What is the difference between a psychiatric illness and a character flaw?
Introduction
Thesis: Character flaws and psychiatric illnesses are distinct concepts belonging to different domains and evolving separately.
Character flaws
Aristotle claims that character develops over time as one acquires habits from parents and community, first through reward and punishment. Character is perceived as not predetermined, it depends on free will. Character features have traditionally been considered to have social, environmental and not biological origin. A character flaw is a negative personality trait or a persistent pattern of behavior that is generally considered undesirable or harmful. Since character flaws are rooted in the environment, their perception will change as the result of the changing society.
Due to change in perception towards better understanding the causes of behaviors (environment, upbringing) and ability to change, the perception of character flaws becomes more nuanced and compassionate:
From Blame to Understanding: (How has the perception of character flaws recently shifted from blame to understanding?
Character flaws viewed as situational, not inherent traits. Shift from blame to understanding through situational explanations.Skepticism about Character Traits (Harman)
The attribution process for negative events involves making causal inferences based on internal, external, and societal factors, with societal blame associating circumstances with societal issues rather than individual traits. The observer’s tendency to overemphasize internal attributions due to the fundamental attribution error leads to societal blame being crucial in understanding blame for negative events, as explained in the research paper:
The fundamental attribution error results in observers overestimating internal (personality) causes of behavior and underestimating external (situational) constraints on behavior. This bias in person-perception leads to attributions that are predominantly internal, especially in the case of negative events like HIV/AIDS. Societal blame becomes crucial in understanding blame for negative events because it shifts the focus from individual traits to broader societal factors like discrimination or lack of resources. By considering societal blame, the attribution process becomes more nuanced, acknowledging the impact of external factors on events and behaviors, thus providing a more comprehensive understanding of blame for negative events. Understanding Blame and Burnout in HIV/AIDS: Recommendations for Effective Practice (Speakes-Lewis)
Perception of character flaws shifted from blame to understanding. Blame associated with privileged background and choice mindset.Interpersonal BlaShirley Matile Ogletreeme and Perceptions of Choice | Psychological Studies (Ogletree et al.)
Situationism – Situationists believe that thoughts, feelings, dispositions, and past experiences and behaviors do not determine what someone will do in a given situation, rather, the situation itself does. It has been used as the explanation for the famous social psychology studies: Zimbardo’s Stanford prison experiment (Zimbardo et al.); bystander effect (Faul); obedience study, the Milgram experiment (“Milgram experiment”)
Focus on Growth and Change:
The concept of a “growth mindset” (Dweck) emphasizes the belief in one’s ability to change. This encourages viewing flaws as opportunities to learn and improve.
Volitional change studies suggest that people may be able to change their self-reported personality traits through volitional means.Can people choose to change their personality traits? (Hudson and Fraley)
Personality traits do not become fixed at a certain age in adulthood and retain the possibility of change even into old age Personality Development Across the Life Course:The Argument for Change and Continuity (Caspi)
Less stigmatization Character flaws and personality disorders differ in terms of stigmatization. Personality disorders are associated with higher levels of stigmatization than character flaws[1]. People with personality disorders may be perceived as purposefully misbehaving rather than experiencing an illness, leading to increased stigma[2]. Stigma towards personality disorders is influenced by public knowledge, health provider attitudes, and the portrayal in the media[3] [4]. On the other hand, character flaws are often seen as individual shortcomings rather than medical conditions, resulting in less stigmatization compared to personality disorders[5]. The media’s negative portrayal of personality disorders contributes to increased stigma, affecting how individuals perceive themselves and are treated by others.
– Personality disorders are often stigmatized with language of violence in the media. Character flaws may not lead to the same level of stigmatization. Stigma: A linguistic analysis of personality disorder in the UK popular press, 2008-2017. (Bowen)
The Spectrum of Flaws: We’re moving away from seeing flaws as strictly good or bad. Many exist on a spectrum. For instance, shyness might be a manageable quirk in some settings but social anxiety needing help in others.
