"If only I could use this to show people that there really was something different about my brain, my life would be so much easier." This is the reflection of an individual with a history of severe depression. The results of magnetic resonance imaging (MRI) highlighted particularities of his depressed brain through demonstrating shrinkage, particularly in the hippocampus, thalamus, frontal cortex, and prefrontal cortex. Despite suffering from a severe condition, he was subject to prejudice due to the perceived illegitimacy of his illness. Others described him as lazy, selfish, or devoid of the willpower needed to navigate the fundamental obstacles of life (Gergel, 2014). In other words, his psychiatric illness was confused for failings in his character. 

 

Psychiatric illnesses, or more commonly "mental illnesses," are defined as severe disturbances resulting in inappropriate emotional reactions, confused thinking, or dysfunctional behaviour (World Health Organization, 2022). These divergences from what is considered normal often lead to adverse hindrances to developmental processes (Roudiez, 2019). Psychiatric illnesses arise from several causes, including genetic factors, chemical imbalances, or abnormalities in brain structure as diagnosed by psychiatric professionals. Character flaws can also influence their thoughts, actions, and decisions, but to a lesser extent than psychiatric disorders. Converse to diagnosed illnesses, character flaws are traits that are commonly considered "immoral" or "unvirtuous" that individuals have control over and can consciously improve through personal growth. Examples of character flaws include greed, pride, jealousy, impulsivity, or dishonesty (Solace Asia, 2023). This essay will acknowledge the relevance of both concepts in Western psychology, focusing on the ways we can distinguish psychiatric illnesses through how they are socially perceived and recovered from. 

 

Structural Differences

Psychiatric illnesses are identified using paradigms and research from psychology, whereas character flaws are derived from foundations of ethics and morals. Scientifically, psychiatric illnesses require rigorous diagnostic procedures to be identified. Patients presenting symptoms meet with psychiatrists, who prescribe medication, psychotherapy, or both, to treat diagnosed illness including depression, schizophrenia, obsessive-compulsive disorder, substance abuse, and mania (Roudiez and Radden, 2019). 

In Western psychology, two major manuals, the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), represent the scientific and healthcare criteria for diagnosing conditions. This methodical approach ensures that healthcare professionals can accurately identify and treat conditions through well-established and standardised clinical symptomatology, employing effective pharmacotherapy and psychotherapies. These tools are crucial for healthcare practitioners to identify conditions despite the fact that psychiatric disorders are not always distinctly identifiable, but rather are complex combinations of psychological issues (Clark et al., 2017). This methodology has been proved effective in common psychiatric disorders. For individuals with depression, the level of neurotransmitter serotonin, seen as small circles in images, is reduced by selective serotonin reuptake inhibitors (SSRIs). By taking levels of serotonin back into the presynaptic neuron, there is increased serotonin available in the synaptic space (NCBI, 2007). Likewise, in MRI studies of schizophrenia, a study found a reduction in grey matter volumes within the medial temporal, superior temporal, and prefrontal areas, where episodic memory, processing of auditory information, and short-term memory or decision making, respectively, take place (Sun et al., 2024). Abnormalities in grey matter for schizophrenia are partially hereditary and partially modulated by intrauterine risk exposures like foetal hypoxia, reflecting reductions in dendritic complexity and synaptic density, frequency impacting interneuronal communication. For patients who later developed psychosis––often an aftermath of schizophrenia––there was an additional brain surface contraction away from the skull in the prefrontal cortex (NCBI, 2010). 

Conversely, character flaws are not identified by or categorised according to standardised psychological understandings, but are rather conceptualised according to a moral and philosophical construct, reflecting deficiencies in personal behaviour. Character flaws are a part of vice, which is "all that is contrary to natural laws and duties" (Jaucourt, 2002). Aristotle defined vices as qualities without virtuous influence, giving in to self-centred motives (Williams, 1998). Cowardice is a vice demonstrated by a surrender to fear in the absence of courage, and self-indulgence is a vice that results from the abandonment of restraint. From this perspective, vices and character flaws are actions that may arise from natural motives, expressed in ways a fully virtuous person would not. Unlike a psychiatric illness, where behavioural symptoms can be traced to a psychological condition, no diagnostic criteria can place an individual on the spectrum of “virtuous” or “evil.” However, from the interactions of an average person, observable characteristics may have crossovers, thus leading to some similarities in social perception. 

