Explanatory methods in psychiatry: interview with Paul McHugh, MD.

This interview with Paul McHugh, MD, delves into his Perspectives approach to psychiatry. Building on the philosophical work of forerunners such as Adolf Meyer and Karl Jaspers, the Perspectives approach identifies four explanatory methods underlying the practice of the profession: the perspectives of brain diseases, personality dimensions, motivated behaviours, and life encounters. The disease perspective describes how neurobiological injuries can disrupt the functioning of the brain, as with delirium or dementia. The dimensional perspective describes the vulnerabilities of some individuals to emotional unrest tied to aspects of the self-defining features characterising them, as with intellectual disability or personality disorders. The behaviour perspective describes problematic, habit-sustained activities that arise from the teleological features, as with anorexia nervosa or alcohol dependence. The life story perspective describes how emotional distresses is generated by the interaction of life events and the extrinsic/experiential features of mind, as with grief, post-traumatic stress disorder, or demoralisation. The Perspectives approach structures and operationalises the several elements of a psychiatric formulation, with the understanding that the approach to an individual patient requires us to take into account several different aspects of their life and state of mind in making sense of their presentation.