Thread by @drlouisehansen

Power Threat Meaning Framework: This thread lets Australians see what a trauma informed response to sexual abuse or rape inherent in power structures looks like. This thread might trigger you. If it does please call Lifeline on 131114, or for any emergency, call 000. 1/36 #Auspol

Psychology’s been rightly criticised for ignoring for the social context of mental health difficulties and over focusing on individualised diagnoses of mental illness. Despite decades of research on connections between social inequalities and mental health difficulties. 2/36

‘Symptoms of inequality’ continue to be pathologised as ‘symptoms of mental illness’. This obscuring of inequalities continues to locate pathology within the individual. Some have argued that the psychiatric diagnosis systematically pathologises 3/36

women’s rightful and reasonable responses to unreasonable events occurring in oppressive, dangerous and damaging social contexts. This hides/denies the gendered, racist, classist, homophobic intersecting hierarchies of power that shape women’s experience/pervade inner life. 4/36

Extensive research over the last four decades identified sexual violence and abuse as major causal factors in women’s mental health distress. Sexual violence and abuse are significantly connected with women’s mental health difficulties across all ‘diagnoses’. 5/36

Diagnoses: ‘depression’ including post natal depression; self harm and suicidality; borderline personality disorder/bipolar disorder/emotionally unstable personality disorder; hearing voices and psychosis; substance abuse; PTSD, eating difficulties;
phobias and OCD. 6/36

The Power Threat Meaning Framework is a trauma informed approach drawn from broad psychological theory bases. It brings together understanding of external structural inequalities with internal processes of personal experience. It is the way in which ‘the outside gets in’. 7/36

The Power Threat Meaning Framework locates power centrally in understanding distress. The negative operation of “power” (i.e. a family member, educator, employer, the government, religious institution), triggers the “threat system” and fight, run, freeze or collapse occurs. 8/36

The person abused then makes “meaning” of this event(s) (i.e. “Others are out to get me.”, “It was my fault.”, “I’m a bad person.”, “The world is unsafe.”). Trauma is when these meanings and threat responses continue after the event(s) and even in the absence of danger. 9/36

The Power Threat Meaning Framework asks: ‘What has happened to you?’ (How is ‘Power’ operating in your life?), ‘How did it affect you?’
(What kind of ‘Threats’ does this pose?), ‘What sense did you make of it?’(What is the ‘Meaning’ of these experiences to you?), 10/36

‘What did you have to do to survive?’ (What kinds of ‘Threat Response’ are you using?). The Power Threat Meaning Framework also asks: What are your strengths? What access to Power resources do you have? What is your story? 11/36

The Power Threat Meaning Framework also names the key sources of Power: Power by force or Coercive power - use of violence, sexual violence, aggression or threats to frighten, intimidate, ensure compliance and to silence. 12/36

Interpersonal power - power within close relationships, the power to look after/not protect, to leave, to give/withdraw/withhold affection. Economic and material power - means to obtain valued possessions and services, to control others’ access to resources, 13/36

Legal power coercion, or rules/ sanctions supporting/limiting other aspects of power, offering or restricting choices. Ideological power - control of language, meaning, and perspective, to identify ‘subordinate’ groups on basis of class, race, gender sexual orientation. 14/36

Biological or embodied power - the possession of socially valued embodied attributes eg: physical attractiveness, fertility, strength, physical health. 15/36

Social/cultural capital – a mix of valued qualifications, knowledge and connections, often related to class, race and gender, which advantages some social groups and can be passed directly/indirectly to the next generation. 16/36

Power: ‘What has happened to you?’ Sexual assault or rape, threat to life and survival, profound threat to and contamination of self and identity, severe physical damage from repeated abuse 17/36

severe pain, chronic health difficulties from physical damage, overwhelming distress of terror, shame, sadness, loss, anger, disrupted traumatised attachments, abandonment, betrayal, entrapment in dangerous, damaging contexts, denigration, 18/36

Meaning: How did you understand what happened to you? Self blame: ’I should’ve stopped it/told someone’; Self hate: ‘my body’s bad/I am bad/evil’; Self as different: ‘I’m not like others/not normal’; Profound shame, defiled identity, racial identity, sexual identity; 19/36

Self as deserving abuse as punishment: not deserving love or care; Defeated: powerless to stop abuse or escape, world and people are not safe, dangerous. 20/36

Example: “I blamed myself, blamed my body, felt shamed, felt contaminated, told I was evil, bad, told I deserved it, felt abnormal, people are not safe, world is not safe, cant tell anyone.” 21/36

Threat Response: How did you survive these power abuses? Use alcohol/drugs to numb feelings, self harm to numb/punish self, dissociate: disappear become numb, eat/not eat to numb distress/punish self, try not to remember, became fearful and are untrusting of others, 22/36

hear voices, avoided relationships, comforting others, tried to find safety in attacking relationships, watchful, struggled to manage, hyper vigilant, overwhelming distress, experience of terror, shame, flashbacks, loss, anger, confusion nightmares, re-living abuse. 23/36

For the Power Threat Meaning Framework these mental health ‘symptoms’ are survival strategies and sources of strength and resilience: ways of managing/anaesthetising emotional pain, shame, violation, ways of self care, self comforting, soothing, 24/36

distraction from intrusive memories, re-living, nightmares, ways of forgetting, dissociating, as self blame/self punishment, ways of trying to protect against attachment loss, self silencing, ways of speaking directly or indirectly about damage experienced. 25/36

They’re all ways of trying to protect from danger. The courage of survivors of sexual/physical abuse is no different to the courage of war veterans; complex responses no less. They’ve the right to be acknowledged for their strength, courage, resourcefulness and resilience. 26/36

What are your strengths? I survived. I am still alive. I am in a safe place to live. I have friends I trust. I don’t harm others. I’m a role model for others impacted by this. I’m an advocate for social change. I have hope. 27/36

There are multiple levels of interventions for recovery and re/empowerment. Increasing safety: safe accommodation, police protection, legal action; increasing access to power resources; increasing survival strategies; 28/36

trauma processing using trauma therapies: individual and group therapy; increased access to group/community strength; social and political change.

Trauma therapies pay special attention to power processes. 29/36

How is the Power Threat Meaning Framework more helpful for survivors of sexual abuse or rape than simply focusing on individualised psychiatric diagnosis? It examines the social context of mental health difficulties over individual isolated accounts of distress. 30/36

The Power Threat Meaning Framework names the power and power abuses involved in sexual violence and abuse; offers an understanding of power and power processes; links these directly to understanding symptoms of distress, 31/36

enables a gendered, race and intersectional lens to be added to understand the multiple oppressions women experience; views symptoms as strategies of resilience and survival; recommends multiple levels of intervention to enable healing, recovery and re/empowerment; 32/36

focusing on power and power abuses can reduce the risk of continuing the denigratory misdiagnosis of women survivors of sexual violence as ‘bipolar’, ‘psychotic’, ‘emotional unstable personality disordered’, ‘BPD’; 33/36

enables the rightful naming of profound distress from multiple power abuses; requires careful attention to intersecting power processes in understanding symptoms of distress and strategies of survival and in the process of recovery and healing; 34/36

Lastly - crucially - the Power Threat Meaning Framework looks also to change in the social context to reduce inequalities and injustice. 35/36

Source: Gilli Watson Clinical Psychologist Consultant and Trainer with thanks to Suzanne Azer Senior Lecturer Doctorate in Clinical Psychology, University of Exeter, Training Lead Exeter PPT Devon Partnership Trust (2020). Edited to be user friendly for Twitter. 36/36

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*Also 1800RESPECT is a 24/7 Domestic Violence phone/online support service.