The Difference Between Character Illness and Psychiatric Flaw

If we examine the definitions alone, psychiatric illness and character flaw seem like distinct concepts. Psychiatric illnesses are defined as “pathological psychological changes” that require professional diagnosis and treatment and are rooted in genetics, brain chemistry, and environmental stressors. Character flaws, on the other hand, refer to traits that hinder personal growth like biases, imperfections, and prejudices. Upon closer examination, however, the two concepts are similar because they both refer to behavioral patterns that impede one’s well being. In fact, for a period of time, depression, now a diagnosable psychiatric illness, was incorrectly characterized as a character flaw. Why then are some behaviors categorized as psychiatric illnesses and others as (non-psychiatric) character flaws?

In this essay, I will explore the fundamental differences between psychiatric illnesses and character flaws by delving into their histories and symptoms. There are many similar terms for psychiatric illness in the literature including mental illness, mental disability, mental disorder, psychiatric disorder, psychological disorder, and others. For the purposes of this essay, I will treat all of these terms as synonyms. Thus, if a quote refers to depression as a “mental illness,” I will refer to it as a “psychiatric illness” here. Character flaw lacks a medical definition; however, it is closely linked with the concept of personality, which is defined as “the characteristic manner in which one thinks, feels, behaves, and relates to others.” Thus, I interpret any colloquial terms in the literature like bad personality, bad character, obnoxious trait, and other negatively

connotated personality terms as “character flaws.”

Before the emergence of modern psychiatry, the term psychiatric illness did not exist, but societies around the world had various ways of identifying and treating behaviors that were deemed problematic. It would be easy to say that if there were no psychiatric illnesses, then such behavior was always seen as a character flaw, but this is simply not true.

Throughout history, many societies believed that disruptive behaviors had supernatural, somatogenic, or psychogenic origins. Supernatural theories attributed the behaviors to “possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin;” somatogenic theories attributed behaviors to a physical ailment or genetic inheritance; and finally psychogenic theories identified the root cause of disruptive behaviors as “traumatic or stressful experiences, maladaptive learned associations and cognitions, or distorted perceptions.” From these early categorizations, it is clear that if someone could identify a biological or spiritual root, the behavior was not labeled a character flaw, which is a trait inherent to one’s personality. Thus, two distinguishing factors emerge:

(a) Behaviors associated with psychiatric illness are the result of forces beyond the

individual’s direct control.

(b) Psychiatric illnesses can, but do not always, have a biological basis.

Character flaws, in contrast to psychiatric illnesses, are traits that are generally viewed as undesirable or problematic but do not stem from biological or medical conditions. These flaws are aspects of an individual's personality primarily shaped by environmental influences, upbringing, and personal choices that can hinder personal and social functioning but are typically within personal control and improvement. Examples of common character flaws include laziness, dishonesty, arrogance, and irresponsibility. Unlike psychiatric illnesses, which require medical intervention, character flaws are often addressed through personal effort, self-reflection, and behavioral changes. For example, a person might develop a tendency toward laziness due to a lack of discipline instilled during childhood or due to reinforcing social environments. In short, character flaws are behaviors that fall within a “normal” spectrum of human behavior and are not diagnosable or treatable with medical intervention.

It is important to note here that both diagnosis and treatment of abnormal behavior depended on context and were culturally determined. Issac writes that those deviating from cultural norms were usually the ones labeled as having a psychiatric illness because the majority viewed their own practices as correct. Having someone diagnosed with a mental illness and then forcefully treated for it was a means to exert control. For example, historically women have been labeled as “mentally unwell” when they expressed themselves differently from men, or led alternative lifestyles. From calling women witches to women being sent away for hysteria (“a mental disorder characterized by emotional outbursts, susceptibility to auto-suggestion, and, often, symptoms such as paralysis that mimic the effects of physical disorders”), the definitions of psychiatric illness have also changed at the whimsy of those in power to maintain the status quo. This is one reason why the definition of psychiatric illness has shifted over the years and in different contexts.

