Personality Disorders: Moral or Medical?

[proteanmix]

From this article:

In a brief but original discussion, physician-philosopher Carl Elliott (1996) argued that we should hold persons with personality disorders morally responsible for their actions; he stated that "a person with a personality disorder who behaves badly ordinarily intends to behave badly, and people should generally be held accountable for what they have intended to do" (p. 70, emphasis in original). According to Elliott, a diagnosis of personality disorder is normally not sufficient for excusing a person's actions, nor do disorders or defects of character excuse. As he argued, "judgments of responsibility are essentially judgments about a connection between an agent and an action, and these types of judgments must be distinguished from questions about a person's character" (p. 58).

The central argument of this paper is that the DSM-IV personality disorders are actually comprised of two very different kinds of theoretical entities that denote two very different kinds of syndromes. Some denote genuine clinical disorders; these are the disorders in Clusters A and C. The others denote moral disorders; these are the disorders in Cluster B. The Cluster B disorders include the antisocial, borderline, histrionic, and narcissistic types. Thus, even if the Cluster B disorders are empirically valid theoretical categories, it does not necessarily follow that they are also necessarily empirically valid clinical categories.

Cluster B behaviors are traits such as manipulative, deceitful, impulsive, selfish, aggressive.

An example of a personality disorder that falls under this criteria is Narcissistic Personality Disorder with indicators such as:

1. has a grandiose sense of self-importance
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is "special" and unique
4. requires excessive admiration
5. has a sense of entitlement
6. is interpersonally exploitative
7. lacks empathy
8. is often envious of others or believes others are envious of him or her
9. shows arrogant, haughty behaviors or attitudes

These aren't empirical symptoms that someone can be tested and diagnosed like weight gain or loss, pain, sleep disturbances, etc.

So does this guy have a point or is he not enabling the way he should?

 

[cafe]

I think that, given their inability to learn via empathy/morality, the best way for people with this disorder to improve is though behavioral conditioning. Being held morally accountable and being allowed to experience the consequences of their actions is a highly effective form of behavioral conditioning and I don't think that the character-disordered should be denied what is probably the most effective and might even be the only effective treatment for their condition.

As it is, I believe they are already held legally responsible for their actions.

 

[matmos]

Dr Sam Vaknin is a self-confessed NPD sufferer. Somewhere on his site he says NPDs ar a *superior sub-species* [http://samvak.tripod.com/] of human [with a hint of irony]. I guess the reasoning would apply to PPD and APD also, given that central to these characteristics is a lack of empathy. The trait is an interesting one...

I read some research that suggests that, for example, a common anatomical trait with psychopaths is an elongated amygdala [google it] - that the predisposition to these behavioural preferences is inherited, rather than developed. (The problem with studies od this kind is they look for commonality in a small range of subjects, rather than looking at a larger distribution.)

Ergo, if you accept the notion that *God made man in his own image*, then the awful truth is that most psychopaths are extensions of *God's will*. Even the non-interventionist God argument falls to pieces.

One less reason to believe in God if you take it to it's logical conclusion.

If the dog is sick, you should put it down. For it's own good - nobody else's.

 

[heart]

Interesting view.

 

[Night]

Interesting idea.

Personality disorders tend to be the end result of a constellation of maladaptive behaviors paid to the recipient and/or inherent biochemical thought "poisoning".

As an example, many who suffer from Borderline Personality Disorder have a history of childhood sexual abuse - this is especially true with women.

With Antisocial Personality Disorder, the patient will often suffer from erratic neurochemical events and/or depleted arrays of myelin. This cooperation is particularly damaging to the accuracy and frequency of neural transmission inside fundamental portions of their Frontal Cortex and Limbic System.

In both instances, the individual is operating with profound disability.

My examples aren't intended to provide a sort-of "philosophical sanctuary" for criminals. I support victim's rights far beyond the legal civilities afforded to the criminally insane.

I simply don't support the premise that guilt consequent/incidental to mental disease presupposes a morally negotiable transaction.

Morality lacks context.

 

[matmos]

I support victim's rights far beyond the legal civilities afforded to the criminally insane.

I too. With respect - and I don't know about the US legal system - personality disorders are not regarded as *insane*. Paricularly PPD which is classified here (and I believe in the US) as an *untreatable personality disorder* with all the legal loopholes that entails.

