On Wakefield's harmful dysfunction analysis of mental disorder
Section snippets
Identifying natural functions
Wakefield holds that disorder is a hybrid concept comprising a factual component and a value component. The factual component specifies what has gone wrong, and the value component specifies the resultant harm. A harmful condition, however, is not a disorder unless it involves a failure of a psychobiological mechanism to perform its natural function. Identifying the function of an artifact (e.g., a pencil) is easy; one merely cites the purpose for which it was designed (e.g., writing).
Nonhistorical approaches to natural function
Wakefield's emphasis on the importance of evolution for understanding psychopathology reminds me of Dobzhansky's (1973) famous epigram, “Nothing in biology makes sense except in the light of evolution” (p. 125). But is this true? Harvey (1628/1952) knew nothing about evolution, but that did not prevent him from discovering the functions of the heart and circulatory system. Likewise, contemporary functional anatomists investigate the current roles fulfilled by various structures without worrying
Does the concept of dysfunction imply normative (value) judgments?
As Wakefield emphasizes, the concept of dysfunction entails factual statements about what abides; dysfunction is not merely a matter of social value judgments. Yet not only is disorder a hybrid concept comprising a factual component and a value component, dysfunction is so as well. To say that a mechanism is dysfunctional is not only to specify its state. It also implies that things are not as they ought to be, and ought-statements are inescapably normative. For example, to report that
Conclusion
The concept of disorder as harmful dysfunction seems hybrid in two ways. First, it comprises a social value judgment about harm arising from an internal psychobiological derangement. Second, specification of the derangement itself comprises both a factual statement about what abides (i.e., extent of departure from a standard) and a normative judgment that the mechanism is not operating as it ought to be.
Because the phylogenetic trajectory of human cognition is difficult, if not impossible, to
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2013, Journal of Sexual MedicineCitation Excerpt :Thus, it is impossible to define the criteria of sexual dysfunctions in an objective way. One might note a similarity with the concept of harmful dysfunction suggesting that it is impossible to escape from value judgments in decisions about what to call a (psychiatric) disorder [41,43,44]. Others have proposed an “in‐between solution” in DSM‐5 and suggested that distress should not be regarded as a necessary criterion for a diagnosis, but instead should be used as a specifier of sexual dysfunction [12,13,45-47].
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2003, Biological PsychiatryCitation Excerpt :Diagnosing ASD may amount to pathologizing normal, human reactions to extreme events. Unfortunately, Wakefield’s framework requires psychopathologists to distinguish evolved adaptations from other features of the human phenotype, and this task can be daunting (McNally 2001a). Nevertheless, his work points to an important challenge facing the trauma field: How do we tell the difference between acute reactions to trauma arising from properly functioning mechanisms from those arising from dysfunction in these mechanisms?
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