The Hopkins Psychiatry Approach to Patients

by Academy of Clinical Excellence on July 26, 2011

This year, for the first time ever, the Department of Psychiatry and Behavioral Sciences has been ranked #1 in the country by U.S. News & World Report.To appreciate why this is such an important achievement for our department, a little historical context is needed.

Since 1980, the Diagnostic and Statistical Manual (DSM), which categorizes mental conditions based on their outward appearances – the signs and symptoms they produce – has reigned as the dominant classificatory system for psychiatric conditions in the U.S.Since 1980, Hopkins Psychiatry has steadfastly viewed the DSM system as fundamentally flawed and has consistently expressed concern about its negative impact on the field.Hopkins Psychiatry has strongly advocated for the clinical utility of an alternative approach built on concepts developed by Adolf Meyer and Karl Jaspers in the early 20th century (and later articulated by Paul McHugh and Phillip Slavney in The Perspectives of Psychiatry (1).

The Hopkins Psychiatry, or Perspectives, approach presumes that different psychiatric disorders have different natures (e.g., schizophrenia and anorexia nervosa are fundamentally different in their origins) and stresses that understanding the brain will not lead to a causal understanding of all mental illness since many psychiatric disorders are not the result of a broken brain. This approach emphasizes the importance of taking a thorough and detailed history in order to appreciate the full context of an individual’s psychiatric distress.For over three decades, the Perspectives approach has been used to teach Hopkins medical students and residents how to formulate and treat patients with psychiatric disorders.Over 100 peer-reviewed journal articles and book chapters have used this approach in a substantive way, however it has not yet been widely adopted by other institutions for use in patient care or teaching.This recognition by U.S. News & World Report helps us move U.S. psychiatry towards a more personalized and systematic approach for the diagnosis and treatment of our patients


[1] McHugh PR, Slavney PR. The perspectives of psychiatry: Johns Hopkins University Press Baltimore, MD; 1998.

Margaret S. Chisolm, MD
Assistant Professor
Department of Psychiatry and Behavioral Sciences
Johns Hopkins University School of Medicine


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