Positive psychology reframes character flaws as imbalances in the use of character strengths, emphasizing that overuse and underuse of strengths can lead to suboptimal outcomes like less flourishing, lower life satisfaction, and greater depression [1]. By viewing character flaws through the lens of strengths overuse and underuse, individuals can recognize that these imbalances are not inherent deficiencies but rather misalignments in utilizing their strengths effectively in different situations [2]. Understanding character flaws as imbalances in strengths usage shifts the focus from a deficit-based approach to a more strengths-based perspective, offering opportunities for growth, self-awareness, and skill development in managing strengths for optimal outcomes [3].Finding the golden mean: the overuse, underuse, and optimal use of character strengths (Niemiec)
Psychiatric illness
On the other hand, a psychiatric illness (or mental illness) is perceived as predetermined. It is a diagnosable medical condition. It is caused by a combination of genetic, biological, environmental, and psychological factors. Psychiatric illness is rooted in the realm of medical science, which has recently shifted towards biomedicine.
This shift towards a biological approach in understanding and treatment of psychiatric illnesses has resulted in a number of changes in perception and hope for a successful treatment. Even expert mental health clinicians make strong distinctions between psychological and biological phenomena Mental Health Clinicians’ Beliefs About the Biological, Psychological, and Environmental Bases of Mental Disorders – PMC (Ahn et al.)
destigmatization – Genetic explanations reduce blame, destigmatize mental disorders. The Implications of Genetic and Other Biological Explanations for Thinking about Mental Disorders. (Lebowitz) Americans who attribute mental health problems to structural causes (e.g., stress or genetic/biological causes) are more willing to interact with the vignette person than those who see individual causes (e.g., “bad character” or the “way the person was raised”) as the root of the problem. Of Fear and Loathing: The Role of ‘Disturbing Behavior,’ Labels, and Causal Attributions in Shaping Public Attitudes toward People with Mental Illness (Martin et al.)
increased readiness for help seeking Biogenetic concept linked to positive attitude towards help-seeking. Influence of Biogenetic Explanations of Mental Disorders on Stigma and Help-Seeking Behavior: A Systematic Review and Meta-Analysis (Baek)
reduced belief in recovery -Biomedical perspective may reduce belief in improvement of mental disorders. The Implications of Genetic and Other Biological Explanations for Thinking about Mental Disorders. (Lebowitz)
increase dangerousness of mental illnesses and being untreatable Influence of Biogenetic Explanations of Mental Disorders on Stigma and Help-Seeking Behavior: A Systematic Review and Meta-Analysis (Baek)
patients feel powerless – Misleading messages in biological psychiatry, emphasizing brain diseases cured by medications, can contribute to patients feeling powerless and overshadowing effective psychotherapeutic and social approaches .Biogenetic explanations of mental disorders can lead to increased levels of perceived dangerousness and prognostic pessimism, contributing to feelings of powerlessness among patients . Social explanations may offer more hope for the patients and make them feel more empowered. The Power of Perception: Lived Experiences with Diagnostic Labeling in Mental Health Recovery without Ongoing Medication Use (Eads et al.)
limitation: biopsychosocial model still exists resulting in treatment diversity, holistic care, better understanding of mental health determinants
limitation: the public still sees mental illness as influenced by social roots – requires professionals to adjust to this perception in how they relate to patients. Contemporary public perceptions of psychiatry: some problems for mental health professions (Dixon and Richter)
Counterargument: Blurred Lines
However, as medicine is advancing, some behaviors considered character flaws are gradually turning into psychiatric illness. It is a change from the perception of volitional to the predetermined. This blurring of lines between the two concepts has a number of consequences.
First, mental health awareness efforts are leading to more accurate reporting of previously under-recognised symptoms, a beneficial outcome. Second, and more problematically, awareness efforts are leading some individuals to interpret and report milder forms of distress as mental health problems. This then leads some individuals to experience a genuine increase in symptoms, because labeling distress as a mental health problem can affect an individual’s self-concept and behavior in a way that is ultimately self-fulfilling. (PDF) Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis (Foulkes and Andrews)
The example of ADHD:
ADHD was first considered a defect of moral control, then a result of brain damage. Further research revealed its basis in the brain, and a genetic link between family members. Today, we still don’t know the exact causes of ADHD, but studies suggest three main factors: genetics, environmental factors, or a disruption of development – like a brain injury.
