Paul R. Mc Hugh - Theoretical Orientation

Theoretical Orientation

McHugh proposes that alterations in mental life be viewed from four perspectives:

1. The perspective of disease: what is wrong with the structure of the brain itself? Depression, schizophrenia and dementia are often viewed from the disease perpective.
2. The perspective of dimension: in what way does an individual's character cause him trouble (e.g., extraversion/introversion, high IQ/low IQ)?
3. The perspective of behavior: what actions persist because they have been reinforced, or are driven by biological means? Addiction, obesity, or paraphilias are often seen from the behavior perspective.
4. The perspective of life-story: what has happened to a person which leads him to experience life as he does? Grief is often viewed from the life-story perspective.

He opposes the symptom-only system of classification presented in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (editions III, III-R, IV, and IV-TR) on the grounds that it classifies mental disorders according to observation of signs and symptoms while not addressing underlying causes.

McHugh's theoretical orientation has led him to take controversial stands on a number of current psychiatric/medical issues including post traumatic stress disorder, multiple personality disorder (MPD) or dissociative identity disorder (DID), physician assisted suicide, and sexual reassignment surgery.

McHugh argues that multiple personality disorder (MPD; now known as dissociative identity disorder ) is not, as has been maintained by some, a disorder in which a person actually has two or more distinct personalities. He further argues that MPD/DID is not "the linear consequence of child abuse" Instead, McHugh argues that MPD/DID is an artifact—a symptom or symptoms designed to garner medical attention or sympathy. Other such artifacts include conversion disorder, Briquet syndrome, and malingering.

He generally opposes sexual reassignment surgery for both children and adults. With respect to male infants (i.e., those with the XY chromosome) born with genital malformation, McHugh feels that parents should refrain from deciding to surgically alter them to appear female. Instead, he feels that these children should be allowed to mature at which point they themselves can make an informed decision about what surgery to obtain, if any. When McHugh became head of Johns Hopkins psychiatry department in 1975, he fought John Money and other founders of the school's pioneering Gender Identity Clinic to have it successfully shut down.

McHugh believes that adult males who wish to surgically alter themselves to appear anatomically female fall into two main groups: (1) "conflicted and guilt-ridden homosexual men" and (2) "heterosexual (and some bisexual) males who found intense sexual arousal in cross-dressing as females". McHugh, had several other impressions: First, "they were little changed in their psychological condition. They had much the same problems with relationships, work, and emotions as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled". Second, they expressed little interest in and seemed indifferent to babies or children (typically female interests). Third, they came off as caricatures of the opposite sex.