Ethics: Individual Marriage Group and Community

Ethics

Individual, Marriage, Group, and Community

Ethics: Individual, Marriage, Group, and Community

The Mental Health Profession is committed to treating the whole psychological person. That commitment requires the consideration of both moral and clinical categories for the effective diagnosis and treatment of the patient. Exclusive reliance on either moral or clinical categories may result in an incomplete diagnosis, ineffective treatment and ultimately a failure of the practitioner's ethical duties to the patient and to the patient's spouse, groups and community.

Ethical Implications of Using Exclusively Clinical Categories or Exclusively Moral Categories for Diagnosis

The Mental Health Profession's ethical responsibility to the individual, marriage, group and community begin, at least theoretically, with diagnosis of the individual. The vital coaction of Moral and Clinical categories has emerged as scholars examine the implications of the DSM-IV. In fact, thoughtful review of DSM-IV categories reveals that personality disorders in Clusters A and C (AllPsych, 2002) are clinical disorders while personality disorders in Cluster B (AllPsych, 2002) are moral disorders (Charland, 2006, p. 117). Cluster A disorders -- paranoid, schizoid and schizotypal disorders, and Cluster C disorders -- Obsessive-Compulsive, Avoidant and Dependent Personality disorders, are set forth in clearly clinical terms (AllPsych, 2002). However, Cluster B disorders, including borderline, narcissistic, histrionic and antisocial types of disorders (Ivy_League0.tripod.com, n.d.; Vaknin, 2009, Slide 121), are "morally loaded" and morality is an essential element of their descriptions (Charland, 2006, p. 119). Since a patient is quite capable of being simultaneously obsessive-compulsive and antisocial, for example, a thorough diagnosis of the individual must involve a probing inquiry of both clinical and moral categories.

Using strictly moral categories in diagnosis will necessarily limit the mental health professional to Cluster B disorders, curtailing the practitioner's ability to correctly diagnose Cluster A and Cluster C disorders, which the DSM-IV explicitly sets forth in clinical terms. Furthermore, treatment of Cluster A and Cluster C disorders does require "[w]illingness, commitment and effort" but "moral willingness, commitment and effort…is not required" (Charland, 2006, p. 123). In addition, pharmacological treatment may be necessary for the effective treatment of Cluster A and Cluster C disorders but will not be readily used for disorders limited to exclusively moral categories (Charland, 2006, pp. 121-122). Finally, Charland raises the concern that clinically trained therapists might not have sufficient training to treat exclusively moral disorders (Charland, 2006, p. 117). Consequently, reliance on merely moral categories will cause the mental health professional to misdiagnose and mistreat any Cluster A or Cluster C disorder present. The ethical implications of exclusively moral categories for the patient, the patient's spouse, his/her group and the community are clear: the moral-centric practitioner will fail in his/her duty to correctly diagnose and treat this patient and other patients, harming or at least failing to help the patients' spouses, groups and communities.

Using exclusively clinical categories in diagnosis may well cause a misdiagnosis. As Charland states, "one could argue that it is logically impossible to properly identify the Cluster B disorders without presupposing moral terms and notions or using descriptions that imply such moral terms" (Charland, 2006, p. 119). By disregarding moral categories in diagnosis, the practitioner is deliberately discarding a tool that can empower him/her to predict how the patient will behave (Charland, 2006, p. 119) in marriage, groups and community. The patient's predictable immoral behavior is conceivably visited upon his/her marriage partner, group and community; consequently, the mental health professional who ignores moral categories will be shirking his/her duty to the broader interests of the patient's marriage partner, group and community. Furthermore, Charland argues forcefully for the trend toward holding patients with Cluster B disorders morally accountable for their actions, which presupposes adequately diagnosing those disorders with moral categories.