The Power Threat Meaning Framework (PTMF) and Covid-19.

Declan Aherne and Cian Aherne

Covid and PTMF

Abstract

Covid-19 has forced many of us into introspection in attempts to figure out what is important to us individually and as a society. Here we have used the Power Threat Meaning Framework (PTMF; Johnstone & Boyle, 2018) as a framework of reflection in an attempt to illuminate some understanding of Ireland’s responses to the illness and some thoughts on how to approach things going forward. In this, we acknowledge the authors’ influence and input on the piece from a social constructionist perspective whereby our opinions, backgrounds and bias have all clearly played significant roles in its development. Nonetheless, unique perhaps to this potential trauma, is the universal similarity with what objectively has happened and how it is a uniform virus that we all have had to contend with (albeit in our own unique manner). What follows are intended as prompts for each of us to consider in terms of how we have engaged with Covid-19. Our invitation is that we all might seek to use this template to explore our own experience of the pandemic and how we are dealing with it. Notably the PTMF is as relevant for identifying a community response as it is for individual responses, and so by pooling together our individual responses we may also be able to identify community-wide responses.

 

The Power Threat Meaning Framework (PTMF)

The PTMF was published by the Clinical Psychology Division of the British Psychological Society in 2018. Its core tenets are four questions:

  • What happened to you? (i.e. how is power operating in your life?)
  • How did it affect you? (i.e. what kind of threats does it pose?)
  • What sense did you make of it? (i.e. what is the meaning of these situations and experiences to you?)
  • What did you have to do to survive? (i.e. what kinds of threat response are you using?)

With two additional questions:

  • What are your strengths? (i.e. what access to power resources do you have?)
  • What is your story? (i.e. how does all this fit together?)

We feel this can be a helpful framework through which to view current responses to Covid-19 in Ireland. It offers a non-medical perspective on our mental health which we believe can be a nourishing approach to our reflection.

Please see Special Issue of Clinical Psychology Forum for relevant individual and systemic examples of its use2.

 

What has happened to you: how is power operating in my life?

The world has been infected with a deadly virus putting all of our lives in danger.  This poses a definite risk to all of our health.  The power invested in this virus is palpable.  It is invisible and yet it has the potential to kill. Healthy bodies have the power to fight against the virus and those with good health can be grateful for it. The power posed by this virus is its potential to cause so much damage worldwide and frontline workers are particularly at risk of becoming ill.  It has the power to at least make some sick and confined to bed and isolated for a short while. We may be feeling somewhat powerless against this virus and yet we can also be aware that we have power over certain aspects of our own self-care which we can endeavour to exercise as best we can.

 

Because of the power that this virus possesses, there is the knock-on effect of how the power of the State can be used for the greater good, forcing us to behave in a way that is alien to us.  The Law is being used to ensure that we all behave in a certain way so as to limit the spread of the virus.  We are no longer free to come and go as we please and to do what we want right now. It is strange to be in such a position whereby the State can control all of our activities, up to and including preventing us from leaving our own homes. We are helpless in this situation but realise that it is for our own good. Because the country was in almost complete shutdown and business had come to a halt, there is the knock-on effect of limited income and realising all of a sudden that the availability of finance that was there, is no longer present. The security that finance provides is absent and we are not all in the same boat when it comes to financial security and, as research has shown, social inequality is one of the major determinants of mental distress3. There is a lack of money available now and a resulting inability to plan to purchase things we may have hoped to purchase or invest in. Under the circumstances, there is little that can be purchased in this climate anyway which somewhat mitigates the impact of having a lack of money.

 

Throughout this emergency, the importance and power of relationships, has become particularly salient. Relationships can provide us with the love and understanding and support needed at such a difficult time. Relationships are also being truly tested through this. This may hold especially true for relationships with conflict. In addition, this emergency has challenged us all to revisit our priorities and realise what values are worth upholding at this time.  We might find that these have changed. The ideologies that promote economic agendas for example have become less a priority right now.  Of more priority for governments as well as our own local communities has been to protect and look after one another, by co-operation and loving, kindness, rather than using war and conflict or buying power to resolve matters. Such a governmental response may actually prove to be what our collective mental health has needed all along4.

