Is Borderline Personality Disorder a Moral or Clinical Condition? Assessing Charland's Argument from Treatment

Neuroethics (2014) 7:215226 DOI 10.1007/s12152-013-9199-3

ORIGINAL PAPER

Is Borderline Personality Disorder a Moral or Clinical Condition? Assessing Charlands Argument from Treatment

Greg Horne

Received: 19 May 2013 /Accepted: 18 November 2013 /Published online: 4 December 2013 # Springer Science+Business Media Dordrecht 2013

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 patients 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.

Keywords Borderline personality disorder. Cluster b personality disorders . Dialectical behaviour therapy. Mentalization-based treatment . Moral treatment

Introduction

Is borderline personality disorder (BPD) a fundamentally moral condition or a fundamentally clinical condition? Recently, philosophers and psychiatrists have shown an increasing amount of attention to the more general question of whether all Cluster B personality disorders (CBPDs)1, including BPD, are moral conditions or clinical conditions. This interest is not surprising, given that up until the past two decades, CBPDs have proved recalcitrant to clinical treatment, and BPD especially so [1]. The debate surrounding this question was largely instigated by Charland [2], who put forth a sharp and provocative two-pronged argument that attempts to show that CBPDs are primarily moral, rather than clinical, kinds.2

The first prong of Charlands argument, which he calls the argument from identification, uses philosophical analysis of the language used in the DSM-IV [3] to reveal that...