Touchstone Terms: Personality Disorders and Ego-Syntony

I find the distinction between psychological disorders and personality disorders fascinating.

Consider obsession and compulsion. Someone suffering from the anxiety disorder OCD will often engage in ritualistic actions: locking and unlocking a door a set number of times, carefully arranging furniture, repetitive washing, or hoarding. A person with the personality disorder OCPD may do some or all of these things, but the key difference is that the anxiety disorder feels invasive and unwanted by the sufferer, while the sufferer of a personality disorder will endorse his maladaptive behaviors, finding them appropriate, suitable, or correct. He’ll even judge others for failing to behave likewise.

This makes personality disorders particularly difficult to treat; they may be heavily maladaptive, but the sufferer doesn’t experience the personality disorder as an illness. Someone with OCPD instead experiences the world’s failure to live up to their standards or accommodate their behaviors as the major source of their suffering. Personality disorders are thus ego-syntonic: closely tied to the person’s sense of self and their view of the nature of existence. This is different from ego-dystonic disorders, which the sufferer experiences as alien or other: a set of invasive thoughts, reactions, and compulsions at odds with the life and goals she wants.

So far, so good; this is textbook psychology, the normal science hammered out in the last few Diagnostic and Statistical Manuals (DSMs), since the revised third edition in 1988. But there’s a lot to think through here.

Sigmund Freud coined the term “ego syntonic” in his book On Narcissism, where he tried to show that what makes many disorders untreatable is our ability to find support in a partner or a group. This “cure by love” crystallizes a maladaption in what he calls “happy love,” but is supposedly anything but happy. It is merely self-assured “intact narcissism,” because it has intimate social recognition.

Is this the first account of group polarization? Anthony Greenwald thought so. In his essay, “The Totalitarian Ego,”  Greenwald argued that there was a clear connection between the narcissistic ego’s tendency to find self-supporting information and ignore self-critical information and the totalitarian state’s tendency to suppress dissent:

Interestingly, characteristics that seem undesirable in a political system can nonetheless serve adaptively in a personal organization of knowledge.

Conceiving of the ego as a self-protective organization of knowledge strikes me as a useful metaphor for some elements of our thinking. But as always with analyses of bias, especially those like Greenwald’s or Freud’s that take it as a given that everyone is biased in her own way, it raises interesting questions about where to identify disorders and illnesses: the individual ego or the community.

Like Freud, the first DSM classified things like homosexuality as “sociopathic” personality disorders. From one perspective, this makes sense: gays and lesbians don’t experience their sexuality as invasive, but rather experience the world’s hatred as the main impediment to their flourishing. But as we learned then, sometimes it is the world, and not the deviant individual, that must change.

The same thing could be said for a perfectionist with OCPD; perhaps the real problem is that the rest of us are too sloppy or not conscientious enough. Am I wrong to give so little to charity, or is Peter Singer wrong to demand I give so much? Certainly, the personality disorder carries with it a maladaption, a kind of ill-fit between self and world. What empowers the medical establishment to decide where the blame for that misfittedness lies?

It took gays and lesbians activists, sympathetic researchers, and philosophers several decades to remove homosexuality from the DSM. But perhaps other such errors are still present. Some things, like anxiety, depression, or the word salad that schizophrenia produces can be safely recognized as disorders because sufferers experience them as such. But many mental illnesses aren’t precisely ego-dystonic; they merely create a mismatch between self and world: it is the sufferers who decide that it is they who must change and not the world. In their treatments, psychologists put their finger on the scale of that decision, placing the burden on the sufferer and not the world.

That’s why philosophers who have tried to make psychological disorders contained in the DSM into viable worldviews. Activists and sympathetic researchers have embraced depression, anorexia, schizophrenia, multiple personalities, and borderline personality disorder as healthy adaptations rather than maladaptive disorders.

“We are not so inclusivist as to tolerate intolerance such as yours … I don’t see anything herrschaftsfrei [domination free] about my handling of my fundamentalist students. Rather, I think those students are lucky to find themselves under the benevolent Herrschaft [domination] of people like me, and to have escaped the grip of their frightening, vicious, dangerous parents … I am just as provincial and contextualist as the Nazi teachers who made their students read Der Stürmer; the only difference is that I serve a better cause. I come from a better province.” (Richard Rorty, “Universality and Truth,” in Richard Rorty and His Critics, edited by Robert Brandom, 2000.)

Now, if you take someone like Richard Rorty as your guide, this is the particular mission of philosophy: to supply a justification for our pre-philosophical worldviews. It’s not hard to see that what many philosophers are doing is engaging in a defense of their own lives. Bourgeois liberals defend bourgeois liberalism; excluded groups challenge their exclusions; conservatives and theists defend these perspectives. What if this is all just the process of coming to terms with our misfit with the world; all just a kind of narcissism, rooting out ego-dystonic feelings and becoming more fully ego-syntonic?

