There are many different ways to frame this, but you chose the moral one. In any case, some people are, in fact, “bad.” Not irredeemable or wholly bad, mind you, but certainly bad in the sense that their personality structure is such that it leads them to repeatedly do bad things.
I think that the DSM is the source of the moral framing here, which is why I am not a fan of the diagnosis of conduct disorder. To illustrate, I will apply Jonathan Sadler's Moral Wrongfulness Test (MWT) when analyzing diagnostic categories to see how irretrievably moral judgments are embedded in the definition of the disorder in question. The MWT is simple and poses two basic questions when examining any psychiatric diagnosis:
1. Would a substantial number of people of this culture, when considering the behavior or experience in question, conclude that this behavior or experience is morally wrong?
2. Is it possible to revise or eliminate morally-laden criteria while preserving the basic structure of the disorder?
If a disorder has criteria that are heavily morally-laden and it does not seem to be possible to simply eliminate the morally-laden criteria, Sadler would suggest that we should be thinking very hard about whether we are really talking about a disease entity or simply a way of medicalizing our values.
Let's compare and contrast conduct disorder with schizophrenia. My comments in bold.
Conduct Disorder
A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:
Persistently violating the basic rights of others and breaking major social rules repetitively is absolutely something a significant number of people would conclude is morally wrong. If it's not bad to violate people's rights, in what sense are they rights?
Aggression to People and Animals
1. Often bullies, threatens, or intimidates others.
Does anyone really think bullies who go around threatening people are acting in an upstanding and morally correct fashion? "bullies" presupposes that this threatening and intimidation is not justified.
2. Often initiates physical fights.
Many people feel that it is wrong to constantly be starting physical altercations, but maybe there are good reasons, give it a pass
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
Without very good justification this is definitely a no-no for most people's morality. The particular list of weapons suggests something very opportunistic but say we strike that, maybe we can give it a pass
4. Has been physically cruel to people.
"Cruel" presupposes vice, basically.
5. Has been physically cruel to animals.
Ditto.
6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
You're not just taking something that doesn't belong to you or stealing, you are stealing from a "victim", which means you are victimizing them. This is generally regarded as a morally bad thing. You also have to be doing it while confronting them and the examples support the idea this is to be understood as stealing from them in a violent way, which most people would regard as double-bad.
7. Has forced someone into sexual activity.
I really hope it doesn't have to be explained why this is morally wrong.
Destruction of Property
8. Has deliberately engaged in fire setting with the intention of causing serious damage.
Not starting fires because you have some irresistible impulse, but specifically to be destructive and in a calculated, controlled way. I don't see how you rephrase this in a morally neutral way.
9. Has deliberately destroyed others’ property (other than by fire setting).
Could be accidental, gets a pass.
Deceitfulness or Theft
10. Has broken into someone else’s house, building, or car.
Fairly neutral, maybe they forgot their keys and you are helping them out. Locksmiths are not intrinsically evil.
11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
You cannot "con" someone in a morally good way, and obligations are obligations because we recognize that you are morally obliged to honor them. If avoiding them is not bad they are not actual obligations.
12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).
Maybe you are desperate and just trying to get by, could be regrettable but necessary. I don't think it's hard to imagine scenarios in which anyone might do this with a heavy heart. Certainly much less wrong than number 6, let's give it a pass.
Serious Violations of Rules
13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
You wouldn't want your kid to do it, but not necessarily wrong.
14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
Again, alarming to a parent but could be there's a very good reason.
15. Is often truant from school, beginning before age 13 years.
Morally neutral, unless you believe that children missing school is morally wrong, in which case be prepared to apply that judgment to any family that takes their kids out a couple days early to go on vacation.
Leaving just the criteria that aren't obviously value-laden, we have a disorder with seven possible criteria. Three of them have to do with not listening to your parents and playing hooky, Also maybe you start fights that get real serious real fast and you steal things without directly hurting anyone. Not ideal childhood behavior, sure, but maybe your parents suck and you grow up in a rough neighborhood.
@sloop , can we agree that what is left of conduct disorder in this analysis is missing a lot of the core features that probably make it predictive of ASPD? I also wonder how one would justify what remains as mental disorder. So I think we can conclude that conduct disorder is a heavily moral-laden construct.
