- Affective Dysfunction and the Cluster B Personality Disorders
medicalization of morals, lack of empathy, homosexuality, Cluster A Personality Disorders, moral responsibility
We are grateful for the opportunity to respond to the insightful commentaries of Professor Nancy Nyquist Potter and James Southworth. We begin by addressing Potter’s concerns with the ‘medicalization of morals,’ after which we turn to Southworth’s overlapping concerns with the nature of Cluster B dysfunction. We conclude with a few brief remarks regarding the moral language of the Cluster B diagnostic criteria, and the moral responsibility of the Cluster B patient.
Potter: Medicalization of Morals
Potter contends that the proposed ‘medicalization’ of the morally laden Cluster B Personality Disorders would have undesirable consequences for both science and society. In replying, we argue that whether or not this is so hinges crucially on how ‘medicalization of morals’ is understood. Given the sort of medicalization that we envisage, consequences for both science and society would arguably be desirable, decidedly so.
What Does It Mean to “Medicalize Morals”?
Potter draws on John Sadler’s (2005) conceptualization of medicalization, according to which medicalizing a phenomenon involves “constrain[ing] it with medical instead of other, usually social, meanings” (Potter 2013, 217). The implication is that any such medicalization would be inappropriate insofar as the phenomenon being medicalized is, in fact, more appropriately understood as social (or moral) in nature.
We question the suggestion that “Moral Disorder” (Reimer 2013) advocates “medicalization of morals” construed à la Sadler. For we believe that the medicalization advocated therein is enlightening rather than constraining, because the phenomena in question, the Cluster B Personality Disorders, are in fact medical rather than moral/social in nature—the patently moral language of their diagnostic criteria notwithstanding. We elaborate on this idea throughout our responses to both Potter and Southworth, tentatively conceding [End Page 225] with Potter that (irreducibly) moral concepts may nevertheless be necessary for a thorough understanding of a genuinely medical phenomenon currently (and naturally) conceptualized largely in terms of moral/social deviance.
Undesirable for Science?
According to Potter, the “medicalization of morals” (construed à la Sadler) requires that psychiatry attend to culturally relative moral/social norms, which “greatly compromises … [its] status … as scientific knowledge” (Potter 2013, 217).
We question the idea that the moral/social norms relevant to a Cluster B diagnosis are culturally relative in a way that would undercut psychiatry’s status as a scientific discipline. With the possible exception of Borderline Personality Disorder, the Cluster B disorders are defined in large part by diagnostic criteria that reflect inherentlyantisocial attitudes and behaviors: attitudes and behaviors that would undermine social order regardless of the particular norms governing the patient’s society. Thus, Antisocial Personality Disorder is characterized as involving “a pattern of disregard for, and violation of, the rights of others.” Histrionic Personality Disorder is characterized as involving “a pattern of excessive [but shallow and exaggerated] emotionality and attention seeking.” And Narcissistic Personality Disorder is characterized as involving “a pattern of grandiosity, need for admiration, and lack of empathy” (American Psychiatric Association 2000, 685).
These outwardly moral traits are suggestive of affective dysfunction: lack of empathy and/or pronounced self-centeredness, in particular. In more colloquial terms, they suggest an inability to connect, on an emotional level, with one’s fellow human beings. In this respect, the dysfunction underlying the Cluster B Personality Disorders contrasts with the dysfunction underlying the Cluster A Personality Disorders which, as Southworth notes (2013), is cognitive and perceptualin nature.
The ‘moral bads’ engendered by affective Cluster B dysfunction are arguably cross-cultural; that is, they would be regarded as morally bad in anyculture. After all, the societies wherein cultures flourish are themselves sustained through empathically driven cooperation among their collective members. This would certainly comport with the apparent universality of the empathically based (moral) values relevant to the Cluster B Personality Disorders, such as honesty (vs. deceit), remorse/guilt (vs. callous indifference) sincerity (vs. shallowness), ordinary concern (vs. reckless disregard) for the safety of others, and cooperation (vs. interpersonal exploitation). Because of the pervasiveness of these inherently prosocial values, we might think of them as ‘human values,’ thereby highlighting their apparent cultural...