My sense is that many philosophers understand themselves to be “merely” engaged in this kind of justification and activism on behalf of excluded lifeworlds. And I think that “merely” is a product of their own disillusionment, sometimes quite legitimately. They believe that any greater project of reconciliation or unification is really destined to failure or is propaganda for permanent domination, and so we should settle for this “good enough” work.

But I’d like to believe that we’re doing something more than that: that we’re engaged in a kind of discovery, that we’re working towards some telos in that scholarship, rather than mapping incommensurables. Philosophical justification is not merely a conflict between mutually exclusive personalities, cultures, and ideologies, but the expansion of our shared horizons to find a frame of reference that is inclusive. Rorty’s deflationist account opens us up to the nonsense of Jonathan Haidt (previously here, here, and here.)

In this I find the imagery of Kant’s “kingdom of ends” (at least as interpreted by Christine Korsgaard) evocative: a world where each person finds her own connection with a rule–and a metaphysics–we make together. This necessarily involves some movement back and forth between the diversity of human personalities and the rule that allows us all to flourish. This, it seems to me, involves accepting Korsgaard’s gloss on Kant:

“If you view yourself as having a value-conferring status in virtue of of your power of rational choice, you must view anyone who has the power of rational choice as having, in virtue of that power, a value conferring status.” (Christine Korsgaard, Creating the Kingdom of Ends, 123)

All that is left is to determine how to make each act of value-conferral harmonious with all the others. It’s a difficult practical and philosophical problem that will involve regular digressions into difficult metaphysical and meta-ethical matters, and it can no longer be accomplished while embracing Rorty’s deflationism.

(This post is a part of a series on some ideas that I find particularly useful or interesting.)

In-Groups Defend Their Turf? Philosophy versus Psychology in the New York Times

A showdown of sorts with Jonathan Haidt is brewing on The Stone.

Michael P. Lynch gives us “A Vote for Reason.”

The judgment that reasons play no role in judgment is itself a judgment. And Haidt has defended it with reasons. So if those reasons convince me that his theory is true, then reasons can play a role in judgment — contra the theory. Think about the passage I quoted above in this context: those who love truth need to take a good, hard look at the evidence and see reasoning for what it is. This sounds like a self-defeating argument: we are being advised to use reason to see that reason is flawed.

Gary Gutting adds “Haidt’s Problem with Plato.”

Plato’s intuitions derive from a long and complex process of physical, emotional and intellectual formation in a supportive social system.  (This is what Plato means by the “education” of his philosopher-rulers.) These intuitions are what — given sufficient experience, maturity and, especially, responsible intellectual engagement with others — we hope will replace the snap-judgment intuitions Haidt rightly sees as underlying so much of our moral life.

Haidt is scheduled to respond this Sunday evening. (My own previous challenge to Haidt has gone unanswered.)

Jonathan Haidt’s Conflation of the Personal and the Partisan

There’s been a conflict running through Jonathan Haidt’s work that it’s time for him to address.

On the one hand, he asserts that there are characteristic moral intuitions that distinguish partisan liberals from partisan conservatives. He recently argued that these moral intuitions are demonstrated by the fact that the vast majority of social psychologists identify themselves as liberal.

If this is true, then there’s an important spectrum of the human condition that liberal social psychologists will fail to address. According to Haidt, liberal partisan identification hamper scholarship because liberals are unable to understand or be motivated by in-group affinities, deference to authority, or purity and disgust. Haidt’s earliest claim was that conservatives have moral intuitions that liberals can’t recognize.

But when he polled social psychologists looking for liberals, their answers signified that they are Democrats or have even more radically “leftist” policy preferences. Is this the same as being liberal in the way that his research suggests, which is to say that they allow their moral lives to be ruled by the intuitions associated with fairness and care? Haidt has said that it is:

The current American culture war, we have found, can be seen as arising from the fact that liberals try to create a morality relying almost exclusively on the Harm/Care and Fairness/Reciprocity foundations; conservatives, especially religious conservatives, use all five foundations, including Ingroup/Loyalty, Authority/Respect, and Purity/Sanctity.

One the other hand, Haidt has been going out of his way to show that liberal partisans demonstrate the supposedly conservative “moral intuitions.” We are now told that partisan liberals evince purity intuitions, in-group solidarity, and deference to authority, too. If they’re excluding Republicans from the academy because of tribalism, they can certainly understand the motivation to allow loyalty to dominate fairness! So liberals can recognize conservative moral intuitions, if only they’d reflect on the ways that they do similar things.

He can’t have it both ways: either liberals have a purity, hierarchy, and in-group intuitions, which keeps partisan conservatives out of the academy, or they *fail* to have those intuitions in ways that importantly hamper their work. So which is it? Are liberals just like conservatives, making conservative perspectives superfluous, or are they unable to feel or understand the full spectrum of moral intuitions, and thus no threat to conservative participation in the academy?