 

Other paradigms of mental health may not acknowledge the extent to which the current pandemic has “happened to us” and may look instead at how “mental health disorders” are going to be widespread following the virus5. Reflecting on the PTMF, however, helps us to see that it is natural that such a universal trauma has happened and is going to impact on our mental health in various ways. Framing our reactions to Covid-19 as “Adjustment Disorders” for example obfuscates much of the context that each individual is uniquely experiencing.

 

How does it affect you: what kind of threats does it pose?

Health and livelihoods have been threatened. Freedom to do the things we want to do has been curtailed majorly. Emotions are under threat because we don’t know how to react or how to feel. The future is very uncertain now, so planning a future is difficult. What the future will look like is uncertain. Relationships have had to be let go or neglected. The threat to the long-term viability of relationships is evident. Will we be in isolation forever? The future is under threat for all of society. All behaviour has been affected. Social distance is now in the vernacular. Hand-cleansing is the norm.  It is affecting our daily routines. We are unable to carry out our work as we had been able to do. We cannot plan for holidays and we have to cancel plans already made. Our abilities to financially support our families throughout this is under threat. Our values are under threat with the tension between survival of the fittest/looking after ourselves versus the greater good and looking after those most vulnerable. Can we do both? How well will we cope with this emergency if it goes on for more than two or three months? What are the possible outcomes? How might we not cope? Our identities are at stake here, in so far as we don’t know what the outcome will be and if we will be in the same position socially as we were before this. How important is that to us?

 

The virus was not a deliberate act by anyone. However, how individuals respond to the virus leaves open the possibility of people deliberately infecting others or not being compliant with general guidelines on keeping safe and thus putting us all at risk. It’s an ongoing threat, not just a once-off and it has many off-shoots. This is a shared threat and so it can be shared by everyone across the world – we are all in this together. The threat it poses for all of us therefore is the challenge to our whole belief system, our identity, our very survival on this planet, our economic survival, our ability to think of others and our overall ability to cope with the uncertain nature of our existence.

What sense did you make of it: what is the meaning of these situations and experiences for you?

Humans’ default strategy is to try to make sense of things and we use this to good effect in many aspects of our lives – through much struggle and pain at times. In the current crisis we are made acknowledge that the world is not under our control and we are very much at the mercy of Mother Nature. Ultimately, we are powerless when faced with the Universe in action. The human race is vulnerable and is capable of being made extinct. This has always been a possibility but one that we have tended to keep at a distance6. This existential angst is hidden deep within us and rarely aired. Now it is unavoidable. That being the case, the current crisis allows us time to reflect therefore on our priorities given that the world is not ours to control. Being forced to accept this fact encourages us to review our priorities in life, what life is about and what gives us meaning and purpose to go on. We end up asking ourselves what is life about and if this is how it can all end?

 

Again, each individual’s experience is unique but it is worth reflecting that for many of us, this crisis may have made a bad situation worse. This becomes yet another trauma on top of a whole life of trauma we may have had to be dealing with.  The increased stress this emergency presents, may be the tipping point for many, leaving them feeling totally abandoned and helpless in the face of overpowering forces.  This could lead to a total collapse of one’s ability to cope and manage from day to day.  Interestingly, however, it may be that in the face of this great adversity, we discover inner strengths, wisdom and insights that can help us in carrying on. These may be strengths that we never realised we had, until faced with the stark reality of Covid-19.

 

For sure, many of us will have discovered that many of those things which we had previously considered essential to our happiness and well-being are not in fact as vital and as necessary as we had assumed. Could this be a good thing? Paradoxically, in the midst of such devastation and tragedy, there may be a brightness shining through that will enable us to carry on into our futures in a less stressful world.

