Johns Hopkins Psychiatry Guide

The Perspectives Approach to Psychiatry

Matthew E. Peters, M.D., Margaret S. Chisolm, M.D.
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DEFINITION

  • The Perspectives approach to psychiatry was originally outlined in The Perspectives of Psychiatry written by Paul McHugh, M.D., and Phillip Slavney, M.D., in 1983 [1]. The second, and current, edition of the book was written in 1998 [2].
  • Extending beyond what is offered by the Diagnostic and Statistical Manual of Mental Disorders (DSM), the Perspectives approach presumes that different psychiatric disorders have different natures (e.g., schizophrenia and anorexia nervosa are fundamentally different in their causal origins) [3].
  • The Perspectives approach is derived from concepts developed by Adolph Meyer, M.D., and Karl Jaspers, M.D., in the early 20th century.
    • Meyer felt that psychiatric disorders could not be properly understood without considering how they emerge out of the complex lives of individual patients [4].
    • Jaspers emphasized the importance of the methods used in the formulation of a patient and the appropriateness of using multiple conceptual frameworks [5].
    • The Perspectives approach builds on Jasper’s emphasis on methodology, while retaining Meyer’s emphasis on a complete and detailed history [3].
  • The approach acknowledges what is known about biological contributions to psychiatric disease, personality, and behavior, while at the same time stressing that understanding the brain will never lead to a causal understanding of all mental illness.
    • In other words, every psychiatric disorder is not the result of a "broken part" in the brain, but may have other and/or multiple origins.
  • The Perspectives approach requires that the clinician perform more than a checklist assessment.
    • The sequential and thorough nature of this approach distinguishes it from the DSM criteria-based system.
  • The Perspectives approach differs from Engel’s biopsychosocial model [6] in that it helps the clinician bring together multiple elements in a coherent manner.
    • The Perspectives approach can be viewed as the recipe needed to bring together all the ingredients of the biopsychosocial model into integrative and rational formulations and treatment plans for individual patients [3].
  • The Perspectives approach lists as its intention "to consider and render explicit the basic patterns of thought and explanation by means of which psychiatrists arrive at diagnostic and therapeutic assertions" [2].

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Last updated: December 26, 2014