Antisocial Personality—Diagnosis or Moral Judgment?

Abstract

Antisocial personality is a problem-filled diagnosis. Even when diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) II manual, it was replete with value laden terminology. DSM III makes repeated criminal behavior central and includes a list of other behaviors that do not always truly imply an antisocial personality. In order to test the possibility that factors other than those listed in the manual may often influence the diagnosis, the prevalence of required characteristics in patients diagnosed antisocial personality was compared with the prevalence of required characteristics in another personality disorder, schizoid personality. The study involved a hospitalized Veteran's Administration (VA) population, employing DSM II criteria, which was used by the VA at that time. The difference was statistically highly significant. Examination of the case histories suggests that dislike of the patients or negative moral judgments about their actions frequently were involved in making a diagnosis of antisocial personality. It is therefore crucial that moral judgments not be disguised as scientific ones, and the meaning of an antisocial personality diagnosis as utilized by clinicians needs to be seriously questioned.

Hebephilia: Quintessence of diagnostic pretextuality

“…Research in correctional settings suggests that a large proportion of offenders meet the minimum criteria for this nonspecific diagnosis with poor construct validity (Rogers & Dion, 1991). In routine correctional practice, the diagnosis is often invoked arbitrarily based on race (Stevens, 1993) and/or to convey a negative message to other clinicians (Rhodes, 2000;Toch, 1998;Weinstock & Nair, 1984). In court, use of this diagnostic label stigmatizes defendants, priming judges and jurors to perceive them negatively (Graham & Lowery, 2004;Greenberg, Shuman, & Meyer, 2004).…”

The Role of Traditional Medical Ethics in Forensic Psychiatry

“…Even in clinical work, a truthful diagnosis such as antisocial personality may be harmful to a patient. 45 Although traditional Hippocratic values or biases should not operate in the attempt to reach a truthful honest opinion, they should operate in the decision about whether to participate or in how the opinion will be used-at least to the degree that the forensic psychiatrist has any control over this process. If he determines that some harm would be done to the defendant but good would be done to society, most forensic psychiatrists would probably see no ethical conflict.…”