The Four Perspectives of Psychiatry

Psychiatry is a branch of medicine. It is the specialty of medical doctors who focus on problems of the mind. It is related to but separate from neurology which is the study of the brain and the nervous system. It overlaps with psychology, which is also a study of the mind. Most other mental health professionals focus almost exclusively on life events and behaviors and cannot prescribe medications. I am Dr. William H. Hankin, MD and have been practicing Psychiatry for over 20 years in Cape May County and now in Atlantic County. As I learned in my studies of psychiatry at the Johns Hopkins Hospital, psychiatrists examine four perspectives from which to view the problems of the mind.
First there is the disease perspective. This includes such problems as schizophrenia and bipolar disorder which seem to be mental diseases even though we cannot point to the actual cells that cause the symptoms. If you break your leg you can see the fracture on an X-ray. If you have an infection doctors can culture the bacteria. In mental diseases we can’t see the actual brain cells that aren’t working right. You have to make the diagnosis based on the signs and symptoms. Those depressions which have biological symptoms seem to fit the disease model very well. Schizophrenia, too, has certain characteristic patterns. These are the disorders that most commonly and best respond to medication.
Second there is the behavior perspective. In this case we assume that the mind responds to a system of rewards and punishments. People unconsciously choose to do the behaviors that are rewarded. This may be little children who learn how to have tantrums to get more attention or adults who are rewarded by feeling excitement when they gamble. With behavioral disorders, patients have learned ways of coping that are dysfunctional. They end up causing more problems than they solve. Cognitive behavioral therapy, which is practiced by both psychiatrists and other mental health professionals, is often an effective treatment for this type of problem.
Third is a dimensional perspective, that is a way of looking at the mind from the point of view of personality. Some people are more perfectionist than others, while other people are more carefree. Some people are pessimistic and look at the world darkly, while others are optimistic and see the bright side of everything. Looking at the mind from the dimensional perspective is a way of understanding how people are without trying to explain it. One can then scale back their expectations to the realm of the possible.
And fourth is the life story perspective, which is looking at the mind as the product of one’s life experiences. This is the most common way that we human beings try to explain how it is that we think and feel as we do. In everyday life we try to understand cause and effect. When we feel bad we ask ourselves what it is we’re feeling bad about. We search for some explanation as a way of understanding why we have difficulty.
Part of the job of psychiatrists is to help patients to make sense of everything. Sometimes it is true that life events are the cause of how we feel and what we think but in psychiatry we often have to go beyond that and look at all the four perspectives.
The job of a well-trained psychiatrist is to choose among these four perspectives and find the approach that offers the best solution for a particular problem. In my practice I work with people to achieve the benefit of using all four perspectives to make a treatment plan. I work together with the patient to first evaluate the causes of their distress and difficulty. I look at family history, past experiences to see where these may influence a person’s feelings and mode of coping with problems and we try to understand how personality shapes the patient’s makeup. Problem behaviors may represent faulty coping styles that may be modified. The goal in my practice is to achieve a balance among the four perspectives and find the quickest and surest path to a solution to whatever mental problem the patient may present.
Dr. William Hankin, MD is Board Certified in general psychiatry and is a Fellow of the American Psychiatric Association. For more information about this or other issues, contact Dr. Hankin at his Atlantic County office in Linwood 609-653-1400 or his Cape May County office in Cape May Court House at 609-465-4424. Or visit www.WHHMD.com.