Representations of power, threat and meaning in individual accounts of psychosis: A meta-ethnography of psychosis narratives

Despite the wealth of evidence linking adverse experiences and “psychosis,” biomedical explanations of distress still represent the dominant narrative within UK mental health services. The Power Threat Meaning Framework (PTMF) offers a conceptual alternative to this position and, in doing so, considers the experience of emotional distress, and its associated behaviors, as a response to adverse life experiences. While the application of the PTMF to experiences of psychosis appears to be both logical and insightful, the extent to which overarching PTMF concepts are represented in people’s subjective experiences of psychosis is less clear. The aims of this review were to explore the perceived role of adversity in psychosis, to understand the extent that concepts of power, threat and meaning were represented in depictions of psychosis and to investigate the types of strengths and opportunities that contributed to individual survival and recovery. A systematic literature search and meta-ethnographic synthesis of narrative studies focusing on people’s subjective experience of psychosis was undertaken. Six overarching constructs were developed (third-order constructs) from 33 underlying researcher-interpreted themes (second-order constructs) identified within the research. The findings provide further supporting evidence for the role of adversity in psychosis and the importance that meaning-making and re-storying one’s experience plays in recovery.