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Medicalizing character flaws

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I have great respect for psychology (my wife is a psychologist), but the coming revision of the DSM is cause for comment.  I do not doubt that there are real medical psychoses, and that clinical counseling as well as psychiatry can help people.  But we should be careful to not make everything a “clinical disorder”.  Some of what we now call “diagnosable disorders” (and we give a purely medical or psychological account of these things) are what we used to just call “character flaws”.  Not to put too fine a point on it, but sometimes aren’t those who get tagged with “oppositional disorders” (“negativistic, defiant, disobedient and hostile behavior”) really just assholes?  They don’t need medicine or even counseling, they need moral formation (and maybe a spanking).

George Will remarks on all of this here.

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3 Comments

  1. Dan says:

    If modern psychology had always been around, the vast majority of great artists, composers, or writers would have been marginalized as having some sort of disorder. My respect and appreciation for psychologists like Jung or Frankl notwithstanding, I think modern psychology often homogenizes and marginalizes just about everything interesting and meaningful in the world.

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  2. Kleiner says:

    A psychologist I happen to know responds:

    “I read the article. They are the same kinds of concerns I had about DSM diagnoses before I was trained and knew what the DSM REALLY says and what is involved in diagnosing people. So the article really oversimplifies DSM diagnostic criteria. What it doesn’t mention is that to meet the criteria for a diagnosis, the behaviors have to be exhibited in a significantly more severe form than what would be considered typical for a person at that age/phase of life or in that situation. Additionally, the behavior has to cause significant impairment in 2 or more areas of one’s life (occupational, academic, interpersonal/social, family). In fact, if you meet full criteria for any diagnosis in DSM, but there is no marked impairment in any area of your life, technically you wouldn’t receive the diagnosis. BUT, once you’ve actually met someone who meets the full criteria for something like Oppositional Defiant Disorder, you will almost immediately be able to “feel” how different they are than someone who is just a “jerk” or a “difficult adolescent.” The same goes for the personality disorders that the article mentions. The thing about it is that you can not read the DSM or snippets of the DSM and oversimplify. One of the things that happens to almost every intro psychology student on earth is that they start freaking out that they have every disorder they are learning about in class because behaviors exist on a spectrum, and most of us exhibit some of the behaviors or symptoms of many of the diagnosis in the DSM.

    You really do have to be trained to read the DSM and understand what it is saying and what it means to diagnose someone. Surely there are therapists out there who are too loose with diagnoses—medical doctors mis-diagnose mental health issues all the time— There are also practitioners who pathologize people—so they see things as being pathological when I might not. But if you are following DSM diagnostic criteria properly, there really shouldn’t be too much of a problem with mis-“tagging” someone like you mentioned.”

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