 

Stigma Differences

Psychiatric illnesses are considered with greater severity over character flaws. While the amount of stigma towards character flaws, a factor within an individual's control, outweighs the amount of stigma towards a difficult-to-control condition, diagnosed individuals are greater impacted by stigma. Stated by author Tania Louise Gergel, stigma is defined as "a mark of disgrace," and in the case of an individual with a psychiatric illness, it can occur from two perspectives: "unlikeness-based stigma" and "likeness-based stigma" as Gergel phrases. Either the diagnosed individual is significantly different from the rest of society and likely to be excluded, or the individual is not so different from everyone, resulting in their illness being overlooked (Gergel, 2014). "Unlikeness-based stigma" is easier to understand. It characterises the experience of discrimination due to illnesses, which impacts an individual’s ability to reach their full potential and overall engagement in society. For instance, individuals suffering from severe depression experience fatigue, lack of concentration, and persistent sadness (Sawchuk, 2022). Similarly, those suffering from schizophrenia find difficulties engaging in social interactions due to hallucinations or delusions, consequently resulting in social isolation and difficulties obtaining employment (American Psychiatric Association, 2024). Because of these issues, people with psychiatric illnesses are considered "intrinsically different," or "alien," making it easier for them to be "easily feared, ridiculed, or restrained." 

Conversely, likeness-based stigma usually results in overlooking psychiatric illness and confusing it with a character flaw. It takes on the view that people with psychiatric illnesses are "fundamentally the same, but lazy, weak, or incapable" and they are to blame  for their condition. (Gergel, 2014). This results in the issue being overlooked, with people believing that, because psychiatric illnesses are intangible, they are not true medical illnesses (Gergel, 2014). Character flaws, like psychiatric illnesses, also receive likeness stigma considering they're in individual control, but rarely receive unlikeness stigma unless the flaw is highly severe and misinterpreted as a psychiatric illness. Common traits like excessive pride may make an individual less appealing, but will not be likely to result in drastic exclusions from participation in society as a whole. Rather, character flaws are comparatively more accepted as part of the modern notion of celebrating human imperfections, with the belief that these traits do not define an individual's identity (Kelly, 2024). 

 

Legal Differences

Because of the gravity of the issue, people with diagnosed illnesses are more likely to be assessed in legal contexts, where the defendant’s mental state is relevant to their capacity to understand and control their actions. The insanity defence exemplifies this. Through four tests––namely The Model Penal Code Test, The Durham Rule, The Irresistible Impulse Test, and The M'Naghten Rule––defendants can plead that while a criminal act has been committed, there is a lack of culpability due to a mental illness (Cornell Law School, n.d.).  An individual with paranoia may claim to be free of legal guilt by reason of insanity. Most psychiatrists acknowledge how those affected by paranoia unreasonably believe the world is “out to get them,” resulting in unjustified actions arising from fear (UMN Libraries, 2015). Character flaws, while also having the potential to affect quality of life in any environment, have a lesser impact than psychiatric illnesses. For instance, someone perceived as lazy may face challenges building professional relationships, though it would generally not incapacitate them from participating in the working world entirely. While flaws like selfishness and arrogance are common, they are also seen as controllable traits. Thus, character flaws do not play a part in legal contexts because their ability to be controlled would not affect their legal responsibilities, believing that individuals can and should overcome their personal deficiencies. 

 

Recovery Similarities

Psychiatric illnesses, even when not fully cured, can be minimised through professional treatment and medication. Between psychiatric illnesses and character flaws, only psychiatric illnesses can be medically treated, but recovery for both has several overlaps. Psychotherapy involves treatment under the guidance of a mental health professional, guiding a patient to change their thoughts or behavioural patterns. These sessions may cover past experiences, problem-solving approaches, and illness management. Whether it be individual, couples, family, or group therapy, psychotherapies for psychiatric illnesses have a universal goal: to reduce symptoms of psychiatric illness. Apart from eliminating society's most common conditions like addiction, anxiety, depression, eating disorders, and post-traumatic stress, psychotherapists have notably aided less health-threatening issues, like character flaws (Cherry, 2023). In analysing cognitive-behavioural therapy (CBT), a reported "75% of people receiving anger management therapy improved as a result" (American Psychological Association, 2017). This is similar to counselling, a shorter, less extensive version of therapy. However, for individuals with lower income and limited resources, the recovery process hinges on the individual approach. For both a psychiatric illness and a character flaw, individuals can use self-help books, reflective journals, habit trackers, and personal relationships. While treatment for psychiatric illnesses is seemingly more systematic, a mental recovery process is tailored to what individuals find most effective for themselves. 

 

Conclusion

While psychiatric illnesses and character flaws differ in clinical nature and treatment approaches, they share overlaps in their hindrances to an individual’s participation in society and quality of life. Certain character flaws are manifested through symptoms of psychiatric illnesses, and psychiatric illnesses occasionally stem from a growing character flaw. For instance, obsessive-compulsive disorder involves biological underpinnings resembling the trait of perfectionism. However, their differences are the crucial insight to how future developments in Western psychology can guide inclusive psychological treatments. In Western psychology, psychiatric illnesses are based on a scientific standard and are thus given greater consideration in legal settings or treatment. This differs from the philosophical background of character flaws, which are less prone to all types of stigma and less likely to be perceived as a serious matter in defence and treatment due to the less detrimental severity of the issue. Clarifying these distinctions is pertinent to how an individual goes about their own recovery process, ensuring that there is minimised confusion regarding how a person should view and treat their own challenges, whether it be a diagnosed illness or a controllable flaw. 

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