Framing, Filtering and Hermeneutical Injustice in the Public Conversation about Mental Health

Abstract

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 metatheoretical 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. Approach to narrative in the Power Threat Meaning FrameworkThis special issue includes an article on each of the two aspects in the 'Meaning and narrative' chapter of the main Power Threat Meaning Framework (PTMF) document (Johnstone & Boyle, 2018). John Cromby's article (this issue) discusses the different facets of meaning: language; feeling; culture; materiality; habit; and memory. The present article focuses on one of the most pervasive sources of linguistic meaningnarrative.

“I found hundreds of other people…but I still wasn’t believed” – An exploratory study on lived experiences of antipsychotic withdrawal

“…However, it should be noted that anecdotal reports of antidepressant withdrawal effects are eventually becoming internationally recognized, and the recent calls for antipsychotics to be included in NICE guidelines on medications associated with dependence suggest that the same evolution may be underway in the UK (Anderson & Herxheimer, 2013;Iacobucci, 2019;Timms, 2020). In the current study complaints of difficulties withdrawing from antipsychotics had been re-conceptualized as the re-emergence of mental illness, which can be argued to be representative of hermeneutical injustice stemming from deficient collective understanding of social experiences of another (Harper, 2020). Overall, users' personal experiences are all too often overlooked due to the perception that subjectivity results in unreliability (Greenhalgh et al, 2015).…”

The Lost Social Context of Recovery Psychiatrization of a Social Process

“…Different research traditions have developed looking at peoples' recovery in context such as enabling places (Duff, 2012 ), post asylum landscapes (Högström, 2018 ), assemblage (Larsen et al, 2021 ), and relational (Price-Robertson, 2017). The centrality of civil rights and of social injustice has been stressed in different studies (Harper, 2020 ; Reis et al, 2022 ; Zeira, 2022 ).…”

A primer for clinicians on alternatives to the Diagnostic and Statistical Manual of Mental Disorders.

“…However, the PTMF acknowledges the factual constraints that life circumstances impose upon the meanings that people can create (Johnstone & Boyle, 2018b). Narratives are products of social interactions (Harper, 2020). By reintroducing clients’ reactions back into their social contexts, the PTMF does not construe mental distress as an exclusively individual problem remedied via health care; instead, it shifts toward emphasizing larger societal solutions (Johnstone & Boyle, 2018b).…”

“…Second, if we accept the premise that many of the presenting problems that other diagnostic schemes view as mental illnesses are better understood as due to social factors, then should such problems continue to fall under the purview of health care providers and be paid for by insurance companies as reimbursable medical services? Further, is it reasonable to expect clients who are in acute distress to be up to the task of questioning the foundations of mainstream diagnostic practices and engage in narrative analysis of how power and threat have led them to their current situation (Harper, 2020)? The PTMF offers an important social corrective to medicalized approaches to human distress.…”