The Perspectives Approach at Johns Hopkins Psychiatry

Why the Perspectives?

Short answer: Because sometimes a patient’s problem is not – or more than – simply a disease.

Longer answer: because the biomedical approach to medical problems, although extremely powerful, fails to guide a clinician through common scenarios such as:

  • The middle-aged man who had a heart attack and a stent placed three months ago, but has yet to lose weight, change diet, or quit smoking.
  • The adolescent with new onset diabetes who insists that she can monitor her own glucose and insulin without parental involvement, yet repeatedly is hospitalized for uncontrolled diabetes.
  • The patient who is HIV-positive and forgets to take antiviral meds whenever an emotional crisis occurs, which - for this patient - happens at least once a week.

(adapted from Dean MacKinnon Brain Mind Behavior Curriculum for Johns Hopkins Medical Students)

Clinical and Research Applications

"The 3 approaches [Perspectives approach, DSM, and biopsychosocial frameworks] can complement one another and together enable richer descriptions and deeper understanding of patients' conditions. What distinguishes the Perspectives is its comprehensive, sequential, systemic approach to understanding the nature and origin of each patient's presentation and its focus on the integrative, holistic formulation of the patient and his/her treatment plan.

The Perspectives approach also provides a useful framework for developing research hypotheses regarding the nature of different conditions listed in the DSM."

(excerpt from Peters MP et al "Beyond the DSM: The Perspectives of Psychiatry Approach to Patients" Prim Care Companion CNS Diord. 2012;14(1).)

What is the Perspectives?

The Perspectives Approach to Patient Presentation

PERSPECTIVEDiseaseDimensionalBehaviorLife Story
WHAT A PATIENT...HasIsDoesEncounters
LOGICCategorical (Disease)Quantitative (Dimensional)Teleological (Behavior)Narrative (Life Story)
Pathophysiologic processProvocationConditioned LearningSequence


Take Home Points

(adapted from Systemic Psychiatric Evaluation)