The law exists to protect humanity from itself - what is a pychopath if not a *sick puppy*; dehumanizing him would solve the problem but create so many other problems.

The question remains, moral or medical? Almost impossible to answer without going places you don't want to go.

 

[ThatsWhatHeSaid]

Moral Propaganda?

I guess you can classify/describe anything any way you want. If the Cluster B people neglect their moral duties, sure, we can say they have a "moral disorder" but since the disorder goes deeper than that, I would hesitate to describe it that way. Like Night said with respect to Narcissistic, and Borderline (and I'd bet with Histrionic though I don't know enough about it), there's suffering and fear that underlie those disorders, and many therapies are designed around confronting those fears to eliminate or provide context for the behaviors and thoughts that serve to resist those fears. Anti-social Personality is a better candidate of the group, but even then, environmental factors play an important role in causing the disorder.

The description is just a word, but it seems like branding it a "moral disorder" is propaganda, as if to say that we suddenly have a right to punish these people because they're equivalent to sane criminals who are simply neglecting their moral duties. That raises 2 questions: are they really like ordinary criminals? and if they are, does that give us a right to punish them?

There's certainly a relationship between criminals and antisocial personalities, but I'd even go as far as to say that there's a relationship between all disordered folks and criminals, in that all them are where they are because they don't know how to deal with their fears and needs. Some express that by psychological subterfuge, others by behavioral subterfuge. But it's the same shit.

Whether or not to punish depends on your philosophy. Some subscribe to a retributive theory while others to a rehabilitative/utilitarian theory of punishment. Seems like the author in the OP advocates the former; I advocate the latter. If you view criminals or disordered people as people who haven't learned how to deal with the pressures of anxiety, it's hard to justify punishing them just because they fucked up and you want to get back at them. It's even harder when you consider all the genetic and environmental factors that lead to the offensive behavior that are out of the hands of the offender. For me, the questions isn't CAN WE ASSIGN BLAME and PUNISH this person based on some justification (e.g., his disorder is only "moral"), but rather WHAT DO WE GAIN BY PUNISHING THIS PERSON? Are we rehabilitating him? Protecting ourselves? What's the point?

 

[Nadir]

Societal, honorable mention to medical.

 

[Totenkindly]

There seems to me to be a whole gray area in the middle of "personal choice" vs "inherent wiring" where it's near impossible to tease out what options a person reasonably has in how they view and process and react to or act within the world.

Our legal and moral codes are built upon the notion that we always have a choice; thus, we are culpable for our behavior and are open to reward or punishment based on that. As soon as people can't be held responsible for their behavior, the entire basis of law seems to erode. (How can we fairly enforce anything?)

The other end is that people are merely products of the forces upon them, and that they can thus be improperly wired or improperly trained, and with time and effort they can eventually be rehabilitated to perform in ways that are better long-term for themselves and society.

But usually people fall somewhere in-between and it's hard to tease out exactly where things are at.

As far as why do we punish people? Lots of reasons, some of what Edahn mentioned. Punishment, though, seems primarily with "righting the balance" -- someone did something bad, therefore they must have something bad happen to them so the scales are now even again. (It's actually quite Karmic, which is funny in a Christianized nation like the United States.) We wrap it in pretty language and say it's for the benefit of the victims... and perhaps to some degree emotionally it can be satisfying to see someone punished who has wounded you... but ultimately, on the large scale, there's also a view that it just creates two wounded people rather than healing the first wounded one. Yet "fair play" still seems built into our psyches and we still want to see people get what's coming to them if they've done us ill.

I don't know. I've had to think about the nature/nurture thing a long time for other personal reasons, but it carries into discussions like this. I don't know if we can ever separate the two. And it's hard to confine situations to just one paradigm when more than one is operating due to a myriad of people being involved.

 

[Athenian200]

I simply don't support the premise that guilt consequent/incidental to mental disease presupposes a morally negotiable transaction.

Morality lacks context.

I don't agree with that at all. That's the most disturbing thing I've ever heard. That's not even fair. I'm glad you're not in charge of the law, that would be awful. You cannot say that your perception of morality applies to everyone absolutely.

That is so... irrational, brooding, terrifying an idea.

 

[Night]

I don't agree with that at all. That's the most disturbing thing I've ever heard. That's not even fair. I'm glad you're not in charge of the law, that would be awful. You cannot say that your perception of morality applies to everyone absolutely.

