vice, conduct, culpability, mental disorder
Dr. John sadler’s interesting paper raises an important issue. It defines vice as criminal, wrongful or immoral behavior. He claims that the Diagnostic and Statistical Manual of Mental Disorders (DSM) “confounds the concepts of vice and mental illness” and that this confounding has “important implications . . . for the relationship between crime, criminality, wrongful conduct, and mental illness.” The paper correctly notes that disorders for which vice is the primary criterion tend to be impoverished diagnostically and are probably less valid than non–vice-related disorders. Dr. Sadler wonders if the subjects of his case studies are “involved in sick behavior, immoral behavior, both, neither, or some other metaphysical kind altogether.” This is an excellent question that this comment will seek to clarify. It will also consider the moral and legal implications of the answer.
The domain of immoral, wrongful, and criminal behavior is essentially action. Some moral and religious traditions evaluate the content of an agent’s thoughts, desires, and character, but the dominant view is that vice primarily describes action that is wrongful because it violates the rights of others or it is wrong in itself. The rules of morality and law create value, but their essential task is to guide the action of agents who must live together. Dr. Sadler does not explicitly recognize that the diagnostic criteria that are vice are all actions, and not simply abnormal perceptions, desires, thoughts, or moods. His three case studies of conduct disorder, factitious disorder, and paraphilia confirm this point. Even pedophilia, which can be diagnosed simply on the basis of urges or fantasies that cause marked distress or interpersonal difficulty, would not be considered a vice unless the agent acted on these sexual urges. Those individual actions that meet Dr. Sadler’s criteria for vice I will term “vice actions.”
Actions, including vice actions, may be evaluated medically and morally. There is no logical or conceptual reason why the same action cannot be both a sign of mental disorder and wrongful and potentially blameworthy. Actions can be just mad, just bad, or mad and bad. Also, the same action may sometimes be a sign of disorder and sometimes not. No general argument suggesting the contrary is provided. Consequently, there is no confound between the concepts of vice and mental disorder unless vice actions fail to satisfy the generic criteria for being a sign of mental disorder. Dr. Sadler seems to implicitly recognize [End Page 47] this when he asks whether vice–mental disorder relationship criteria are impoverished because there is a lack of consensus about “the minimum requirements for an acceptable set of descriptive criteria for a mental disorder category,” or when he asks “where criminal syndromes . . . fit into a classification of mental disorders.”
No consensual, generic definition of mental disorder exists, and deciding whether actions should be signs of mental disorder is particularly fraught because cultural context and values always play a role in the definition of mental disorder. The other potential signs and symptoms of mental disorder are virtually all phenomena that simply happen to people and are not products of agency. Actions are by definition the product of agency, however, and vice actions affect by definition the rights and interests of others. The latter is true whether or not the agent is “vicious.” Even if an agent who has done wrong is excused, the rights of the victim have been violated.
Moral, political, and legal evaluation is largely beside the point for non-action signs and symptoms, but it is always on point for vice actions. This is the primary potential source of the confound between vice and disorder. To claim that a vice action is a sign of disorder because it is vice begs the question and is indeed a confound. Even the presence of a biological marker will not save this claim. All human action presumably has biological markers and one cannot say that a marker is of a disorder without first having an independent definition of disorder that the vice action satisfies.
Until a robust theory of mental disorder is provided, we cannot determine whether a vice action is...