As a Board Certified psychiatrist, Dr. Hankin trained at the Johns Hopkins Hospital in Baltimore, Maryland, under the Psychiatrist-in-Chief, Paul R. McHugh, M.D. The practice is based, in part, on Dr. McHugh's excellent book, Perspectives in Psychiatry. It is not a psychoanalytic practice although I do have a couch.
"Unlike many practices and clinics I do not start by prescribing drugs. The first step is to do a thorough evaluation, formulate an understanding of the problems at hand, and consider all the possible ways to meet the patient's challenges. To do this, it is important to look at the patient from the four perspectives of psychiatry, not just one or two."
The first perspective is the disease model. An expample of this is bipolar disorder formerly called "Manic Depressive Illness." This often severe condition is clearly an illness that happens to someone. The patient will be perfectly normal and then they suffer a dramatic mood change. They may shift into mania or they may slip into a deep depression. There is often no trigger in the outside world that causes this illness. It is a problem that comes from within. It often runs in families. There is a high twin concordance. It certainly will be traced to a combination of genes that code for the problem. It usually gets better with one or another medication such as lithium, lamotrigine or valproate. Other psychiatric diseases include clinical depression, panic disorder, schizophrenia, anxiety disorders, or dementia.
The second perspective is the behavioral model. People learn to act a certain way because their behavior is rewarded, either positively or negatively. One big reward is attention paid to one. Many child-rearing problems are addressed using the behavioral approach, which was espoused by Skinner. There is also inherent psychological rewards at work in the addictions, whether to alcohol, drugs or gambling. Treatment in all these areas is based on behavioral modification.
The third perspective is the life story model. It supposes that we are the way we are because of what happened to us in our lives. There is an absorbing interest in explaining life as a series of causative events, which result in logical effects. Thus Freudians postulated that potty-training methods cause some people to be obsessive compulsive. Aunt Harriet says that Junior is afraid of public speaking because he was made fun of in third grade. Life stories are compelling for patients and their families. They are an essential ingredient in getting to know the patient and making sense of their lives.
The final perspective, as taught by Dr. McHugh (and co-author, Dr. Philip Slavney), is the personality dimension. This explanation looks a person according to their several defining characteristics. Are they more optimistic versus pessimistic, more stable or unstable, or more extroverted or introverted. These are opposite extremes on either end of these three continua, and the many others that we look at when we describe a person. Know someone's traits and you have a better idea of what changes you can expect from them. As a psychiatrist, one knows better how to design a therapy.
In formulating a diagnosis and creating a plan for treatment, it is important not to limit oneself to only one or two perspectives. It is important to use all four perspectives to assess a person's problem set and to work with them on resolving their issues. For a bipolar patient, for example, even though a "disease" is at work, it is also import to look at the impact of life events, at the personilty traits that are strengths and weakness points and any behaviors that may impact their lives.
What happens on the psychoanalytic COUCH? What are the different THERAPIES?