That is so... irrational, brooding, terrifying an idea.

Right back at ya.

 

[disregard]

Re: OP

The intention is there, but its important to note that those afflicted with NPD are created. One can point the moral finger, or one can treat it like a medical disorder: keep that which will accelerate the disorder away and give what will help to stabilise health.

 

[nozflubber]

I don't really see the reasoning behind calling someone with borderline PD morally decrepit unless you pick on them for the promiscuity thing, which has more to do with the confusion over people in their lives rather than chastity. The rest of the "B" cluster has at least one classic deadly sin embedded in them.

 

[Nonsensical]

Moral! I watched a show that told a story of how a teacher was very impatient with one of her students, so she, herself, had the child prescribed to Ritalin for ADHD, and he fell into a psychotic state, because the teacher had it take it too much.

But this is an example of how people are just too impatient, or don't want to deal with variations in behavior, and given the technological advances of this century, they lazily resort to medications, and saying it's all medical..but it's not! Not every kid conforms to sitting quietly all day in a classroom, there are those occasional children who just want to be active instead of stressing their fragile minds all day long on things they may not find interesting.

Anyways, I'm rambling on, but I have been so angry about this for so long! So there's my opinion, like it or not.

 

[Mole]

What is really interesting about personality disorders such as Psychopathic Personality Disorder or Narcissistic Personality Disorder is that the sufferer thinks there is nothing wrong, and in particular, nothing wrong with them.

And so they are almost impossible to treat.

However they do suffer and their lives are failures - but still they can see nothing wrong.

And of course they make their victims suffer. And quite unsurprisingly they see nothing wrong in this.

And although it is tragic to say this, it is a mistake to try and help them because no matter what you do, they will continue to make themselves and you suffer.

Tragically, the best you can do is avoid them.

 

[Jack Flak]

I honestly believe a sentence of one year hard labor (in a group setting) would easily cure most so-called personality disorders. People stir around with their thoughts and make themselves crazy in this fucked up modern world. I'm not referring to real disorders like schizophrenia.

 

[Mole]

I honestly believe a sentence of one year hard labor (in a group setting) would easily cure most so-called personality disorders. People stir around with their thoughts and make themselves crazy in this fucked up modern world. I'm not referring to real disorders like schizophrenia.

Good on you, Jack Flack.

But it is probably important to distinguish between personality types and Personality Disorders.

Personality Disorders are psychoses, while personality types are just that: personality types.

But they have similar names and so are easily confused.

For example, there is Psychopathic Personality Disorder and the psychopathic personality. And there is the Narcissistic Personality Disorder and the narcissistic personality.

See, they sound the same but the Disorders are bona fide mental illnesses.

 

[disregard]

The individual should be held responsible for all of his actions, but an understanding of the disorder afflicting the individual should be sought by those close to him, for their own well-being.

 

[Anja]

Interesting topic and one that I have pondered.

I agree with much that is said here.

There is a great deal of value judgement involved for humans in typing personalities. I try to view them as clusters of symptoms which may or may not hold true. A handy-dandy and quick method to provide a lot of information in shorthand.

What you say though, cafe, about consequences being a valuable learning tool is spot on. When humans provide the consequences we certainly are apt to look for underlying motives. When the cosmos provides them we call it "bad luck" or "fate."

But it is my understanding of the way things work that if one is not in tune with the force which works for good and growth there will inevitably be unpleasant results.

I suppose that observation of natural forces by early religious thinkers was how the concept of sin occurred.

 

[Anja]

I'd like to also add that people with Personalty Disorders can be treated, and if motivated, can alter their behavior. (The "if motivated" is the hook, of course. Someone working with a personality disordered person has to find it and emphasize it.)

Antisocial Personality Disorder? Who do you think our high profile police, politicians, emergency room personnel, ministers, doctors, war heroes are? Many are flip sides of the coin. They have their place in society as does everyone, I think. They tolerate high levels of stress, aren't bothered by difficult decisions, prefer leadership roles and have a rapid recovery rate from situations which would crush a sensitive.

The ones who don't hold the line are the ones we read scary stories about in the newspaper. But all around us people with Personality Disorders are making their lives work. And struggling much more than we can know.

Short of uncontrollable psychosis anyone can learn to build on their strengths, minimize their weaknesses and live a healthy, productive life. But it isn't an easy thing to accomplish and may take years and a lot of help.