On Wakefield's harmful dysfunction analysis of mental disorder

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Abstract

Wakefield's harmful dysfunction analysis of mental disorder is among the most rigorous and thoughtful attempts to address serious conceptual problems that beset the foundations of abnormal psychology. According to Wakefield, disorder is a hybrid concept comprising a factual component specifying derangement in a naturally-selected function, and a value component specifying the resultant harm. It is unclear, however, whether an evolutionary interpretation of dysfunction is either feasible or necessary; a nonhistorical causal role analysis of psychological function may enable ascription of disorder (assuming resultant harm). Moreover, the dysfunction component itself appears hybrid, comprising both a factual assertion about the state of a mechanism and a normative assertion implying that the mechanism is not functioning as it ought be.

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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