ns with a comparable influence on character and personality that are present at a much earlier developmental stage, in some cases possibly from birth. This category includes the cluster of conditions known as “personality disorders”. Because there is no previously developed alternative personality, it is much harder to get any grip on the contrast implied by the question, “Is it her or is it her psychiatric condition?”
A. The Personality Disorders.
“Personality disorders” are typically said to be “deeply ingrained maladaptive patterns of behaviour”. The personality is “abnormal either in the balance of its components, their quality and expression or in its total aspect. As a result either the patient or society suffers or both.” There are obvious questions about such an account. The word “maladaptive”, with its evolutionary overtones, may disguise a residue of the bad old tendency to medicalize behaviour that deviates from socially accepted norms: the approach that once allowed being gay to count as a psychiatric problem. Or, if a really Darwinian interpretation of the word is intended, so that behaviour is “maladaptive” when it reduces the chances of survival, other problems arise. Did Socrates have a personality disorder? His deeply ingrained pattern of behaviour, his persistent asking of awkward questions, certainly seems to have shortened his life.
But objections to the general definition are too easy. It is worth mentioning some particular “personality disorders”. Although textbook lists vary, several appear on most lists. “Paranoid”, “hysterical” and “narcissistic” personality disorders involve having the kind of personality the names suggest. Another is “Schizoid personality disorder”. Typically it is said to be characterized by a defective capacity for close relationships, by lack of empathy, by withdrawal, solitariness and detachment. There is also “Obsessional personality disorder”. People in this category are characterized by perfectionism and rigidity. They are mean with money and obsessed with cleanliness and tidiness.
Lists of personality disorder invite an obvious party game, seeing in which categories ourselves and our friends fit. And there is an equally obvious danger, that people whose personalities are unappealing to others will find themselves diagnosed as having a psychiatric disorder. That there is some subjectivity here is clear. The person diagnosed as having obsessional personality disorder on the basis of perfectionism, rigidity, being mean with money, and being obsessed with cleanliness may turn round and say that the psychiatrist who diagnosed her is a slapdash, unprincipled spendthrift who needs to take a shower more often.
Personality disorders are thought of in terms of two different models. There is the model based on the thought that some personalities dispose people to particular psychiatric illnesses, so that “schizoid personality disorder” might be thought of as a kind of incipient version of schizophrenia. The alternative model is based on the idea that there are dimensions of personality, with personality disorder being at an extreme of a continuum. Each of these models has its difficulties. The link between personality disorders and psychiatric illnesses such as schizophrenia is not clear. And it is hard to see why a personality at the extreme of some dimension should count as disordered. This is the part of psychiatry where scepticism about the “medical model” is most powerful. It is hard to make a case for treating “personality disorder” as a kind of illness.
One alternative to the medical model is to think of personality disorders in an Aristotelian way, invoking a species-specific idea of the good life for human beings. In the same way that caging a bird is cruel because the good life for birds includes freedom to fly, solitary confinement for people is cruel because the good life for human beings includes the ability to mix with other people and to make friends. If some such account can be given, it may be possible to apply it in explaining some of the personality disorders. T