PATTERNS IN THE POWER THREAT MEANING FRAMEWORK

The Patterns (set out in both the Main and Overview documents) are central to the PTMF’s aims of:
offering an alternative non-medical theoretical framework and generating from it an alternative set
of patterns of mental distress, troubled and troubling behaviour. These alternative patterns are very
different from the diagnostic system’s problematic ‘symptom’ clusters and categories. The PTMF
Committee is building on the principles underpinning the patterns in order to develop additional
ones which will be added to the website as and when they are ready (see below for links to the
examples to date).

The PTMF Patterns are about populations and groups, not individuals. They are based on the
assumption that our shared biology, society and culture leads us to respond in typically regular, but
not individually predictable, ways when we are exposed to particular material, relational and
ideological environments – in the case of the examples in the PTMF, largely Western or Westernised
ones.

The additional patterns that have been developed also reflect the fact that the PTMF Patterns are
described at several levels of specificity. First, at a population level, is the Foundational Pattern
which brings together general evidence on the roles of power, threat, meaning and threat responses
to describe what are often cyclical and transgenerational trends and links for a whole society (see
Overview Document, pp24-5; Main Document, pp95-6).

At the second, more specific level are the seven Provisional General Patterns. They describe how
groups of people can typically respond to certain broad kinds of abuse and misuse of power and
resulting threats. Two examples are ‘Surviving social exclusion, shame and coercive power’ and
‘Surviving disrupted attachments and adversities as a child/young person’.

The third level of patterns describes interactions of power, threat, meaning and threat responses in
relation to more specific contexts, or in some cases specific threat responses, as the starting point.
We very briefly outlined several of these in relation to each General Pattern in the Framework
documents. Examples from each of the two General Patterns above are: ‘Surviving homelessness’
and ‘Surviving invasive medical interventions as a child/young person’.

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It is this more specific form of pattern that the PTMF Committee has been developing, but in much
more detail than those outlined in the Framework documents. Each additional pattern has been
produced through a process of reviewing the evidence, synthesizing it into a PTMF structure, getting
feedback from relevant sources including Lived Experience Experts, and further refining it through
discussion with PTMF committee members. Like all the other patterns, these are by their nature
provisional and evolving, and we welcome ongoing feedback on their content, coherence and utility.

The simplest way to explain the PTMF Patterns, of any kind, is that they describe interactions of
power, threat, meaning and threat responses in relation to particular contexts and life experiences.
They can be seen as meta-narratives that go beyond the individual and offer multiple narrative
possibilities. The PTMF shows how the core questions can be used to develop a narrative at a one-
to-one level. These personal narratives are based not just on the particular events or circumstances
an individual has experienced, but also, crucially, on the meanings of these events and life
circumstances to the person concerned. However, the PTMF also shows that our personal meanings
are never wholly personal. Rather, we construct meanings about our lives by drawing on the
meanings we find around us – from our families, education, the media, and so on. These meanings
are in turn derived from the wider standards and assumptions (sometimes called ‘social norms’) of a
particular social group, community, society and culture. To give a simple example, someone’s
personal story might be shaped by the belief that they are a failure for being unemployed. This belief
is itself based on general assumptions about the definitions of success and failure in a given society.
And these assumptions are themselves shaped by ideological meanings and forces – for example, in
societies structured along Western economic lines, having a paid job or ‘being productive’ has come
to be seen as the most important social role.

The PTMF Patterns help us to see that our personal stories, although having an individual flavour,
are always based in part on the wider meanings and narratives of a particular time and a particular
culture. This may be useful in helping people to put their own narratives in a wider context, and to
see themselves not as an isolated or failing individual who has some kind of deficit or illness, but as
someone who is doing their best to survive within often very difficult circumstances. The patterns
represent what people DO in the face of threat, and not ‘disorders’ that they HAVE. They can be
used to support the construction, or co-construction, of non-diagnostic narratives and stories about
people’s lives. And because we share biological characteristics and social contexts, the patterns –
some more than others – can also be relevant to groups and communities with shared experiences
(see pp45-6 PTMF Overview).

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The PTMF Patterns have other characteristics that follow from this central emphasis on meaning and
from the number and complexity of factors contributing to mental distress. The points below are
based on the discussion in the PTMF Overview pp 40-45:

o There is no such thing as a pattern that ‘fits’ a particular person or their problems, and nor is
there an intention to assign people in this way. People may find parts of their story in one or
several patterns. We hope that the patterns can serve as a helpful resource to inform the
construction of narratives at an individual, family, group or community level.
o The patterns are not based on simple cause-effect links between what happens to people
and whether, or how, they might experience distress. This follows from the complexity of
our life circumstances and from the fact that everything is shaped by the meanings we
create about them.
o As a result, the patterns are, and will always be, loose and overlapping, provisional and
uncertain. There is no ‘pattern for psychosis’ or ‘personality disorder’, and nor do we expect
a simple fit between one person’s narrative and a specific wider pattern. This isn’t a failure
of the patterns. It is just how things are in the field of human behaviour and emotional
suffering, and it means that there is always hope for change.
o Having said this, there are certainly regularities, or common ways of responding to threat,
which reflect our shared biology, our societies and our cultures. The PTMF Patterns reflect
these regularities.
o The patterns cut across ‘normal’ and ‘abnormal’, ‘mentally ill’ and ‘mentally well.’ They apply
to all of us, since we are all affected in some areas of our lives by the negative operation of
power, we all experience threat, we all make meaning, and we all use threat responses.
o The patterns will always reflect ideological meanings that apply within local social, political
and cultural contexts so that there will be different patterns more relevant to groups and
societies with different worldviews.

So the patterns are, and always will be, in a state of evolution and development. However, they are
‘the necessary basis for a wholesale move beyond the current diagnostic paradigm’ (Johnstone
2022) and provide a justification for moving towards a non-medical conceptual approach based on
fundamentally different assumptions.

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The additional patterns are:
o Identifying/being identified as a person with intellectual disabilities
o Stalking Behaviour
o Surviving a highly unequal society
o Surviving spiritual crisis
o Surviving poverty and low socio-economic status
o Suicide and suicidality in middle-aged men

Further reading on the Patterns

Boyle, M and Johnstone, L (2020) A Straight Talking Introduction to the Power Threat Meaning
Framework. PCCS Books. (Chapter 8).
Johnstone, L (2022) General patterns in the Power Threat Meaning Framework – principles and
practice. Journal of Constructivist Psychology 35:1, 16-26.

PTMF Overview, pp22-73

PTMF Main, pp193-243