I was inspired to make my short film FREE from my knowledge of human rights issues in the mental health system. The UK government is attempting to address some of these issues this year via its reform of the Mental Health Act.

Coincidentally, shortly after I wrote the script, publicity surrounding the #FreeBritney movement appeared in the press. I was shocked that someone of such fame and fortune could become trapped by such systems.

This is not just important for human rights, but because oppression and coercion can increase mental distress and potentially lead to poorer mental health outcomes.

Around the time of making the film, I was interested to find out the British Psychological Society has released an alternative framework to traditional psychiatric diagnosis, the   Power Threat Meaning Framework (PTMF) using the concept of power, which focusses more on ‘what happened to you’, not ‘what’s wrong with you?’

This allows people to no longer be made to feel the burden that their distress lies solely within them, with little focus attributed to what has happened around them.

Given it was promoted as an alternative to psychiatric diagnosis, the PTMF has been subject to scrutiny and criticism, such as it may appear politically/ideologically driven or that it does not currently incorporate thermodynamics or systems thinking.

Nevertheless, explanations for mental extremes using dominance/power are some of the few mental health theories that tie in with the evolutionary human sciences.

Similar ideas have been in circulation for over half a century. The figure below is from the book Evolutionary Psychiatry (2000). One difference is that it uses the term ‘disorders’, while the PTMF considers the same behaviours as adaptive threat responses that may have outlived their usefulness, rather than ‘disorders’.

Evidence suggests a core force driving evolution of the human brain/mind was social competition (1), so this may be of significance to mental extremes. Although other powerful ‘threats’ can also impact mental health, as evident from COVID pandemic.

Academics who study leadership power have researched how this aspect affects human psychology. While individuals with power are more capable of focussing on essential aspects of a task, power lessens understanding of the perspectives, emotions, and feelings of others, and makes individuals more likely to deviate from norms (2).The United States Constitution has a ‘Two-Term Limit’ (8 years) for US Presidents – to limit this dark side of power: with its risk of tyranny or corruption.

Research also suggests that not all individuals are affected equally when in power, as explained by Dr Benjamin Voyer, a Professor of Behavioural Science here.

At the opposite ‘that’s what you get when you’re bottom of the heap’ (a sad sentence from a patient of mine who complained to me about his treatment in a psychiatric hospital), traditional psychiatry could be said to ‘silence’ by way of its terminology of ‘delusion’ or ‘false belief’ for altered states (4) shown to be associated with social defeat (5), which invalidates the communication, in contrast with Open Dialogue psychiatric technique, which prioritises discussion.

Invalidation/restrictions on basic freedoms, such as control over chemicals taken into own body/mind, and in Britney’s case, needing permission to leave her own house, may amplify imbalances of power that according to Power Threat Meaning Framework, may have contributed to mental deterioration in the first place.        

Alternatives to traditional management for mental crisis, such as Open Dialogue and Soteria Houses, which offer more choice and so freedom, may in part be successful because they help break cycles of imbalance of power.

The most egalitarian and happiest countries in the Western World on many measures, those of Scandinavia (7,8) have a major psychiatric concept which denotes many extreme altered state mental breakdowns as determined purely by psychosocial traumas (9) rather than traditional ‘broken brain‘ models.

This Scandinavian concept wasn’t translated into English until the 21st century, almost a century after it was first described, so never really caught on in the rest of the psychiatric world.

The PTMF similarly is widely described as focussing on traumas, although its authors prefer the word ‘adversity’ as they find this more ‘inclusive’ (10), perhaps as US psychiatric classification DSM 5 defines trauma as exposure to an event that involves ‘actual or threatened death, serious injury, or sexual violence‘.

The Scandinavian concept instead defines content of the person’s mental breakdown as comprehensibly determined by the ‘trauma’, which can include less dramatic ‘trauma’ such as job loss or family conflict. A significant number of mental crises in Scandinavia fulfil this content criteria (9)….

So in Scandinavia mind-altering ‘traumas’ are fully acknowledged and learnt from, rather than sidelined by labels that ignore them in favour of chemical/genetic interpretations. Could enough validated ‘traumas’, allowing more confidence in communicating them, help influence society in a more equitable/happier direction?

Strange times, strange questions, not enough answers.

References

1. Bailey, DH, Geary DC (2009). Hominid Brain Evolution. Testing Climatic, Ecological, and Social Competition Models. Human Nature 20: 67-79
2. Can Power Change How We Connect With Others? | Benjamin Voyer | TEDxHultLondon
3. Kaufman, Scott (2019). The Light Triad vs Dark Triad of Personality. Scientific American
4. Bortolotti, L, Lancellotta, E (2019). Are clinical delusions adaptive? Wiley Interdisciplinary Reviews. Cognitive Science 19(5): 15
5. The Social Defeat Hypothesis of Schizophrenia: An Update. Schizophrenia Bulletin 39(6): 1180-1186
6. Philips, Nicola (2017). Power and Inequality in the Global Political Economy. International Affairs 93(1) 429–444
7. Bendixsen S, Bringslid M, Vike H (2018). Egalitarianism in Scandinavia. Palgrave Macmillan/World
8. Happiness Report. Oxford University.
9. Bertelsen, Aksel (2007). Reactive or Psychogenic Psychoses: The Scandinavian Concept. PsiLogos 4.
10. Johnstone L, Boyle M, Cromby J, Dillon J, Harper D, Kinderman P, Longden E, Pilgrim D, Read J (2019). Reflections on responses to the Power Threat Meaning Framework one year on. Clinical Psychology Forum 313.