Entre a insanidade e a imoralidade: uma análise da racionalidade da classe diagnóstica dos transtornos da personalidade

Abstract

This article aims to investigate the rationale that structures the diagnostic class of Personality Disorders. The Psychiatric discipline faces a persistent conflict regarding the ontological status of emotional and behavioral diseases, an element necessary to ensure the legitimacy of these conditions for medicine. Moral and social standards as references for the definition of Personality Disorders makes this conflict even more blatant. Given the attempt of the main current diagnostic manuals to promote an asepsis to a series of diagnostic categories that, in reality, carry philosophical, historical and cultural assumptions, and that are the result of epistemological encounters and disagreements, the interest in analyzing the rationale that underlies the nosological entities of the Personality Disorders class is justified. A bibliographical research was carried out, in which the eight editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) were analyzed. The history of this class in DSM denounces that the essential characteristic that these diagnostic categories share is the quality of moral deviation. The epistemological foundation of the Personality Disorders class can be located in the need to create nosological entities to frame cases that pertained to a certain indeterminacy and ambiguity with regard to madness, marked by volitive and affective changes, accompanied by the conservation of intellectual faculties. Considering the DSM’s search for diagnostic reliability, which demands the removal of subjectivity in the clinical setting, and the adoption of a naturalistic and descriptive paradigm, it is understood that the class of Personality Disorders is constitutively and permanently ambiguous.