David J. Harper

Aims: To propose that the language and concepts in public mental health are often medicalised and to suggest that the power threat meaning framework (PTMF), can be a useful resource for those wishing to take a de-medicalising approach. Method: Examples of medicalisation from the literature and from practice are discussed and key constructs in the PTMF are explained, drawing from the report which presented its research base. Results: Examples of medicalisation in public mental health include: the uncritical use of psychiatric diagnostic categories; the ‘illness like any other’ approach in anti-stigma campaigns; and the implicit privileging of biology in the biopsychosocial model. The negative operations of power in society are seen as posing threats to human needs and people make sense of such situations in varied ways, though there are some commonalities. This gives rise to culturally available and bodily enabled threat responses which serve a variety of functions. From a medicalised perspective, these responses to threat are characteristically seen as ‘symptoms’ of underlying disorders. The PTMF is both a conceptual framework and a practical tool that can be used by individuals, groups and communities. Conclusion: Consistent with social epidemiological research, prevention efforts should focus on preventing adversity rather than ‘disorders’ but the added value of the PTMF is that varied problems can be understood in an integrated manner as responses to a variety of threats whose functions could be met in different ways. Its message that mental distress is often a response to adversity is comprehensible to the public and can be communicated in an accessible way.

Although histories of cognitive behaviour therapy have begun to appear, their use with people with psychosis diagnoses has received relatively little attention. In this article, we elucidate the conditions of possibility for the emergence of cognitive behaviour therapy for psychosis (CBTp) in England between 1982 and 2002. We present an analysis of policy documents, research publications and books, participant observation, and interviews with a group of leading researchers and senior policy actors. Informed by Derksen and Beaulieu’s articulation of social technologies, we show how CBTp was developed and stabilised through the work of a variety of overlapping informal, academic, clinical, professional, and policy networks. The profession of clinical psychology played a key role in this development, successfully challenging the traditional ‘division of labour’ where psychologists focused on ‘neurosis’ and left ‘psychosis’ to psychiatry. Following Abbott's systems approach to professions, we identify a number of historical factors that created a jurisdictional vulnerability for psychiatry while strengthening the jurisdictional legitimacy of clinical psychology in providing psychological therapies to service users with psychosis diagnoses. The National Institute for Health and Clinical Excellence played a significant role in adjudicating jurisdictional legitimacy, and its 2002 schizophrenia guidelines, recommending the use of psychological therapies, marked a radical departure from the psychiatric consensus. Our analysis may be of wider interest in its focus on social technologies in a context of jurisdictional contestation. We discuss the implications of our study for the field of mental health and for the relationship between clinical psychology and psychiatry.

Over recent decades a research programme involving nonclinical samples has provided a justification for the use of normalising practices within cognitive behaviour therapy for psychosis. These studies have found that, contrary to mainstream psychiatric assumptions, beliefs considered delusional are neither rare in the general population nor qualitatively different from “nondelusional” beliefs, whilst theories from a “normal” rather than “abnormal” psychology have shown them to be intelligible rather than un-understandable. Yet the programme’s inherent limitations have meant that the potential of nonclinical research has not been fully realised. An alternative research programme is proposed which could elucidate the diversity of belief in the general population by examining the role of social norms and lived belief narratives in unconventional belief communities. This could address the limitations of the normalising programme, provide a necessary corrective to the “clinician’s illusion” bias, and prompt a more fundamental reconceptualisation of beliefs considered delusional.

English learners (ELs) in K–12 schools must acquire English while simultaneously mastering content knowledge. Educational technology may support students’ learning through the affordance of individualized language practice. The current randomized controlled trial intervention study examined the effects of Rosetta Stone Foundations software on English learning among middle school ELs. The study took place in Grades 6 to 8 of an urban U.S. school district (N = 221). Predictors of interest included time of testing (pretest vs. posttest) and software usage, and covariates included grade level, sex, and attendance. Additionally, socioeconomic status and home language were accounted for due to sample homogeneity. Multilevel models indicated that treatment group students showed larger gains than control group students on oral/aural outcomes. These results indicate that the software intervention enables individualized practice that can produce proficiency-related gains over and above the typical classroom curriculum.