 

We may inevitably end up reflecting upon our spiritual roots in search of answers to these questions. Having a spiritual base can be an anchor point since the spiritual journey carries on regardless7.  Almost everything about the world has changed radically this past month but one thing that does not change is the spiritual path. This is the path that can lead us towards contentment, regardless of what is happening in our environment; the rules and values do not change. The current predicament has got us all to stop and recognise what is really important in life, the importance of loving kindness, relationships, connection, co-operation and being able to let go of our incessant drive to achieve more and more success. This is the Universe teaching us a lesson in how to survive and what is most important to Mother Nature for this survival. We are being forced into having to consider others, not just ourselves. In doing this, we are learning to appreciate acts of kindness and realising that it is not as difficult as we may have thought. In a weird way, many of us can be grateful to this virus for getting us to stop in our tracks. Yet sadly, that is obviously not the case for all.

 

 

What did you have to do to survive: What kinds of threat responses are you using?

We are discovering sadly that many people are not surviving this pandemic. But even among those who are surviving, there will be casualties.  For many, despite their best intentions, the responses will be unhealthy.  Fear will take over and lead to adjustments that will make life very difficult for themselves and those around them.  For these people, the response to a very real felt threat, will be to collapse into further addiction or obsession or despair. The Covid-19 pandemic will confirm their worst fears, of not being in control, that life is unbearable and that they are not ‘good enough’ or worthy enough to survive.  The feelings of fear and anxiety are too much for them and they will seek out ways and means of numbing this emotion or suppressing it, believing that it is stronger than they are.

 

A significant (and possibly helpful) threat response is finding meaning that makes sense and with which we can live. Once we can make sense of things, we feel safer and more secure – or at least we feel in control of not being in control. Whilst we may not be able to make sense of the virus as an entity in itself, we can recognise that it is part of the bigger picture of how the universe functions. Our practical responses to this threat have to do with taking all necessary measures to keep ourselves as safe as possible and then resigning ourselves to the fact that we still may get sick. At some point we will realise that chance and luck may play a role. We may need to face into the existential realisation that our time may come. We may need to prepare ourselves to be ready for this and we may need to find solace in the experiences that we have had to date and be grateful for these. Trying our best to be good people can be part of that. Everyone has had pain and suffering in their lives, no one is immune; these are the commonalities of human existence in living and in death. Maybe some of us can find comfort in this considering the background of what is going on in our lives right now. Coming to terms with our lives on a personal level is needed to try and bring some level of peace.

 

The other more practical response to the threat is to be patient and still. Over-eating, over-drinking or drugs to numb feelings can be tempting at this time. On the other hand, examining our feelings more deeply as we reflect on this experience can help us to discover more about ourselves. Taking good care of ourselves, having a regular daily schedule and looking for opportunities where we can be of help to others can help us to cope with the invisible threat that is presented. These can lessen the fear and the stress. It’s important not to lose faith in mankind. In fact, the World’s response when ‘the chips are down’ may restore our faith. Thus far, we are surviving as a human race and we are not letting this virus get the better of us – though much tragedy continues to happen. Many are taking on a “Fight Response” (“Bring it on!”), mobilising our energy to defend ourselves and our families against this virus.

 

Other mental health frameworks of understanding may look at our responses as symptoms. For example, obsessional thoughts, anxiety, low mood/energy and substance misuse are all often commonly cited as symptoms in medical frameworks. Reflecting on the PTMF, however, can help us to see the meaning in these responses for some people. Anxiety and obsessional thoughts, for example, are keeping people safe right now. These emotional responses are helping us to self-isolate and look after ourselves and others. If these responses come to a point that they feel overwhelming for an individual then help may be sought but the PTMF gives us insight into why they might be there in the first place and what need they are meeting.

 

What are my strengths: what access to power resources do I have ? 

Strengths may include loving and secure relationships, a supportive family and a good sense of belonging. Having people in our lives who love us and to whom we can turn and depend upon should we need their help is important. We need people with whom we can be vulnerable and be ourselves. Many of us can access self-care programmes and we can find out what is good for us in terms of food, rest and relaxation, exercise and companionship.

For those less fortunate, who do not have access to these resources, the challenge is going to be even greater. It may be that people will discover strengths that they did not know they had. As a community, for example, we are witnessing a collective response to behaviour changes and providing supports to the more vulnerable, in a manner that we probably never imagined possible prior to this. If we can learn to maintain social isolation, go without pubs and golf courses, queue in an orderly fashion at our supermarkets and not travel more than 2km from our homes unless necessary, then perhaps there is a lot more resilience and capabilities in each one of us that we had not realised until now.

