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March 30, 2012

The Perspectives of Psychiatry Approach to Patients

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Margaret S. Chisolm, MD

Johns Hopkins University School of Medicine, Baltimore, Maryland

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The Diagnostic and Statistical Manual of Mental Disorders (DSM), which categorizes mental conditions based on their signs and symptoms (ie, their outward appearances), has reigned as the dominant classification system for psychiatric conditions in the United States since 1980. However, with the anticipated publication of the fifth edition of the DSM in 2013, controversies are emerging regarding issues such as the proposed inclusion of certain normal human experiences like grief. In this context, an alternative approach based on The Perspectives of Psychiatry1 warrants renewed interest.

The Perspectives model was built on concepts developed by Adolf Meyer and Karl Jaspers in the early 20th century and later articulated by Paul McHugh and Phillip Slavney. Advocates of the Perspectives approach have long viewed the DSM system as fundamentally flawed and have consistently expressed concern about its negative impact on the field of psychiatry. Unlike the DSM, the Perspectives model posits that different psychiatric disorders have different natures (eg, schizophrenia and anorexia nervosa are fundamentally different in their origins). Therefore, understanding the brain will not lead to a causal understanding of all mental illness because many psychiatric disorders are not the result of a “broken” brain. The Perspectives approach to patients emphasizes the importance of taking a thorough and detailed history in order to appreciate the full context of an individual’s psychiatric distress. Patients are considered from 4 perspectives: disease, dimensional, behavior, and life story.

For about 3 decades, the Perspectives approach has been used to teach Johns Hopkins University medical students and psychiatry residents how to formulate diagnoses and treat patients with psychiatric disorders. Many peer-reviewed journal articles and book chapters have used this approach in a substantive way, but the model has not yet been widely adopted by other institutions for use in patient care or teaching. In 2011, for the first time, the Johns Hopkins University Hospital Department of Psychiatry and Behavioral Sciences was ranked #1 in the country by U.S. News & World Report. Perhaps this recognition, coupled with renewed concerns over the DSM’s classification system, will encourage other clinicians and institutions to take a look at The Perspectives of Psychiatry and consider its alternative way of thinking about psychiatric illness. Embracing the Perspectives model would be a first step toward using a more personalized and common-sense approach to the diagnosis and treatment of patients with psychiatric disorders.

Financial disclosure:Dr Chisolm had no relevant personal financial relationships to report.

Reference

1. McHugh PR, Slavney PR. The Perspectives of Psychiatry. 2nd ed. Baltimore, MD: Johns Hopkins University Press; 1998.​

Category: Mental Illness
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