Definitions also continue to evolve as technology and medical science progresses. For instance, Greek physicians such as Hippocrates believed that both physical and psychiatric illnesses stemmed from an imbalance of “humors,” which were thought to be the four essential bodily fluids. These beliefs persisted into the 19th century. When bacteria was discovered as the source of infectious diseases in the late 1800s, German physicians Kraepelin and Alzheimer began working to identify psychiatric illnesses by biological indicators. As medical science and technology developed, previous ideas about what psychiatric illnesses were debunked and reformed.

While steps have been taken to establish an empirical basis for the diagnosis and treatment of psychiatric illnesses, definitions continue to change even in modern psychiatry, further muddling the difference between illness and character flaw. For example, around 1940 American psychiatry “emphasized individual differences rather than commonalities in illnesses,” and every practice had its own in-house classification system, meaning they all had different definitions of psychiatric illness and different ways of diagnosing them. In theory during this time period, a patient’s behavior could have been deemed a non-psychiatric aspect of their personality (character flaw) by one doctor and labeled a psychiatric illness by another.

Progress in research resulted in the establishment of standard diagnostic criteria and the publication of the Diagnostic and Statistical Manual, Mental Disorders (DSM) in 1952, which recognized both disorders that had a biological basis and those without evidence of “organic brain findings.” With every iteration of the DSM, psychiatric illnesses have come and gone or changed diagnostic criteria. For instance, post-traumatic stress disorder (PTSD) and borderline personality disorder were not classified as psychiatric illnesses until 1980. Before that, in 1942, Helene Deutsch didn’t describe BPD as a disorder but referred to people who expressed symptoms as having an “as-if” personality. Similarly, acute stress disorder, bipolar II disorder, and Asperger’s disorder were not classified as diagnosable illnesses until 1994, with the latter later being reclassified under the umbrella of autism in the next edition of the manual. Finally, homosexuality was first described as a “sexual deviation disorder,” then “sexual orientation disturbance,” before it was finally removed from the DSM altogether. These examples demonstrate how over time, the field of psychiatry has changed its stance on which behaviors are abnormal and the degree to which a behavior must be abnormal to be classified as a psychiatric illness. This history of changes in psychiatry tell us the following:

syndromes of covarying symptoms” based on empirical evidence.

(d) Behaviors are more likely to be examined as psychiatric illnesses if they deviate from a sociocultural norm.

The public will have different interpretations than mental health professionals regarding emotional responses and social behaviors. This is significant when discussing the difference between character flaws and psychiatric illnesses because historically, a person’s social circle was the first to determine if there was a behavior that required intervention; even today, family, friends, teachers, or co-workers often try to diagnose or suggest treatment for individuals based on their own conceptions of mental wellbeing.

Shirley Star conducted interviews that assessed public belief about mental illness in the 1950s. During the interviews, participants were asked to read scenarios depicting paranoid schizophrenia, simple schizophrenia, alcoholism, anxiety neurosis, juvenile character disorder, and compulsive phobia and identify the cause of the behavior. While most of them (75%) identified paranoid schizophrenia correctly, significantly fewer participants identified the characteristics of simple schizophrenia, alcoholism, and anxiety neurosis as psychiatric illnesses. In a 1996, follow up study that used vignettes based on criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-I), researchers found that participants were more likely to classify symptoms as a mental illness, and took that as a sign that the public understanding of mental illness was getting closer to definitions used in psychiatry. What’s interesting about the 1996 study is how participants identified the root cause of the symptoms. In almost all scenarios except cocaine dependence, the majority of participants thought the behavior was caused by stress, chemical imbalance, or upbringing. They attributed cocaine dependence, however, to a character flaw. These results indicate that even if psychiatry has classified a set of behaviors, such as cocaine dependance or substance abuse, as a psychiatric illness, the public is less likely to see it as such if there is a prevailing belief that the individual made the decision to engage in the behavior. In this case, the individual made the decision to seek out cocaine, which would reflect poorly on their character because cocaine is an illegal substance.

The evidence thus far has shown us that behaviors are more likely to be classified as a

psychiatric illness if:

(a) The individual feels they do not have direct control over their behavior.

(b) There is a biological basis for the behavior (but this is not required.)

(d) The behavior is outside of a socially acceptable norm.

