I love to be jolted out of the way I see the world. To be given a new lens through which to look at things in the hope of discovering new patterns in the way the world works. I believe that the Power Threat Meaning Framework, the PTMF, offers a useful new way to look at stuttering, and in particular the mental distress and troubling behaviours associated with it. The PTMF was launched in the United Kingdom in 2018 as an alternative framework for psychiatric and psychological diagnosis. It gives voice to what we know deep inside – that the ‘problem’ of stuttering lies not in us, but in the fact that we live in societies in which disfluency is seen as a deficit and we are being constantly reminded of it.
What is it like to stutter? Consider this:
I thought I was a ‘normal’ kid. The world was wonderful. I had friends, I was excited to go to school each day. I was eight years old.
Then, the most terrible thing happened. Standing in front of my classmates – all the friends I had in the world – my mouth opened and closed, and nothing came out. F-f-f-f-forcing out w-w-w-words, my face contorting, I was filled with shame and terror as I suddenly realised I couldn’t speak like the other kids. I went home in tears, inconsolable. Turns out I wasn’t like everyone else and it seemed I was the only one cursed in this way.
I withdrew into myself. Despite being as smart as anyone in the class, I rarely put my hand up to answer a question. I felt shame and terror every time I was made to stand in front of the class and read something out. I had more sick days than anyone else in my class. I felt like the ugliest person in the world.
I was now nine years old.
My stutter grew in my mind. At times it seemed to be the only thing I thought about. I reached adulthood and never told jokes because they require … timing. I never told stories because they put me at the centre of attention and required an ending. I had much to say but often stood by silently, watching and listening, as the people around me stated their opinions, engaged in conversation, gossiped, traded light-hearted insults – in short, did all the amazing things that language makes possible; all those things that allow a person to stake a claim to their rightful place in the social hierarchy that surrounds them. What started out as a simple neurophysiological glitch that affected the co-ordination of my mouth, tongue, vocal cords, and breathing became a full-blown pyschosocial condition that affected just about everything I did.
What followed was three decades of being vigilant, making sure I didn’t slip up in public. Three decades of choosing my words carefully and not taking up social space. Three decades of avoiding employment that I thought would require too much talking. In restaurants I ordered the meal I could say rather than the dish I wanted to eat. I suffered panic attacks, an anxiety disorder, intermittent mild depression, insomnia. I didn’t give a speech on the day I got married.
Though I stuttered from the time I could talk, the psychosocial aspects of stuttering began when I was eight, when my sense of self was still forming, when crucial connections were taking place in my brain. It was a trauma that played out daily, for decades.
Research confirms that mental distress is closely associated with stuttering. And why wouldn’t it be, for a social species like Homo sapiens, for whom whole cultures are built around the notion of ‘saving face’ and an emphasis on status, reputation, personal mastery, and honour? To not be able to speak feels like a constant existential threat.
And this is where the PTMF comes into play. In simple terms, the PTMF is based on the idea that mental distress operates largely from the outside in, not from the inside out. This honours the sense we have that mental distress has causes and meanings; it has context. The PTMF works on the assumption that everyone’s experience makes sense; their mental distress is an understandable response to the circumstances they find themselves in. It has been applied to thinking about the understanding and treatment of mental distress among various groups including prisoners, mental health support groups, survivors of domestic violence, and people experiencing grief.
Under the PTMF, mental distress is an understandable effect of exposure to a perceived threat, with this threat stemming from a perceived or actual lack of power experienced by the distressed person. Both the power differential and threat are understood by the individual through the lens of narrative and meaning making, often in ways that consolidate or even amplify the threat. Mental distress is understood as a predictable, normal response by the body and mind to the threat associated with a feeling of powerlessness, and the stories the world tells about us, and that we tell about ourselves, can increase or decrease this distress.
The message for the person who stutters from the PTMF is this: ‘You are experiencing an understandable and indeed adaptive reaction to threats and difficulties. Many others in the same circumstances have felt the same [and would react the same way you have]’ (Johnstone, 2022, p. 23).
The PTMF explicitly makes a connection between mental distress and social justice, for it understands that circumstances and context are at the root of mental distress and must be tackled if the distress is to be alleviated. In contrast to traditional psychiatric concerns which revolve around the question ‘What is wrong with you?’, the PTMF operates according to the following key questions:
‘What has happened to you?’
‘How did it affect you?’
‘What sense did you make of it?’
‘What did you have to do to survive?’ (Johnstone & Boyle, 2018, p. 190).
In a presentation I gave at STAMMAfest in Nottingham in 2024, I discussed these one by one, showing the remarkable relevance that the PTMF has for understanding the causes of the mental distress of stuttering. For instance, the threat of stuttering (‘How did it affect you?’) is entangled with the common feeling for the person who stutters that when they stutter something of their core, their essence, is on show: an essence that societal narratives have judged to be synonymous with lack and clumsiness or, even worse, cowardice and fear. This is a deeply unpleasant experience and can happen many times each day. For me at least, it felt like I was being turned inside out every time I stuttered, so that everyone could see my feelings, the thing I feared, the thing which could bring me undone.
The PTMF suggests very interesting and useful areas of research and ways forward. With its commitment to seeing humans as ‘active, purposeful agents, creating meaning and making choices in their lives’ (Johnstone & Boyle, 2018, p. 6), the PTMF has ramifications not only for speech and language therapy but for social justice and activism also.
Know this – if you have experienced distress as a result of stuttering, you are not alone. It’s no reflection on you as a person; on the contrary, it is a reflection on the premium placed on verbal dexterity, on fluency, by societies and cultures throughout the world.
By Cameron Raynes
University of South Australia
Cameron Raynes has a PhD on the moral subtext of Aboriginal oral history and teaches Aboriginal history and creative writing at the University of South Australia. His exploration of the removal of Aboriginal children from their families in South Australia in the mid-20th century was published in 2009 as The Last Protector (Wakefield Press). Cameron also writes fiction and his debut novel, First Person Shooter (MidnightSun Publishing), explored courage, adolescent love, and the experience of growing up with a stutter in a small country town. It was shortlisted for the national Adelaide Festival Awards for YA fiction in 2018.
References
Johnstone, L. & Boyle, M. (with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D. & Read, J.) (2018) The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society. [www.bps.org.uk/PTM-Main]
Johnstone, L. (2022) ‘General Patterns in the Power Threat Meaning Framework – Principles and Practice’, Journal of Constructivist Psychology, vol. 35, no. 1, pp. 16-26.
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