he defective capacity for close relationships said to characterize “schizoid personality disorder” can be seen as deprivation of the means of realizing one aspect of the good human life.
On this model, psychiatrists need not necessarily confine themselves to treating psychiatric illnesses. The techniques psychiatrists have developed, whether using psychotherapy or pharmacology, might benefit people who seek help in freeing themselves from the constraints of a life-diminishing personality. Some thoughtful psychiatrists notice a tendency in themselves to prescribe Prozac at first to treat clinical depression but then to continue prescribing it, not to cure an illness but because of its enhancing effects on some patients’ personalities. They are right to be concerned about the boundaries of psychiatric intervention, but the Aristotelian model could provide a justification for their crossing the “medical” boundary. Of course, those they treat must be presented with a proposal that makes clear the non-medical “enhancement”, as well as any risks involved, and they must give their reflective and voluntary consent to it. Under these conditions, psychiatric intervention directed at enriching lives rather than at curing illness sometimes may be justified.
There are some dangers in this Aristotelian psychiatry. A lot of work needs to be done on the basis of the account of the good human life. And there is the danger of an Aristotelianism that underwrites prejudice. It is all too easy to think of a crude version that would again encourage interventions against the sexuality of gays and lesbians. At the very least, Aristotle needs to be combined with John Stuart Mill. Awareness of the open-endedness of our conception of the good life and the value of “experiments in living” is a necessary corrective here. But, despite these dangers, the Aristotelian alternative to the medical model may rescue something of value from the debatable diagnosis of personality disorder.
B. “Antisocial Personality Disorder”.
One of the most problematic and intriguing psychiatric diagnoses is that of “Antisocial personality disorder”. Those with this diagnosis have the broad psychological tendencies of psychopaths. It includes psychopaths, together with others less extreme. Using the popular tool, the “Hare Psychopathy Checklist”, not all those diagnosed with “Antisocial personality disorder” would score high enough to count as psychopaths.
People with this diagnosis are often said to “lack a conscience”. This claim raises more questions than it answers. There are so many different things, some or all of which might be missing. They might lack empathy (the ability to imagine how others feel). Or they might sometimes harm people, out of a lack, not of empathy but of sympathy: they can imagine how their victim feels but do not care about it. Or they might lack feelings of guilt. Or they might lack certain moral concepts, such as cruelty or selfishness. Or they might lack a conception of the sort of person they are, or lack values that would shape a conception of the sort of person they want to be.
Because I am intrigued by these issues, I am taking part in a team project looking at the “lack of conscience” in two groups of people. One group, in a secure hospital, is made up of people having the diagnosis of Antisocial personality disorder. The other group is made up of neurological patients with the diagnosis of Fronto-temporal dementia, a group who at some stage in the development of their dementia may exhibit antisocial behaviour. My part of the study involves interviewing members of these two groups about their moral outlook, trying to find out what sort of conscience they do or do not have.
The study is not finished, so there are as yet no results that have any kind of scientific status. But, speaking unscientifically, in the interviews with the “Antisocial personality disorder” group, I am overwhelmingly struck by the terrible childhoods so many of them seem to have had. The stories are of rejection, denial of love, humiliation and denigration, violence o