are mentally ill and systems get overwhelmed and people that should be at the top of the priority list for support don’t get it. Of course such over diagnosis plays right into the hand of pharmaceutical companies who can offer us medication.

In relation to current treatments she makes the startlingly obvious point that is overlooked that despite such treatments rates of distress across the world are rising. So if what you’re doing isn’t working maybe it’s time to do something different.

First of all what is the problem!?

She suggested that economic conditions brought about by neoliberalism had created job insecurity, reduced welfare services, reduced community ties, excluded some groups and led to materialist values which in turn has led to an increase in mental health problems. It takes me back to a quote from Alvin Toffler that I often use from his book Futureshock written in 1970. He predicted that the change of pace he saw then would continue into the future (our present) and people wouldn’t be unable to keep pace with the change. Add into this Debord’s view in his The Society of the Spectacle that people’s worth will become tied up not in what they ‘are’ but in what they have. This leads to a drive to consume more and more to signal to others our success. This creates a tension that he refers to as an ‘opium war’ that forces people to equate goods with satisfaction. Mental health ‘problems’ are therefore rooted in a social phenomenon that has a psychological impact. This requires us to change the social world to make it a better ‘fit’ with the universal human condition

Johnstone, with Mary Boyle propose in their book ‘A Straight Talking Introduction to the Power Threat Meaning Framework: An alternative to psychiatric diagnosis’ an alternative. The framework mentioned in the title Power Threat Meaning.

The framework haas been developed by a core group of psychologists and service users over a 5 year period laying out the following key principles. The framework builds on trauma informed practice, de-medicalises and de-professionalises mental health intervention, explores how distress makes sense in a context and creates no separate group of the mentally ill.

The framework asks some core questions:

• What has happened to you? (How is Power operating in your life?)
• How did it affect you? (What kind 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?)
• What are your strengths? (What access to Power resources do you have?)
• and to draw it all together What is your story?

Johnstone suggests that this framework draws on the importance of the group to the individual, acknowledges our relationship tot he natural world, integrates mind, body, and spirit with that natural world and builds on (among other things) community narratives and values.

Now if like me you’re a social work you’re probably thinking…. that sounds like it aligns with social work practice and values very well to me! What do you think? Hearing Lucy Johnstone talk about this felt like turning a corner and was so refreshing. Check out the book. It’s available here from the publishers web site and all the other usual places.