These are behavioural and emotional disorders that are, apparently, the
sort of thing doctors should be changing in people.
"
Peter De Vries, America's wittiest novelist, died 17 years ago, but his
discernment of this country's cultural foibles still amazes. In a 1983
novel, he spotted the tendency of America's therapeutic culture to
medicalize character flaws:
"Once terms like identity doubts and midlife crisis become current," De
Vries wrote, "the reported cases of them increase by leaps and bounds."
And: "Rapid-fire means of communication have brought psychic
dilapidation within the reach of the most provincial backwaters, so that
large metropolitan centers and educated circles need no longer consider
it their exclusive property, nor preen themselves on their special
malaises."
Life is about to imitate De Vries's literature, again. The fourth
edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM), psychiatry's encyclopedia of supposed mental "disorders," is
being revised. The 16 years since the last revision evidently were
prolific in producing new afflictions. The revision may aggravate the
confusion of moral categories.
Today's DSM defines "oppositional defiant disorder" as a pattern of
"negativistic, defiant, disobedient and hostile behavior toward
authority figures." Symptoms include "often loses temper," "often
deliberately annoys people" or "is often touchy." DSM omits this
symptom: "is a teenager."
This DSM defines as "personality disorders" attributes that once were
considered character flaws. "Antisocial personality disorder" is "a
pervasive pattern of disregard for . . . the rights of others . . .
callous, cynical . . . an inflated and arrogant self-appraisal."
"Histrionic personality disorder" is "excessive emotionality and
attention-seeking." "Narcissistic personality disorder" involves
"grandiosity, need for admiration . . . boastful and pretentious." And
so on.
If every character blemish or emotional turbulence is a "disorder" akin
to a physical disability, legal accommodations are mandatory. Under
federal law, "disabilities" include any "mental impairment that
substantially limits one or more major life activities"; "mental
impairments" include "emotional or mental illness." So there might be a
legal entitlement to be a jerk. (See above, "antisocial personality
disorder.")
The revised DSM reportedly may include "binge eating disorder" and
"hypersexual disorder" ("a great deal of time" devoted to "sexual
fantasies and urges" and "planning for and engaging in sexual
behavior"). Concerning children, there might be "temper dysregulation
disorder with dysphoria."
This last categorization illustrates the serious stakes in the
categorization of behaviors. Extremely irritable or aggressive children
are frequently diagnosed as bipolar and treated with powerful
antipsychotic drugs. This can be a damaging mistake if behavioral
modification treatment can mitigate the problem.
Another danger is that childhood eccentricities, sometimes inextricable
from creativity, might be labeled "disorders" to be "cured." If
7-year-old Mozart tried composing his concertos today, he might be
diagnosed with attention-deficit hyperactivity disorder and medicated
into barren normality.
Furthermore, intellectual chaos can result from medicalizing the
assessment of character. Today's therapeutic ethos, which celebrates
curing and disparages judging, expresses the liberal disposition to
assume that crime and other problematic behaviors reflect social or
biological causation. While this absolves the individual of
responsibility, it also strips the individual of personhood and moral
dignity.
James Q. Wilson, America's preeminent social scientist, has noted how
"abuse excuse" threatens the legal system and society's moral
equilibrium. Writing in National Affairs quarterly ("The Future of
Blame"), Wilson notes that genetics and neuroscience seem to suggest
that self-control is more attenuated -- perhaps to the vanishing point
-- than our legal and ethical traditions assume.
The part of the brain that stimulates anger and aggression is larger in
men than in women, and the part that restrains anger is smaller in men
than in women. "Men," Wilson writes, "by no choice of their own, are far
more prone to violence and far less capable of self-restraint than
women." That does not, however, absolve violent men of blame. As Wilson
says, biology and environment interact. And the social environment
includes moral assumptions, sometimes codified in law, concerning
expectations about our duty to desire what we ought to desire.
It is scientifically sensible to say that all behavior is in some sense
caused. But a society that thinks scientific determinism renders
personal responsibility a chimera must consider it absurd not only to
condemn depravity but also to praise nobility. Such moral derangement
can flow from exaggerated notions of what science teaches, or can teach,
about the biological and environmental roots of behavior.
Or -- revisers of the DSM, please note -- confusion can flow from the
notion that normality is always obvious and normative, meaning
preferable. And the notion that deviations from it should be considered
"disorders" to be "cured" rather than stigmatized as offenses against
valid moral norms.
"
"
No comments:
Post a Comment