From personality disorders to the fact-value distinction

ABSTRACT

Louis Charland’s claim that DSM Cluster B personality disorders are moral rather than clinical kinds has recently triggered a lively debate. In order to deliver a reliable report of the latter, both (1) Charland’s arguments concerning the impossibility of identifying and treating personality disorders without applying a morally laden conceptual framework and (2) some critical responses they provoked are discussed. Then, in turn, the conceptual history of the notion of personality disorder is traced, including not only well-recognized contributions from (3) medical psychiatry, psychoanalysis, and DSM nosology, but also (4) an important, but often neglected, tradition of virtue and moral character. Finally, (5) the idea of a normatively neutral concept of personality disorder is scrutinized in the context of its logical dependence on the fact-value distinction. The latter dichotomy’s recent criticism, in particular, is employed to support Charland’s argument and to suggest that the normative character of personality disorders may go much deeper than this or that DSM formulation.

KEYWORDS:

• Character
• Charland
• Cluster B
• DSM
• fact-value distinction
• mad or bad
• personality disorders
• thick concepts
• vice
• virtue ethics

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. As a matter of fact, it is the DSM-IV (American Psychiatric Association, 1994) that Charland explores. Still, however, the substantial part of his argument is equally applicable to the DSM-V (American Psychiatric Association, 2013). Accordingly, in what follows, the references to both DSM-IV and DSM-V will be made in order to secure the continuity with Charland’s line of reasoning and the most current nosological formulations.

2. Any purely empirical relationship, as a matter of fact, would be as non-problematic as, say, the situation in which it would turn out that criminals are systematically more often diagnosed with a disease of a particular kind.

3. Even though Zachar provides an example of Otto Kernberg as representing this way of conceptualizing personality disorders, it seems that it is Heinz Kohut who is more often associated with the deficit-focused understanding of these conditions.

4. At some points the author views personality disorders from a slightly broader perspective, including the DSM-IV Casebook (e.g., Charland, 2006, p. 120).

5. Even though ‘manie sans délire’ is usually rendered as ‘mania without delusions,’ both accounts by Berrios (1993, 1996) are careful to notice how imperfect and potentially misleading to the modern reader such a translation is.

6. Zachar (2015) enumerates four milestones in the development of the notion of personality disorder: degeneration theory, Kurt Schneider, DSM III, and DSM V, even though one may wonder whether the latter is actually as revolutionary as it was supposed to be (see Zachar et al., 2015).

7. Actually, as late as in 1971, Kendell and colleagues published a paper in which they showed that one and the same person (Patient F) could have been diagnosed with schizophrenia by 69% of American psychiatrists and only 2% of their British colleagues.

8. The multiaxial system has been abandoned by the DSM-V (American Psychiatric Association, 2013). It is obviously too early to judge how it will influence research on personality disorders.

9. For some conceptual issues connected with such an approach, see Radden’s (2010) analysis of the relationship between grandiose delusions, grandiose personality disorder, and the sin of pride.

10. Among the less well-known influences on Pinel was Cicero’s Tusculan Disputations (Charland, 2010b).

11. Other involved notions are temperament, constitution, self, type, and trait (Berrios, 1993, 1996).

12. Crichton’s approach, importantly, was not universal. It was obviously alien to the religious therapeutic efforts made by William Tuke at the York Retreat (Charland, 2007b). On closer inspection, as emphasized by Charland (2008), it was also essentially different from the stance of Philippe Pinel, who attempted to develop a medical and scientific psychopathology which would reconcile psychological and ethical elements (le moral and la morale, respectively) and employ normative language as a necessary means of clinical explanation.

13. During most of the 19th century, as noted by Berrios (1993, pp. 17–18), the notion of personality referred mainly to the subjective dimensions of the self. Its disorders, accordingly, were phenomena such as somnambulism, automatic writing, or multiple personalities. It was only later that the meaning of this concept became wide enough to be regarded as directly comparable to the notion of character.

14. He was engaged in a broader epistemological project which ended up with the psychologization of human knowledge.

15. Some authors are careful to notice that the fact-value distinction and the is-ought dichotomy should not be considered as altogether equivalent (Dodd & Stern-Gillet, 1995).

16. Brinkmann (2009) himself is strongly critical of such position. For an instance of the latter’s explicit endorsement, see Kendler (1999, 2002).

17. Its general validity as well as some more detailed issues concerning the relationship between the factual and normative aspects of psychological discourse, as a matter of fact, are of pivotal importance for any project that attempts to descriptively reformulate (operationalize) the language which was originally partly evaluative (for recent examples deserving analysis along such lines see Lee & Ashton, 2014; Veselka et al., 2014). In a strictly psychiatric context, furthermore, it may be worthwhile to notice that Jerome Wakefield’s (1992) notion of mental disorder as harmful dysfunction is also reliant on the dichotomy in question.

Additional information

Funding

This work was supported by the Jagiellonian University (Faculty of Management and Social Communication).

Notes on contributors

Konrad Banicki

Konrad Banicki is a faculty member at the Institute of Applied Psychology, Jagiellonian University, Poland.