Little is known about ordinary people’s understandings of conspiracy beliefs and how these understandings relate to the perspectives of researchers and scholars. Working within a social constructionist epistemological framework, we conducted a Q-methodology study aiming to identify a range of lay perspectives on two key topics: the defining features of conspiracy beliefs; and aspects considered important in judging their plausibility. Fifty-six people (32 men and 24 women), recruited via regional UK Facebook groups, sorted their agreement with a set of statements on each of the two topics. A principal component analysis, followed by varimax rotation, was performed on each data set. Five accounts about the defining features of conspiracy beliefs were identified: that they are false, illogical and harmful; that they are forms of political critique; that there are varied types; that they are entertaining but ineffectual; and that they are held by a self-reinforcing minority. Four accounts about their evaluation were identified: conventional realist criteria; the importance of personal judgment; skeptical realism; and the assessment of critical thinking. The findings are discussed in the context of the literature and limitations of the study are considered. Implications for research and educational and policy interventions are outlined.

How do mental health professionals link adverse life experiences with the kinds of beliefs and experiences which attract a diagnosis of psychosis and what implications does this have for women with these diagnoses? Drawing on a broadly critical realist framework, we present data from two studies relevant to these questions. First, we analyse the discursive practices engaged in during a staff-only discussion of a female in-patient with a psychosis diagnosis who had been raped some years previously. Staff oriented to the irrationality and factuality of her ostensibly delusional statements about rape and pregnancy in the present and formulated adverse experience as a “stress factor” triggering a manic episode, thereby precluding alternative contextualising interpretations. In a second, interview-based, study, psychiatrists drew on a range of discursive resources which differentiated “psychosis” from other forms of distress, constructed trauma as a stressor which could trigger psychosis because of a genetic predisposition, and constructed medication as the primary intervention whilst trauma was de-emphasised. We discuss the implications of these findings for the kinds of explanations and forms of help offered and suggest ways in which distress might be contextualised as well as possible future directions for feminist research and practice.

This article describes how the narrative construct is used in the Power Threat Meaning Framework to refer to personal narratives, cultural narratives and as a meta-theoretical language, synthesizing a range of different theoretical perspectives. It identifies ways in which this approach to narrative may differ from its use in a number of therapeutic traditions. Focusing on medicalization and drawing on the concepts of ideological power, framing, filtering and gatekeeping, it discusses the processes which facilitate the dominance of a medical frame in the public conversation about mental health, proposing that such dominance is an example of hermeneutical injustice. The article concludes, firstly, by suggesting some practices which therapists and other professionals could use to broaden and contextualize therapy conversations and, secondly, by making some proposals for how the public conversation about mental health could be re-balanced.

The Power Threat Meaning Framework (PTMF), published by the British Psychological Society (BPS) in 2018, is an attempt to address the question of how we might understand problems in living other than by using psychiatric diagnostic systems. How might we best conceptualize emotional distress and behavior which might concern or trouble others? We describe the context within which the PTMF was developed and explain some of its key elements before giving an overview of the articles in this special issue.

Objectives: Recent studies have suggested that students may experience high levels of paranoia. This study aimed to explore both experiences of paranoia and coping strategies in students scoring at high levels on a measure of paranoia. Design: This was a qualitative study which utilized a quantitative measure to identify potential participants. Methods: From an overall sample of 174 London‐based university students in the United Kingdom, a sub‐sample of 31 students with the highest total scores on the Green et al. Paranoid Thoughts Scale were invited to interview resulting in interviews with seven students (six female and one male) aged between 20 and 36 ( M  = 28.14). A thematic analysis of the interview transcripts was conducted from a critical realist standpoint. Results: Two key foci structured the analysis: perceived causal influences on paranoia (comprised of ‘historical contexts fostering mistrust’; ‘finding a social situation strange’; ‘anticipating threat’; and ‘evaluating the concern’) and living with paranoia (comprised of ‘effects on everyday life’ and ‘trying to minimize the effects of paranoia and regaining control’). Conclusions: Key aspects of the findings discussed in the context of the literature include paranoia as a threat heuristic; the role of internal and external dialogues; the influence of gender on content; and the importance of meaning in life as a coping resource. Practitioner points: Paranoia may be a significant issue for some students. Paranoia needs to be seen in the context of past aversive experiences. Dialogical approaches may be useful in developing new therapeutic narratives. Valued social roles, activities, and responsibilities may be an important coping resource.