Narratives of Troubled Journeys: Personality disorder and the medicalisation of moral dilemmas

Abstract

This thesis examines the interaction of the medical and moral in the historical evolution of “personality disorder” starting with the relationship between Prichard’s (1835) diagnosis of “Moral Insanity” and an anti-modern religious text (Hancock, 1824) describing disorder of the moral faculty. Moral insanity is traced through to Psychopathic Personalities and the military’s Medical 203 to Personality Disorder in DSM I (1952) through to DSM 5 (2013). The extent to which DSM medicalises everyday moral categories is examined by building on the works of writers theorising moral orders and moral selves, such as Harré (1993), Bakhtin (1981, 1984, 1986) and Taylor (1989). This thesis moves from macro-level concerns to the micro-level using dialogical narrative methodology (Sullivan, 2012) alongside Bakhtin’s conceptual tools to examine how medical and personal narratives of "Personality Disorder" interact in lived experience by analysing a triangulation of my psychiatric clinical notes, contemporary diary entries and an autobiographical account. An analysis is undertaken of several diverse autobiographical accounts of ‘successful’ recovery from mental health crisis already available in the public sphere. Consideration was given to how concepts developed throughout this study might be used in future work, concepts such as “dialogical search for a new narrative”, the dialogical ethics of “habitual excess and insufficiency” and “authoritative narrators”. This thesis’s originality is in linking DSM 5’s diagnosis of personality disorder to anti-modern moral discourses on disorder of the moral faculty, and in revealing complex genre relationships between literal/medical and literary/moral understandings of emotional and mental crisis and recovery.