Character vs. Disease

This musing is sparked by George Will; he recently wrote a piece for the Washngton Post titled, "Cure for Character?", taking off on the soon-to-be-published revision of the DSM (Diagnostic and Statistical Manual of Mental Disorders) -- the catalogue that standardizes psychiatric diagnoses.

Mr. Will doesn't like the DSM having categories such as "antisocial personality disorder", "temper dysregulation disorder" and "histrionic personality disorder". He fears that by making these things diseases, a person is absolved of the responsibility to behave in socially-appropriate ways. Of course, Mr, Will, a political conservative, would object; these go straight to the heart of what William F. Buckley once defined as the difference between liberals & conserviatives: "Liberals believe in the perfectability of humankind; conservatives don't."

It's not that I totally disagree with his central point: If we are merely products of bio-chemical processes in our heads, where is the place for free will? If acting like a jerk is a disability, do the rest of us have to put up with jerks?

But what a psychiatrist means by these diagnoses is something more than "people-abuser", "short fuse" or "drama queen". We all know those personality types (and avoid them if we can). A pyshchiatrist encounters them when the phenomena described have become severe; either the person seeks treatment or is brought invountarily to it. Even the seeking of treatment is often less voluntarily than the seeker wishes; it's often a last resort -- after what AA calls "hitting bottom".

Not all in the world of psychiatry are comfortable with the DSM; some worry "whether the disorders it defines are actually real conditions in people in the real world, that can be consistently identified by its criteria." (Source: http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders) On that score, I'll vouch for the reality of these disorders. And, we shouldn't confuse the signs and symptoms in the DSM with underlying causes; DSM focuses on the former by design, admitting that we have a very limited unsderstanding of the pathologies involved.

We can probably agree that some people characteristically behave in antisocial ways, that it's an aspect of their personalities, and that some carry it to extremes. Similarly with short tempers and histrionics. If the shrinks have noticed too & catalogued it, we should be grateful that their world matches ours. Now, we can say not only "He's crazy." but just how he's crazy.