For decades, mental health challenges like low mood, paralyzing anxiety, intrusive thoughts, or malicious voices have been framed as medical problems. They are viewed as symptoms of diagnosable disorders, much like diabetes or cancer.

Extreme sadness might earn a diagnosis of depression, treated with antidepressants or therapy. Overwhelming anxiety might be labeled as panic disorder or generalized anxiety disorder. Hearing harsh voices could signal schizophrenia or schizoaffective disorder.

In the 1990s—the so-called “decade of the brain”—hopes were high that science would soon uncover the biological causes of these disorders. Many believed the biomedical perspective would lift the terrible stigma and shame surrounding mental health issues.

Yet such knowledge remains elusive. There’s still no definitive test—a blood test, brain scan, or genetic marker—to confirm a psychiatric diagnosis. Studies claiming to pinpoint the biological basis of disorders like depression and schizophrenia have proven difficult to replicate.

Even more troubling, emerging research suggests that the biomedical view might amplify stigma rather than reduce it. Framing mental health challenges as biological “defects” risks portraying those who suffer as inherently broken.

Maybe it’s time to consider a radical alternative. Instead of seeing these experiences as signs of broken biology, what if we understood them as meaningful responses to life’s crises?

A New Vision: The Power Threat Meaning Framework (PTMF)

In 2018, the British Psychological Society introduced the Power Threat Meaning Framework (PTMF), developed collaboratively by mental health professionals and service users. In the PTMF, emotional distress, even in extreme forms, is seen as a meaningful response to the problems of life, rather than a medical disorder to be diagnosed and medicated.

Proponents of this approach believe that while experiences of distress are overwhelmingly real and painful, it’s less useful to give somebody a diagnosis, and more useful to help people see their problems as, ultimately, understandable in context.

In other words, instead of asking, “What’s wrong with you?” the PTMF invites us to ask, “What happened to you?”

For example, I’ve written about how depression is better seen as a meaningful response to a crisis, such as a job loss or a relationship breakup, rather than a disorder. Even symptoms of schizophrenia, such as delusions—strange thoughts like the belief that a famous actress is in love with me—can be understood as the mind’s attempt to cope with past trauma or current crisis. We now know quite a lot about how the mind can dissociate from overwhelming emotional events, which may re-appear in the form of unusual beliefs or voice-hearing.

Similarly, traits commonly labeled as personality disorders, such as those linked to borderline personality disorder, often emerge from backgrounds of neglect, abuse, or other trauma. Rather than framing these as signs of brain dysfunction, the PTMF suggests they are survival strategies developed in response to adversity.

At the heart of the framework is the idea that personal narratives can replace diagnoses. These narratives connect individual experiences of distress with broader social and relational factors, such as poverty, discrimination, and inequality. In practice, this means health professionals, patients, and family members work together to construct a narrative within which one’s symptoms can be seen as a meaningful response to a life problem.

The PTMF’s advocates believe this approach is more humanizing, more therapeutically effective, and less stigmatizing than the traditional disease model.

But a critical question remains: Can it truly help those who are suffering?

Putting PTMF to the Test

Recently, a multidisciplinary team decided to put the PTMF to the test. The project was led by Consultant Clinical Psychologist Dr. Faye Nikopaschos—recipient of the British Psychological Society’s prestigious Early Career Award—and Gail Burrell, Borough Director and Trust-Wide Perinatal Lead.

The team implemented the principles of the PTMF and trauma-informed approaches in two mental health wards in the north London area.

Over four years, they offered training in trauma-informed approaches to all staff and held weekly team meetings in which narrative understandings of patients’ problems were developed. These narratives served as a foundation for guiding intervention.

Then they tracked the results. Were patients less likely to harm themselves? Were they less likely to need restraints? Were they less likely to need seclusion?

The results exceeded everyone’s expectations. The two inpatient wards witnessed:

• 55 percent drop in self-harm
• 19 percent drop in restraint
• 28 percent drop in seclusion

Moreover, there was a significant increase in staff morale, and patients reported finding their inpatient stay more helpful.

What drove this success? The team hypothesizes that the PTMF strengthened the relationships between staff and patients, fostered greater empathy, and improved teamwork.

A second article, in press, further confirmed these findings and suggested that the key factor enabling change in both staff and patients was the introduction of a new way of thinking—a new paradigm. All other improvements followed from this foundational change.

Encouraged by these results, 13 more mental health wards and several other services across the UK are adopting these practices. Dr. Nikopaschos, Gail Burrell, and their teams are now gathering additional data to further refine their analysis. NHS England has even highlighted the project as an example of exemplary practice.

If these results hold true, the PTMF may represent a significant leap forward—offering a more compassionate, effective alternative to the traditional biomedical model.