From dealing with trauma and post-traumatic stress, we have learned the importance of facing our fears and experiencing as fully as possible what is happening at the time it is happening, so as to empower ourselves to do the best we can with what we are facing. Very often in the midst of trauma we need to switch off and dissociate in order not to have to feel the overwhelming and overpowering nature of what is occurring to us8.  In the case of Covid-19, where the trauma is a community wide experience, there is every reason to be open to as much of this experience, as it’s happening, as possible, and not to ignore what is going on. By doing so we are more likely to take direct action in the present moment that is empowering and constructive.

Many of us can be thankful that we have come into this crisis in a good state of health and this can help us to cope with whatever comes our way. This may be time to reflect upon what we are grateful for such as the opportunities afforded to us in our lives to date. Many have had the benefit of a good education and don’t lack for material things. Many are healthy and intelligent. We are lucky that we live at a time of technological advancement and information and connection is immediately available throughout the country.

In conjunction with all of these strengths and resources, again we can always turn to our spiritual lives and what strength our spirituality provides for us in times of difficulty. Belief systems and Faith can enable us to have the courage to face life’s challenges and be open to whatever happens9. Spirituality and spiritual practice, communities of Faith and having people close to us share in these beliefs and struggles can be helpful. At this point in time, there is great strength in knowing that the world will eventually be ok. We can gain strength also from being able to offer help to others in this time of need.  This can give us a very real practical sense of purpose.

What is your story? (i.e. how does all this fit together?)

The answer to this question is still in our hands to decide. We are in the middle of the story and watching it unfold in real time. For now, our government and our people are putting life and our most vulnerable in society as our priorities. Social isolation, cocooning and practical health guidelines are mostly being implemented. Social welfare is available to those negatively affected and many business owners are offering reasonable delays in payments. People are reaching out over the airwaves, meaningful voluntary movements are being created on a daily basis, front line workers continue to tackle the problem and many are voluntarily being redeployed in the health system to help. The world is slowing down. The response to the virus has been swift and the power of human action when confronted with a crisis is in full flow. It remains to be seen how long these efforts can last, what the ultimate trajectory of illness and death will be, how the world will have changed (or not) when this is hopefully all over. We are learning so much about ourselves and what is most important to us. For now, Ireland is fighting. We are fighting for survival, no one is yet giving up and we are trying our very best to influence our story in the direction of life, recovery and love for ourselves and our fellow humans.  All the chapters have yet to be written to this story.  It is important to realise how much we can contribute to how these chapters will be recorded, so that when we read our story 20 years from now, we can look back with some satisfaction that we did all that was asked of us, and that we were capable of, at the time.

Authors

Dr. Declan Aherne, Oakwood, Limerick

Dr. Cian Aherne, Oakwood, Limerick. Email  cianaherne@gmail.com

 

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References

  1. Johnstone, L. & Boyle, M. with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D. & Read, J. (2018). The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society. Available from https://www.bps.org.uk/news-and-policy/introducing-power-threat-meaning-framework
  2. Donner, B. (2019). Clinical Psychology Forum. Special Issue: The Power Threat Meaning Framework (Vol. 313). Available from https://shop.bps.org.uk/publications/journals-and-periodicals/clinical-psychology-forum-no-313-january-2018.html
  3. Wilkinson, R., & Pickett, K. (2010). The spirit level. Why equality is better for everyone.
  4. Smail, D. J. (2005). Power, interest and psychology: Elements of a social materialist understanding of distress. PCCS books.
  5. Daley, P. (2020). We face a pandemic of mental health disorders. Those who do it hardest need our support. The Guardian, March24.
  6. Watts, A. (2017). Psychotherapy east & west. New World Library.
  7. Frankl, V. E. (1985). Man’s search for meaning. Simon and Schuster.
  8. Herman, J. L. (2015). Trauma and recovery: The aftermath of violence–from domestic abuse to political terror. Hachette UK.
  9. Ó’Murchú, D. (1998). Reclaiming Spirituality: A New Spiritual Framework for Today’s World. Crossroad.