Abstract
Louis Charland has argued that the Cluster B personality disorders, including borderline personality disorder, are primarily moral rather than clinical conditions. Part of his argument stems from reflections on effective treatment of borderline personality disorder. In the argument from treatment, he claims that successful treatment of all Cluster B personality disorders requires a positive change in a patient’s moral character. Based on this claim, he concludes (1) that these disorders are, at root, deficits in moral character, and (2) that effective treatment of these disorders requires a sort of moral education rather than clinical intervention. In this paper, I evaluate the argument from treatment through a critical analysis of two psychotherapeutic interventions that have shown recent effectiveness against borderline personality disorder. I suggest that both Dialectical Behaviour Therapy and Mentalization-Based Treatment indicate that borderline personality disorder is, at root, a deficit in non-moral cognitive and emotional capacities. I suggest that these non-moral deficits obscure the expression of an otherwise intact moral character. In light of this, I conclude that effective treatment of borderline personality disorder requires primarily clinical intervention rather than moral edification.
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Notes
According to DSM-IV classification [3], the Cluster B personality disorders are antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, and borderline personality disorder.
Charland does not think the two categories are mutually exclusive [5].
Pearce comments on the second prong, but provides no detailed analysis of it beyond a mention that some evidence shows that some CBPDs are responsive to pharmacological and psychotherapeutic treatments [17].
There is actually a body of empirical evidence that suggests a dissociation between moral behaviour and moral beliefs in non-coercive cases [18]. In light of this, my example of a change in moral character, accompanied by no change in moral behaviour, may not be entirely unrealistic.
This situation is not only conceivable, but is actually very common in BPD patients. These patients are known to be able to control their negative behaviours in some instances, perhaps via inhibiting malicious desires and intents [6:10]. These situations could be interpreted as cases where immoral behaviour has been curbed, but an underlying change in values, desires, or beliefs has not occurred.
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Horne, G. Is Borderline Personality Disorder a Moral or Clinical Condition? Assessing Charland’s Argument from Treatment. Neuroethics 7, 215–226 (2014). https://doi.org/10.1007/s12152-013-9199-3
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DOI: https://doi.org/10.1007/s12152-013-9199-3