From ‘What’s Wrong with You?’ to ‘What’s Happened to You?’: an Introduction to the Special Issue on the Power Threat Meaning Framework

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 what Harry Stack Sullivan called ‘problems in living’ other than by using psychiatric diagnostic systems. How might we best conceptualize emotional distress and behaviour 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

Affective normativity and the status quo

Affective normativity and the status qu

Fundamental questions for psychology

This paper argues that the mainstream of psychology is misconceived in ways which make it largely unsuitable as a basis for clinical interventions. Why do we need a new way of thinking about work with distressed individuals? What is wrong with the many different styles of therapy and intervention already in use

Reconstructing the person

This paper proposes that feelings, rather than cognitions or behaviours, are the core stuff of human experience and should provide the starting point for clinical understandings. So far in this special issue, we’ve suggested in various ways that cognition and it’s alternatives, narrative and discourse, are not primary in human experience. But what is

Depression: embodying social inequality

A critical realist social constructionist account of depression that attempts to thoroughly take account of embodiment, materiality and power by drawing on various resources, including neuroscience

Diagnosis special issue - Introduction: Moving beyond diagnosis: Practising what we preach

John Cromby, Dave Harper and Paula Reavey introduce the special issue

Embodying psychology through neuroscience: conceptual and political issues

For the most part psychology is disembodied, the processes and mechanisms it proposes as capable of being enabled by silicon and wire as by flesh and blood. This disembodiment means that analyses tend to grant unwarranted primacy to the cognitive realm, the realm of conscious thought and discourse. As a result, much of psychology lends itself to idealism, voluntarism and a notion of the subject as more-or-less transcendent, bounded, insightful, consistent and controlling. By contrast, in sociology, social theory, anthropology and other social sciences there has in recent years been a renewed interest in notions of embodiment, an interest that may currently be mutating into a focus on affect, emotion and feeling. These are topics on which neuroscience has much to say – indeed, the subdiscipline of affective neuroscience is concerned primarily with these aspects of our experience

Paranoia: a social account

Both psychology and psychiatry are dominated by individualistic accounts of paranoia (and indeed, other forms of distress). As a corrective to these, this paper provides a social account of paranoia grounded in a minimal notion of embodied subjectivity constituted from the interpenetration of feelings, perception and discourse. Paranoia is conceptualised as a mode or tendency within embodied subjectivity, co-constituted in the dialectical associations between subjectivity and relational, social and material influences. Relevant psychiatric and psychological literature is briefly reviewed; relational, social structural and material influences upon paranoia are described; and some implications of this account for research and intervention are highlighted

Paranoia: contested and contextualised

In this chapter we discuss how paranoia might best be conceptualised and responded to. By paranoia we mean experiences of perceiving and relating to others that are characterised by suspicion, mistrust or hostility. Whilst such experiences are common in the general population, amongst people who receive clinical interventions they often include complex, self-insulating belief systems, distorted perceptions and marked distress. In psychiatry these experiences are usually associated with diagnoses of schizophrenia, delusional disorder and paranoid personality disorder. The problems with the reliability and validity of these diagnostic categories are well known (Bentall, 2004; Boyle, 2002; Pilgrim, 2001). One alternative approach is to focus on specific problematic experiences and behaviours (Boyle, 2002) or ‘complaints’ (Bentall (2004) rather than heterogeneous diagnostic categories. Doing so addresses the problem of heterogeneity – but how might we then conceptualise these experiences? Drawing on a discussion of Bleuler’s notion of schizophrenia, we present an approach to paranoia that considers both its social context and its embodied character. We then investigate the notion of ‘distress’. Given the well-established finding that many people have experiences similar in content to those of mental health service users but without any accompanying distress, we discuss the importance of context in the generation of distress – in particular how it may arise because of a lack of ‘fit’ in the way they negotiate their beliefs and unusual experiences with their social world. Finally, we discuss how one might offer help or support differently in relation to paranoia

Paranoia and social inequality

How might we make sense of the findings of epidemiological research showing the effects of social inequalities without accepting the validity of problematic diagnostic categories used by psychiatric epidemiologists (Rogers & Pilgrim, 2003)? How might we make sense of processes happening at a community and systemic level without neglecting individual experience? How should we conceptualise experiences which are embodied (i.e. felt and transmitted through our biological systems) without falling prey to dualistic or biologically reductionist thinking? In this article, we hope to examine the links between social inequality and paranoia without falling into such traps. We use the term 'paranoia' broadly. Although single symptom research into psychosis has made great strides (e.g. Bentall, 2004) we feel there is benefit to be gained from taking the experience of paranoia as a starting point rather than beginning with an unnecessarily narrow operational definition of, for example, the diagnostic criteria for persecutory delusions. Paranoia, of course, is well-represented in psychiatric diagnostic categories (e.g. paranoid schizophrenia, delusional and personality disorders) and is in some measure a feature of many people’s everyday lives. However, focusing on such categories assumes that the differences between them are both valid and more important than the commonalities in the experiences they represent. Accordingly, we begin by presenting a brief critique of psychiatric thinking about paranoia, followed by a re-theorization that focuses on the social and material constitution of experience through feelings. We end by outlining some implications for intervention