During my training, one of my tutors said something that stuck with me. He said that feelings of mental distress, such as despair, hopelessness, or anxiety are trying to tell us something, they are trying to tell us that something isn’t right. In the same way that physical pain tells we are hurt, mental pain tells us we are hurt. But hurt how?
The underlying causes of mental distress are complex, but a basic model is the biopsychosocial. This model says that some of the causes are psychological, perhaps traumatic or difficult experiences and relationships that have led to psychological distress and pain – feelings of low self-worth for example. Some causes are social, perhaps our circumstances have caused us distress and pain, like a marriage break up, or the death of a loved one, or stress due to insecure work. Some causes are biological – where negative thoughts become our automatic reaction because neural pathways get reinforced the more they get used.
These three causes will be inter-related, and each person’s distress will have a unique set of complex causes – there is no model that fits everyone. However, the one thing that I believe this model can help us understand is that mental distress can be a “meaningful, functional and understandable response to life circumstances” (Johnstone, L. & Boyle, M. 2018: 5). Rather than showing you that there is something ‘wrong with you’, mental distress may be showing you that something about your circumstances or experience needs to be addressed. It should lead us not to ask ‘what is wrong with you?’, but ‘what happened/is happening to you’? ‘How did you get hurt?’
A group of clinical psychologists, led by Lucy Johnstone and Mary Boyle, published a framework for understanding mental distress in January 2018 called the Power, Threat, Meaning Framework. It takes into account the multiple factors that may be contributing to a person’s mental distress. In particular, it takes into account power. As an academic, I have spent the last 11 years trying to understand how power relations affect social change, and I have always believed that power relations affect individuals at a subjective/psychological level, I believe power relations can hurt us at this level. This framework not only acknowledges this, it develops an operational way in which this can be used by clinical psychologists, psychotherapists and counsellors.
The Framework poses four basic questions:
1. What has happened to you? (How has Power operated in your life?)
2. How did it affect you? (What kind of Threats does this pose?)
3. What sense did you make of it? (What is the Meaning of these situations and experiences to you?)
4. What did you have to do to survive? (What kinds of Threat Response are you using?)
Interestingly, exploring the answer to question 4, clients often discover that their mental distress is a kind of ‘threat response’ – it is how they are coping or surviving. For example, depression can be a form of withdrawal from a world that experience has taught you can hurt you if you put your head above the parapet. Anxiety can be a way of feeling some sort of control when experience has taught you that life can be scarily beyond your control. And it is through exploring the answers to questions 2 and 3 that clients can start to become aware of how they might find a way to respond differently to life’s circumstances, or how they might try to change those circumstances altogether if they can.
Unfortunately, some circumstances can’t be changed by the individual alone, and this is where I believe we need a wider societal response to the challenging and stressful circumstances many people find themselves in. For example, feeling anxious about having an insecure job is a perfectly reasonable threat response to life’s stressful circumstances. Rather than pathologising the anxiety, we should be focusing on making sure people can find secure work. The power relationship here, between insecure employee and their employer, is hurting the employee not just financially, but at a psychological level too. However, the power relationship is the one that needs to be changed, dealing with the psychological hurt alone isn’t dealing with the underlying cause of mental distress.
This is why I believe anyone who cares about the alleviation of mental distress has to understand how the wider circumstances of a person’s life contributes to mental distress. This isn’t something that can be dealt with only in a counselling room, it requires us to be campaigners for policy changes too that shape people’s circumstances and change power relations.