Beyond the mental health paradigm

The power threat meaning framework

Not only is it time to abandon psychiatric diagnosis, but it is time to move beyond the medicalised perspective of ‘mental health’. A new framework for understanding how we all cope with distress - the power threat meaning framework - can lead the way to a more honest and effective paradigm, writes clinical psychologist Lucy Johnstone.


The idea that people experiencing various forms of emotional distress are suffering from medical illnesses has taken a very deep hold in Western societies, such that to question it is often interpreted as denying the reality of their experiences. As someone who has worked in mental health services for over three decades, this is the last thing I want to do. However, I also know that the traditional diagnosis-and-drugs approach rarely brings the hoped-for solutions. In fact, research increasingly shows that it is more likely to lead to a lifelong dependence on psychiatric services.1

When th

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penny brewer 20 February 2022

the term 'mental health' doesn't still well with me either. Using simple words which convey deeper individual truth work is powerful

Steve Smith 1 26 January 2022

Mental health is a predominant shift, so there’s tons of information especially today about mental health, including the science, social, and historical parts of it. I would try to find some more statistics about suicide if you decide to go that route, or maybe discuss the qualifications for mental illness in the past and now. Overall, it’s a great topic to choose from.

Minnie 21 May 2021

I agree with this article. One questions I have - maybe I have misunderstood this but how does the author distinguish between understandable reactions to pressures and illness caused by disorders in the brain? Do the latter exist? How do we deal with these?

Andy Maufe 10 May 2021

I agree with your criticisms of the current system with it's emphasis on the biological and controlling behaviour of the individual but I don't understand why you think the sociological approach you propose is any better. Visualising people as belonging to different groups based on race, gender, colour, habit, appearance or any other criteria can only lead to antagonism and heighten anxiety. The essential unit of well being must surely be within the familial.


This is amazing Lucy your work and universal truth is outstanding. I think pluristic ignorance leads to pyschatric symptoms that don't fit your frame work. My dad used to strangle my sister and was walking into house with chainsaw when I made him put it down he phoned the ambulance on me and I was seen as pyschotic and aggressive towards him after I'd saved my sister numerous times from being strangled I was said as pyschotic irrelevant of fear response framework and was diagnosed with scitzoprenia I don't hear voices Lucy not really just god a couple of times and my inner voice of peace and balance. I believe killing sentient life forms for food is murder and believe who ever does so is crazed yet we don't protest by eating veg and rice enough I believe in the serotonin hypothesis and know mdma will help us if people don't listen to our fear response power problems it would at least make us happy. Absolutely brilliant frame work to use serotonin hypothesis in. Wonderful pyschology is kicking fake pyschaitry in touch these old nightmare meds need to be pyschadelics now for the future to become. Judgments of mental health divide us opinionated about what meds yet within your framework why judge why not know what happened to patients your ace