Whereas schizophrenia:
Two or more of the following for at least 1 month (or longer period of time), and at least one of them must be a 1, 2, or 3:
delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative symptoms, such as diminished emotional expression
While all of these things can be unnerving and certainly upsetting and impairing for the person experiencing them, I am hard-pressed to imagine anyone describing, say, hallucinating as being morally wrong in and of itself.
Impairment in one of the major areas of functioning for a significant period of time since the onset of the disturbance: Work, interpersonal relations, or self-care.
If you wanted to be a very strict Aristotelian you might say this is intrinsically vicious (in the sense of vice) but I think that's a pretty rare intuition. Doesn't seem to have a significant moral judgment embedded in it, though obviously not free of subjectivity.
Some signs of the disorder must last for a continuous period of at least 6 months. This six-month period must include at least one month of symptoms (or less if treated) that meet criterion A (active phase symptoms) and may include periods of residual symptoms. During residual periods, only negative symptoms may be present.
Boring time-keeping, not morally relevant.
Schizoaffective disorder and bipolar or depressive disorder with psychotic features have been ruled out:
- No major depressive or manic episodes occurred concurrently with active phase symptoms
- If mood episodes (depressive or manic) have occurred during active phase symptoms, they have been present for a minority of the total duration of the active and residual phases of the illness.
I fail to see the moral wrongness or lack of virtue here. Just a question of interpreting chronology and collecting adequate information.
1. The disturbance is not caused by the effects of a substance or another medical condition
If anything this vitiates the possible moral judgment some might attach to hallucinating or being delusional because of, say, smoking weed.
2. If there is a history of autism spectrum disorder or a communication disorder (childhood onset), the diagnosis of schizophrenia is only made if prominent delusions or hallucinations, along with other symptoms, are present for at least one month.
Again, no questions of moral relevance here. No one would conclude that someone actually has a childhood communication disorder, therefore that person is insalubrious.
Schizophrenia as a diagnosis is not value-free (there are assumptions about autonomy, functional independence, and 'productivity' standards we hold adults to) but it is not an especially moral value-laden construct. You will note how starkly different this is to conduct disorder. And for those who say we should be really comparing to personality disorders, I would suggest applying the MWT as an exercise. I think you will find that personality d/o's actually differ a fair bit in the extent to which they pass the MWT, but it is fair to say that ASPD does not under most analyses, which does not increase my confidence that its obligate predecessor is morally neutral.
The other, less judgmental way of framing it is that humans have evolved prosocial behaviors, and the selective pressures have formed a distribution with central tendency just as with most other behaviors that have consequences for fitness and survival. Even so, some people are going to fall on an extreme of the distribution as a matter of temperament, and those people cause significant problems for the social fabric. In more primitive societies, these people would probably have been left to starve in a valley somewhere but we’ve rightly decided that there must be better ways to treat these people or even rehabilitate them. Still, these types of problems cause significant obstacles to successful integration into society.
I am very leery of ev-psych explanations for this sort of thing because you can construct arbitrarily many just-so stories with enough handwaving at the "ancestral environment", which ends up being underspecified in the extreme and also often based on modern hunter-gatherers, a population of people who notably life in
the geographical areas so resource-poor that nobody bothered displacing them. I don't know a pattern of facts that ev psych could not in principle explain about human behavior, and that is a serious problem. As Jerry Fodor put it, 'Mother Nature is God in drag."
Given that most of what we treat in psychiatry is functional impairment, I fail to see why this is much less valid a characterization than anything else we treat.
People plausibly fall on a distribution when it comes to innate musical talent, and some people seem like they don't have a musical bone in their body. Say I am one of those people and I had parents who were concert pianists. They are very invested in me being a professional musician and I also aspire to this, but I just can't seem to get the hang of it and remain terrible no matter how hard I work. This causes me a lot of distress and certainly impairs my chances of being a professional musician.
Is "can't carry a tune in a bucket" a mental disorder? Why not? Having established that, why does conduct disorder count?
You could make the argument that conduct disorder and ASPD likely capture a variety of different pathologies, but that argument could be made of any number of disorders including schizophrenia.
I agree with you there for sure.