Just like the markers have changed in the past, the definitions and classifications of psychiatric illness will continue to evolve as the field and modern technology develops, as well as while social norms continue to change. One ongoing debate is about differentiating between normal lying and pathological or compulsive lying. Several mental health websites write that lying is “natural” (socially acceptable) as well as a character flaw. However, professionals also admit that lying can also be a symptom of psychological dysfunction. This kind of “outrageous” lying was originally called “pseudologia phantastica” by psychiatrist Anton Delbrück in 1891; today, psychiatrists use the term pathological lying to refer to a frequency of lying that “impairs their

social, work, financial, or legal functioning.” While one study has found that there might be biological markers in the brains of pathological liars, such as the amount of white matter or an imbalance in the hormone-cortisol ratio, it is not a reliable way to distinguish between pathological lying and normal lying. Brain scans are neither part of the diagnostic process for pathological lying or other coexisting illnesses.

In this case, the boundary between psychiatric condition (pathological lying) and a character flaw (normal lying) is not well established. A paper by Muzinic et al. asserts that it is important to “assess the patient's control over lying, the function of lying, insight into and awareness of lying, as well as the effect of lying on everyday functioning” in order to work towards a proper classification for the behavioral pattern. Until then, to the layman or medical professional, categorization is ambiguous.

In conclusion, the lines between psychiatric illnesses and character flaws are often blurred, leading to stigmatization and inadequate support for those affected. With the development of modern psychiatry, scholars have sought to identify patterns of behavior and acknowledge groups of symptoms as an illness if it causes a disruption to the life of the patient and can be backed by empirical evidence. As laboratory tests and diagnosis methodologies develop, more non-psychiatric behaviors may come to be considered mental illnesses. Until then, those behaviors will likely be viewed as character flaws or the result of temporary extenuating circumstances. Because many consider this inadequate, there are calls for revision of DSM diagnostic standards and a reconceptualization of psychiatric illness to better reflect the messy reality of human behavior. Such changes in psychiatry and in public discourse would help in providing appropriate care and foster a more compassionate and informed society.

Endnotes

1. Crawford, J. P. (1955). Psychiatric Illness and Health. Postgraduate Medical Journal, 31(354), 180.

2. Widiger, T. A. (2011). Personality and psychopathology. World Psychiatry, 10(2), 103.

3. Farreras, I. G. (2024). History of mental illness. In R. Biswas-Diener & E. Diener (Eds), Noba textbook series: Psychology. Champaign, IL: DEF publishers.

4. Isaac, C. (2016). The Evolution of Mental Illness Definitions and Its Effects on Media Representations:

A. The Compass, Issue 3, 89(9), 20.

5. “Hysteria,” Dictionary.com, s.v., accessed 2015, http://dictionary.reference.com/browse/hysteria

6. Farreras, I. G. (2024). History of mental illness. In R. Biswas-Diener & E. Diener (Eds), Noba textbook series: Psychology. Champaign, IL: DEF publishers.

7. Surís, A., Holliday, R., & North, C. S. (2016). The evolution of the classification of psychiatric disorders. Behavioral Sciences, 6(1), 5.

8. Surís, The evolution of the classification of psychiatric disorders.

9. Surís, The evolution of the classification of psychiatric disorders.

10. OPI Team. (2014, August 25). The History of BPD: From Past to Present. Optimum Performance Institute.

11. Surís, The evolution of the classification of psychiatric disorders.

12. Kendler, K. S., & First, M. B. (2010). Alternative futures for the DSM revision process: iteration v. paradigm shift. The British Journal of Psychiatry, 197(4), 263-265.

13. Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., & Pescosolido, B. A. (1999). Public conceptions of mental illness: labels, causes, dangerousness, and social distance. American journal of public health, 89(9), 1328-1333.

14. Ibid.

15. Johnson, J., & Barkley, S. (2022, August 12). Compulsive Liar vs. Pathological Liar: Traits, Mental Health, and More. Psych Central.

16. Yang, Y., Raine, A., Narr, K. L., Lencz, T., LaCasse, L., Colletti, P., & Toga, A. W. (2007). Localisation of increased prefrontal white matter in pathological liars. The British Journal of Psychiatry, 190(2), 174-175.

17. Muzinic, L., Kozaric-Kovacic, D., & Marinic, I. (2016). Psychiatric aspects of normal and pathological lying. International journal of law and psychiatry, 46, 88-93.