Personalism & the Medicalization of Morality*

If every action which is good or evil in a man of ripe years were under pittance and prescription and compulsion, what were virtue but a name, what praise should then be due to well-doing, what gramercy to be sober, just, or continent?

                                                                                          John Milton

Personalism is both a modern attitude and an implicit ideology that enthusiastically advances the liberation of the individual self from traditional institutional and conventional constraints. Liberation of the self from the constraints of convention necessarily involves an abandoning of self-restraint. Self-restraint has long been encouraged by ancient and modern moralists: the personalist, however, equates self-restraint with repression and judges it to be unhealthy.

With the increasing bureaucratization and rationalization of modern life and its resulting fragmentation, the appeal and attractiveness of personalism has intensified over the last two hundred years. Personalism has relentlessly expanded its reach and both broadened and refined its applications.  It permeates our thinking and conditions many if not most of our assumptions about how we should give order to our lives, discharge our obligations, and develop our expectations of ourselves and others. It has deeply affected in numerous ways many or most of our social institutions.

Personalism has also altered the premises of our moral conversations. We talk in a different way, and thus ultimately think about ourselves and our action, specifically about our personal accountability for the things that we do and the kinds of people we want to become. The shift in vocabulary is an important measure of a basic transformation in the way we think about what principles we should live by, in the assumptions we make about how we ought to act as human beings and as members of communities bound by moral obligations. Our ethical figures of speech, our basic tools of moral articulation, if you will—applied to matters of individual accountability and moral character—have changed remarkably over the last fifty years and reflect what is a relatively new but increasingly dominant perspective of human conduct in our society. 

This perspective is one of the most distinctive marks of our age. It rests upon an understanding of human behavior that regards conduct considered by our predecessors to be vicious, immoral or sinful, as a manifestation, more precisely, a “symptom” of sickness, illness or disease. That view of behavior reflects an important, perhaps the most important, of the many twentieth-century revolutions :the medicalization of morality.

This view is revolutionary because the entire sphere of human conduct to which moral evaluation and judgment have been applied (that sphere of human conduct in which the freedom of an individual to make choices and to be held accountable for those choices), has increasingly become subjected to evaluation by experts who employ a normalcy-pathology perspective of behavior. Human conduct under a medicalized view is regarded as a causally determined phenomenon: the method for dealing with problematic conduct, given this view, is a therapeutic one. The science of medicine and the related practice of the therapeutic arts have been applied to problems of human conduct once considered as moral ones engaged in by beings once considered morally responsible and personally accountable. Thus, the sorts of deeds that traditional moralists have been usually disposed to consider as “immoral” conduct are now understood as the behavioral effects of pathologically induced causes. As the medicalized perspective of moral conduct comes to dominate our thinking, the notion of immoral or sinful conduct upon which blame is properly directed and upon which punishment is justly applied must give way to the recognition that human wrong doing is ultimately a symptom of mental illness to which treatment must be given.

The medicalizing of morality is a most important late-twentieth-century social phenomenon with far reaching consequences for our everyday lives. Viewing the moral core of our lives differently than we once did means that we begin to act differently than we did before. Medicalizing the assumptions about human behavior de-moralizes our notion of moral conduct. This de-moralization process is captured in a vocabulary in which important moral words that have been traditionally applied to human wrong doing—immoral, evil, reprehensible, blameworthy—are conspicuously absent. The removal of the words that prescribe blame and punishment for wrong doing brings the disappearance of the notions behind the words. Then there follows the decline of the practice of blaming or punishing people for wrong doing. A medicalized approach to morality prescribes treatment rather than punishment for people who do things that they are not supposed to do. Punishment deliberately inflicts pain. Treatment, on the contrary, attempts to minimize pain and to change behavior that we disapprove of into behavior we approve of: so why intentionally inflict pain when it is unnecessary to do so?  Such is the logic and the ethic of medicalization.             

The medicalization of morality creates a dramatic turning away from our traditional moral practice of holding individuals accountable for their actions and the kinds of people that they become. This turning away is a turn toward personalism.  One important and specific concrete measure of the extent to which the medicalization of morality has been successful in transforming our attitudes towards certain kinds of behavior and our practical responses to them can be seen with the passage by Congress of The Americans for Disability Act of 1990, a milestone in civil rights federal legislation signed into law by President George Bush. The ADA put the official and legal stamp of medical “disability” on many kinds of behavior that used to be commonly regarded as vices under the old nomenclature, such as habitual drunkenness and gluttony—now alcoholism and eating disorders—along with a whole host of other addictive and compulsive “disorders” such as drug addiction and compulsive gambling. Institutions are responsible now not only for relinquishing any attachment to “judgmental” or moralistic views of these sorts of behaviors but, more importantly, must provide those who “suffer” from them with what the law makers have called “reasonable accommodation.” Sorting out the meaning of the highly disputable “reasonable” in a society already immersed in moral subjectivism and relativism and its implications for the obligations imposed upon institutions, of course, must ultimately be done by means of litigation with all of the attendant social and financial costs and with an enormous shift of formal power to the adjudicating legal system.
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*Excerpted from Stephen Paul Foster, Desolation's March: the Rise of Personalism and the Reign of Amusement in 21st-America, Bethesda, Md. Academica Press, 2003.
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