As a mental health nurse, I have often wondered whether having a diagnosis of a mental illness is helpful or harmful for users of services.
I've met people who found it helpful to have a diagnosis of a mental illness saying, for example, "OK so now I know what I am dealing with and have a better idea of what to do", or those with major depression who can then access effective treatment.
On the other hand, I've met many people who feel that having a formal diagnosis is unhelpful, even positively harmful, and many who feel these labels are out of date and more to do with 'ticking a box' and funding services rather than helping people.
I've also met many people who have been given a mental health diagnosis that has subsequently been proven to be wrong.
For some people, changing this has been part of their treatment and has helped them move forward. For others it can be something that is buried in their notes and passed on incorrectly, often without a good record of this. How often have we heard that someone 'has a personality disorder' 'has schizophrenia' etc. only to later find this is just hearsay.
What are people's views on this?
'Dr Lucy Johnstone, one of the lead authors of the Power Threat Meaning Framework, said:
"The Power Threat Meaning Framework can be used as a way of helping people to create more hopeful narratives or stories about their lives and the difficulties they have faced or are still facing, instead of seeing themselves as blameworthy, weak, deficient or ‘mentally ill’.
It highlights and clarifies the links between wider social factors such as poverty, discrimination and inequality, along with traumas such as abuse and violence, and the resulting emotional distress or troubled behaviour, whether it is confusion, fear, despair or troubled or troubling behaviour.
It also shows why those of us who do not have an obvious history of trauma or adversity can still struggle to find a sense of self-worth, meaning and identity.“
In traditional mental health practice, threat responses are sometimes called ‘symptoms’.
The Framework instead looks at how we make sense of these experiences and how messages from wider society can increase our feelings of shame, self-blame, isolation, fear and guilt.
The approach of the Framework is summarised in four questions that can apply to individuals, families or social groups:
- 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 situations and experiences to you?)
- What did you have to do to survive? (What kinds of threat response are you using?)
Two further questions help us think about what skills and resources people might have and how they might pull all these ideas and responses together into a personal narrative or story:
- What are your strengths? (What access to Power resources do you have?)
- What is your story? (How does all this fit together?)'