As we know more about ADHD, it is growing in awareness and at the same time becoming medicalized – its perception is changing from a character flaw to a psychiatric illness. Increasing awareness of ADHD, as discussed in “Delivered From Distraction: Eliminating Childhood Attention Deficit Disorder” (2005) by Edward M. Hallowell (Hallowell and Ratey #), has blurred the lines between character flaws and symptoms. Difficulty focusing, traditionally seen as a flaw, might indicate an underlying condition like ADHD that requires professional intervention. The medicalization of ADHD, while offering significant benefits like improved diagnosis and treatment, also presents potential risks and limitations:
Overdiagnosis and Overmedication: The increasing recognition of ADHD has led to concerns about potential overdiagnosis, particularly in children. This can lead to unnecessary medication use, exposing individuals to potential side effects without providing clear benefits.
ADHD is being portrayed as a medical condition, eliminating the social context from the behavior and making it strictly biological. ADHD and reification: Four ways a psychiatric construct is portrayed as a disease (Meerman et al.)
On the other hand this blurring may result in a misunderstanding of ADHD symptoms as intentional character flaws rather than manifestations of a neurodevelopmental disorder, potentially hindering appropriate support and treatment for affected individuals.The Relationship of Personality with ADHD and it Symptom Domains: A Meta-Analytic Review (Gomez and Corr)
Impact on Assessment and Diagnosis: The confusion between character flaws and mental illness could affect the accurate assessment and diagnosis of ADHD, leading to underrecognition or misdiagnosis of the condition:
Symptoms being misattributed to personality traits rather than a neurodevelopmental disorder;
Healthcare professionals may misinterpret ADHD diagnostic criteria as character flaws, overlooking the clinical significance of symptoms;
If symptoms are perceived as character flaws, healthcare providers may not conduct thorough assessments;
Stigmatization and bias associated with character flaws may influence healthcare professionals’ judgment, leading to a reluctance to consider ADHD as a valid explanation for behavioral patterns;
Misdiagnosis or underrecognition can delay appropriate interventions and support, impacting the individual’s quality of life and potentially exacerbating symptoms over time.
On the other hand if ADHD symptoms are misconstrued as character flaws, individuals may not receive the necessary interventions and accommodations tailored to managing their specific mental health needs, impacting their overall well-being and functioning.The Relationship of Personality with ADHD and it Symptom Domains: A Meta-Analytic Review (Gomez and Corr)
Impediment to Progress: Viewing ADHD symptoms as character flaws rather than a medical condition can impede progress in developing effective interventions and support systems for individuals with ADHD. Understanding ADHD: Toward an Innovative Therapeutic Intervention (Camp)
Labeling and Stigma: Receiving a diagnosis of ADHD can be stigmatizing, leading to negative self-perception and discrimination. The label can overshadow other aspects of an individual’s personality and abilities.
While awareness of ADHD as a mental condition is growing, some behaviors may be more eagerly taken as concerning. This has good and bad consequences. In some cases they may actually be symptoms of the disorder leading to starting treatment and perhaps improvement of the condition. On the other hand, it may result in overdiagnosis and overmedication and make the individual feel worse and stigmatized.
Children may internalize the reified (biological) narrative, affecting their self-perception and acceptance of questionable notions about their condition. ADHD and reification: Four ways a psychiatric construct is portrayed as a disease (Meerman et al.)