More on Contempt

A friend suggests that my recent arguments against the moral status of contempt ignored an important role it plays in policing our moral community. The concern is that if we cannot feel (and expect others to feel) contempt for someone like Bernie Madoff, then we will lose the morally instructive value of punishment. If we wish to live in a culture that does not encourage people to take advantage of each other, we must collectively judge cheaters and frauds as morally ‘less worthy’ than non-cheaters and non-frauds. My friend claims that we are all better than Bernie Madoff, and a failure to feel contempt for him would itself be a mistake or error in judgment.

I think this is the heart of the dispute over the value of contempt: proponents of contempt can certainly agree that contempt is often misused, that it short-circuits dialog and even often disguises itself as legitimate when it is not. However, they want to say, contempt can be appropriate. We may disagree on when exactly it is warranted, but we can come to an agreement with enough dialog, and perhaps we ought to do so.

This reminds me of Arendt’s account of Adolf Eichmann in Eichmann in Jerusalem. Continue reading More on Contempt

Bridging The Will-Be/Ought Gap

indiana_jones_bridge.jpgSo I’ve been writing the last few days on a number of only tenuously related themes: cruelty and torture, probability and prediction marketstestability, middle-range theories, and moral realism. Today I’m going to try to draw these themes together and point to a couple avenues for further discussion.

Obviously, it’s important to me that our normative judgments be ‘about’ something, something testable, and that there be something like the possibility of moral progress. These are the claims I’d like to ‘mark to market,’ but it’s not clear how you’d go about doing that. If any of those claims are false, then my project is really doomed from the start. If they’re true, I suspect that we might make better progress in morals by breaking our research questions into testable chunks, and once the chunks are testable, we can get betting markets to help push research and excite thinking. To believe something in the face of doubts is to believe it in a probably-unreflective probabilistic way, and the best measure of our reflective probabilities is some sort of market that can mix the ‘show of hands’ model of a poll or vote with some kind of buy-in or stakeholder ritual to incentivize informed deliberation while holding bad faith participants accountable.

But the truth of the matter is that, while I think prediction markets can be tremendously helpful in the natural sciences and in some of the middle-range theories required for political philosophers (mostly social scientific assumptions we build into our institutional design), I don’t see much hope for closing the gap between prediction and normativity using markets alone. Too often, the obstacle is still the conceptual problem, the conditions of testability: disagreement on what counts as proof is usually going to trip up a futures contract, at least on the affirmative side.

On the critical side, however, there may still be room for this kind of falsification. In light of the X-phi movement, I think there is growing agreement that we can no longer ignore a set of questions usually dealt with in metaethics when doing ordinary ethics or applied ethics. These roughly correspond to the failures or major revisions of traditional ethical middle-ranged theories in deontology, virtue ethics, and utilitarianism.

Consider moral intuitions, which have long been the basis for deontology, even the Kantian deontology which requires us to find the result of some universalized maxim repulsive. The polling and fMRI evidence has been growing over the past decade, and it shows that we don’t really form moral judgments in a dependable way. Too often, priming effects have a tremendous power over how we judge a situation, and irrelevant framing effects often cause respondents to favor one or another alternative. If that’s true, then our unreflective moral intuitions are not to be trusted, and much of the “common sense” underwriting natural law and dignity theories is prone to self-deception. See, for instance, Jonathan Haidt’s work, Peter Singer’s “Should we trust our moral intutions?” or Woodward and Allman’s “Moral Intuition: its Neural Substrates and Normative Significance.” Particularly of interest to me is the way that the feeling of disgust often plays an intermediary role in our determinations of what is “just wrong.” Kwame Anthony Appiah has some good examples of disgust misleading moral judgment in his book Experiments in Ethics, but perhaps stranger still is the role that disgust and taste plays in determinations of veracity!

Similar verification problems have been well-document in various accounts of character, the founding concept in virtue ethics, where various kinds of irrelevant priming, like being hurried, or having just found a quarter, are larger indicators of a person’s likelihood to act charitably than anything internal or habitual. (Appiah covers some of this in Experiments, as well.) If I can’t be depended upon to have a stable character, what good are habits? What hope is there for a general epistemic virtue like phronesis, if there’s nothing like an excellence in identifying the minor premise? Combined with the growing acknowledgement of neuro-diversity, and our long-standing commitments to pluralism, both of which challenge the universality of the practical syllogism’s major premise, it has become increasingly evident that old models for human flourishing just won’t cut it any longer.

One middle-range theory that holds lots of promise for utilitarians is the moral heuristic, apparently conceived by the polymath Cass Sunstein. The obvious question is: if we know we can push heuristics with quandaries that lead to bad decisions, what happens when the world hits us with novel situations, as well? (Marc Hauser has charged that Sunstein’s heuristics aren’t testable: too vague!) But if we could somehow generate new heuristics, hopefully using carefully crafted exemplars, like narratives and stories that can serve as prototypes for the unique judgments required in the modern world, we may well be able to trump these limitations… even while leaving unresolved the question of what, exactly, we are obligated to maximize. (I’d love to find some preference utilitarians willing to take the other side of a bet on capability theory!)

In sum, we need a new ethics. (One that won’t quit.)