Cause, Fault, Norm

Thanks to the commentators for their fine work. In my brief comments I cannot address all that is raised, but can touch upon everyone’s discussion briefly.

In her commentary, Gwen Adshead reflects on her experience as a forensic psychiatrist and therapist for violent offenders. Although Adshead discusses a number of important points, I found her insight into why some vices find their way into psychiatric classification particularly compelling and thought provoking. I will here interpret these in my own terms. Dr. Adshead implies that a (perhaps) assumed folk psychology underlies our motivation to classify (as disorder) some, but not all vices. The contribution of this folk psychology does not depend on particular details, but rather, the folk psychology concerns the degree to which the vice–actor’s actions are amenable to explanation, or are transparently understandable or interpretable. We (think we) understand why prostitutes sell themselves and why tax evaders cheat; their folk psychologies are variously constituted by moralistic constructs like desperation, oppression, licentiousness, greed, opportunism, and indignation. In contrast, some offenses step outside our empathic realm: the pedophile, or the serial killer, or even the persistently acting-out child provoke onlookers to wonder, “There has to be something wrong with a person who does that!” “Loud” symptoms in themselves do not qualify; seemingly incomprehensible loud symptoms fit better into the “sick” category. Indeed, in a recent translation of Foucault’s lectures at the College de France, Foucault describes the “monster” as combining “the impossible and the forbidden.” (Foucault 1999, 56) When confronted with the impossible and forbidden, the lust for classification is irresistible.

Adshead’s wonderment about the use of “really” to question the explanation of wrongful conduct (what’s “really” going on) leads naturally to Michael First’s discussion. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV really tries to make a firm distinction between vice and mental disorder, and First describes the DSM approach.

Drawing on his experience as the DSM-IV Text Editor, Dr. First provides a particularly lucid presentation of the distinction between what I call “vice” and mental disorder. He supplies vivid examples to illustrate his points. The DSM key for distinguishing disorder from vice is whether “the deviance or conflict is a symptom of a dysfunction in the individual.” As other commentators point out later, First notes that the “vice action” (a term coined by Morse in his own commentary following) may disguise a number of possible explanations: the car thief may simply be seeking thrills and profit, or may be motivated by a delusion—leading to alternative explanations for the behavior. Sometimes the explanation for vice actions are transparent—as in the red Mustang example, but other times they are not so clear. The DSM approach requires the clinician to make an explanatory claim in order to distinguish the appearance of vice versus the appearance of disorder. I think everyone would agree that an explanation of the phenomenon is required in distinguishing vice from disorder, so that much can be accepted.

In my view, the problems with the DSM account are three: (1) The requirement for an internal psychological dysfunction is an easy claim to make for virtually any vice condition. The prostitute’s vice may be attributable to childhood trauma, deviant social learning, pathological desire to sexually control others, and so on. The tax evader may in turn have a pathological resentment of authority combined with a desperate financial situation and a pathological denial and avoidance of paying taxes. Every misbehavior has its psychology, and if we proclaim this psychology is abnormal or deviant, then we have an “internal dysfunction.” Indeed, it is easy to proclaim a psychology as abnormal if it is less than an ideal response to circumstances, or even an adequate response to circumstances; after all, not everyone who is exposed to sexual trauma becomes a prostitute nor does every financially desperate individual cheat on taxes. The DSM’s overinclusiveness on this account defaults to an arbitrariness about what counts as a legitimate (or not) internal dysfunction. Here there will be great argument.

(2) First (and later, Wells) admits there...