- Can Morally Disvalued Traits Constitute the Symptoms of a Mental Disorder?
Personality disorder, mental disorder, dysfunction, DSM
As doubt has begun to creep in regarding the medical/mental status of the Cluster B Personality Disorders, Marga Reimer’s article provides a timely and compelling defense for why they might warrant their inclusion in the DSM. The article should have us take pause and reconsider the position of mainstream American psychiatry. Owing to space limitations, I focus exclusively on Reimer’s critique of Charland’s argument from identification. I consider her direct and indirect critiques, and point out what I think are some worries with the argument. Ultimately, these worries stem from Reimer’s interpretation of the DSM’s definition of a “mental disorder.” For Reimer, an association between morally disvalued traits and negative consequences is sufficient for determining a dysfunction in the individual. I argue that such an association captures too much. It assumes that 1) the dysfunction is in the individual rather than the culture as a whole, 2) the dysfunction is medical rather than moral; and finally 3) that it is a dysfunction in the first place. I then conclude with a couple of suggestions for how this debate regarding the status of the Cluster B Personality Disorders might move forward.
According to Reimer’s direct critique, although the DSM’s definition of mental disorder needs tightening up, there is no tension in identifying conditions of mental disorder on the basis of morally disvalued traits. She rightly considers the objection that deviations from moral norms that are associated with distress, disability and death might not involve a “manifestation of a behavioral, psychological, or biological dysfunction in the individual” (Reimer 2013, 205). Instead, we might simply be dealing with a moral failing. But Reimer counters this by arguing “that association with distress, disability, death, and loss of freedom is at least suggestive of DSM ‘dysfunction in the individual’” (Reimer 2013, 206; my emphasis). It seems that a proviso has been added. There is no tension between the DSM’s definition of mental disorder and identifying conditions on the basis of moral terms so long as we have a very particular conception of what constitutes a ‘dysfunction in the individual.’ For Reimer, an association between morally disvalued traits and negative consequences is sufficient. [End Page 221]
A problem with associating symptoms of morally disvalued traits with negative consequences such as distress is that it is by no means clear when the dysfunction is in the individual and when it is in the society at large. It was not until 1973 that homosexuality was removed from the DSM and no longer considered a mental disorder. In retrospect, we are inclined to interpret such an inclusion as a cultural failing rather than a dysfunction of individuals, regardless of the distress and other negative consequences incurred by homosexuals. Looking at the present, there is no telling what moral blind spots our culture has. In this respect, consider Antisocial Personality Disorder, which is of the Cluster B grouping. The symptoms are composed of clearly reprehensible moral traits such as deceitfulness, repeated participation in illegal acts, absence of remorse, and hostile-aggressive behavior. Of course, context is everything in determining whether such acts are indeed reprehensible. Such behavior might be undertaken within a repressive political regime against injustices that the rest of us might be blind to. Rather than condemnable behavior, it could very well be commendable. In any respect, whether just or unjust, it opens the door to treating political dissidents as psychiatric patients. The history of psychiatry unfortunately reveals that this is not simply a paranoid worry, but a very troubling reality. The problem, in short, is this: although mental disorders transcend historical and cultural boundaries and are thus universal in scope, morally disvalued traits do not. To make determinations of mental disorder solely on their basis runs the risk of a kind of moral imperialism. This is one reason why the medicalization of morals is a significant worry.
Second, even if we assume that there is a dys-function in the individual, this does not entail it is a medical/mental dysfunction. Consider again the following component of...