Blurring the lines between character flaws and mental illness in ADHD individuals may lead to increased stigma and discrimination, as individuals may be unfairly judged for behaviors that are actually symptoms of a mental health condition. The Relationship of Personality with ADHD and it Symptom Domains: A Meta-Analytic Review (Gomez and Corr)
Blurring the lines between character flaws and mental illness in ADHD can lead to increased stigma surrounding the disorder, making it harder for individuals to seek help and support Understanding ADHD: Toward an Innovative Therapeutic Intervention (Camp)
Negative Stereotyping: Individuals with ADHD may face negative stereotyping, being perceived as lazy, messy, or disobedient, which can impact their self-esteem and confidence. Understanding ADHD: Toward an Innovative Therapeutic Intervention (Camp)
Impact on Treatment Adherence: The blurring of lines can affect treatment adherence as (“ADHD and reification: Four ways a psychiatric construct is portrayed as a disease”)individuals may resist seeking help due to the fear of being labeled or stigmatized. Understanding ADHD: Toward an Innovative Therapeutic Intervention (Camp)
Social Challenges: People with ADHD may experience challenges in social interactions and relationships due to misunderstandings about their behaviors, potentially leading to social isolation. Blurring the lines can contribute to decreased self-worth and self-esteem in individuals with ADHD, potentially leading to other mental health issues like depression and substance abuse Understanding ADHD: Toward an Innovative Therapeutic Intervention (Camp)
Narrowing of Focus: Medicalization tends to focus on biological factors and pharmacological interventions, potentially overlooking the importance of environmental, social, and psychological contributors to ADHD. This can limit the scope of treatment and support options.
Misguided Treatment Approaches: Reification of ADHD as a concrete disease entity may lead to misguided treatment approaches that focus solely on the perceived biological aspects of the condition ADHD and reification: Four ways a psychiatric construct is portrayed as a disease (Meerman et al.)
Ignoring Individuality: ADHD manifests differently in different people. The medical model may not fully capture the nuances of individual experiences and needs, leading to standardized treatment approaches that may not be effective for everyone.
Totalization of Being: The scientific discourse of ADHD can totalize being by reducing unique characteristics of children to a brain disorder, ignoring alternative explanations and diverse characteristics. ADHD and reification: Four ways a psychiatric construct is portrayed as a disease (Meerman et al.)
Misinterpretation of Individual Differences: Overstating genetic research and presenting small correlates concerning brain physiology as applicable to all individuals with ADHD can lead to a misinterpretation of individual differences, further contributing to stigma. ADHD and reification: Four ways a psychiatric construct is portrayed as a disease (Meerman et al.)
Neglecting Alternative Approaches: The focus on medication can overshadow the potential benefits of alternative approaches like behavioral therapy, educational support, and lifestyle modifications, which can be effective for many individuals with ADHD.
The dominant, reifying, and medicalizing view of ADHD may influence how professionals and laypeople perceive the condition, thereby limiting the consideration of alternative approaches to treatment. ADHD and reification: Four ways a psychiatric construct is portrayed as a disease (Meerman et al.)
By portraying ADHD as a disease entity using medical jargon and metaphors, alternative non-medical interventions may be overlooked, limiting the scope of treatment options. ADHD and reification: Four ways a psychiatric construct is portrayed as a disease (Meerman et al.)
Overstating genetic research results and omitting societal factors in discussions about ADHD can contribute to a narrow view of the condition, potentially hindering the exploration of alternative treatment modalities. ADHD and reification: Four ways a psychiatric construct is portrayed as a disease (Meerman et al.)
Shifting Responsibility: Medicalization can shift responsibility for managing ADHD from the individual and their environment to the healthcare system, potentially reducing the individual’s sense of agency and control over their condition.
Perpetuation of Stigmatization: Reification contributes to perpetuating stigma by portraying ADHD as a concrete disease entity through language choice, logical fallacies, genetic reductionism, and textual silence. ADHD and reification: Four ways a psychiatric construct is portrayed as a disease (Meerman et al.)
Institutional Reality Perception: Reification leads to ADHD being perceived as an objective reality, affecting how social institutions like schools respond to children. ADHD and reification: Four ways a psychiatric construct is portrayed as a disease (Meerman et al.)
Conclusion
As we go along, and our knowledge is growing, character perception becomes more dependent on free will and perception of mental illness seems even more predetermined. Shifting perception of a behavior from a character flaw to a medical condition, like ADHD, provides patients with more chances for recovery but paradoxically it is perceived as less dependent on the patient by shifting responsibility from them and leaving them with limited options. This could make patients feel more depressed, discouraged and break their spirit, even if they are offered potentially a better cure.
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