Defining mental disorder

Philosophers discuss Jerome Wakefield's influential view of mental disorder as “harmful dysfunction,” with detailed responses from Wakefield himself.

One of the most pressing theoretical problems of psychiatry is the definition of mental disorder. Jerome Wakefield's proposal that mental disorder is “harmful dysfunction” has been both influential and widely debated; philosophers...

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Philosophers discuss Jerome Wakefield's influential view of mental disorder as “harmful dysfunction,” with detailed responses from Wakefield himself.

One of the most pressing theoretical problems of psychiatry is the definition of mental disorder. Jerome Wakefield's proposal that mental disorder is “harmful dysfunction” has been both influential and widely debated; philosophers have been notably skeptical about it. This volume provides the first book-length collection of responses by philosophers to Wakefield's harmful dysfunction analysis (HDA), offering a survey of philosophical critiques as well as extensive and detailed replies by Wakefield himself.

HDA is offered as a definition of mental disorder, but it is also the outcome of a method—conceptual analysis—and contributors first take up HDA's methodology, considering such topics as HDA's influences on the DSM, empirical support for HDA, and clinical practice. They go on to discuss HDA's ultimate goal, the demarcation between normal and abnormal; the dysfunction component of the analysis, addressing issues that include developmental plasticity, autism and neurodiversity, and the science of salience; and the harmful component, examining harmless dysfunction, normal variation, medicalization, and other questions. Wakefield offers substantive responses to each chapter.

The open access edition of this book was made possible by generous funding from Arcadia – a charitable fund of Lisbet Rausing and Peter Baldwin.

Harold Kincaid

Harold Kincaid is Professor in the School of Economics and Director of the Research Unit in Behavioural Economics and Neuroeconomics at the University of Cape Town. He is the coeditor of Distributed Cognition and the Will: Individual Volition and Social Context and What Is Addiction? (both published by the MIT Press).

Peter Zachar

Peter Zachar is Professor in the...

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Harold Kincaid

Harold Kincaid is Professor in the School of Economics and Director of the Research Unit in Behavioural Economics and Neuroeconomics at the University of Cape Town. He is the coeditor of Distributed Cognition and the Will: Individual Volition and Social Context and What Is Addiction? (both published by the MIT Press).

Peter Zachar

Peter Zachar is Professor in the Department of Psychology at Auburn University Montgomery. He is the author of Psychological Concepts and Biological Psychiatry: A Philosophical Analysis.

Dominic Murphy

Dominic Murphy is Senior Lecturer in the Unit for History and Philosophy of Science at the University of Sydney.

Justin Garson

Philip Gerrans

Philip Gerrans is Professor of Philosophy at the University of Adelaide.

Rachel Cooper

Steeves Demazeux

Leen De Vreese

Maël Lemoine

Tim Thornton

Andreas De Block

Jonathan Sholl

EDITORS

Luc Faucher

Luc Faucher is Professor in the Philosophy Department at the at the University of Québec in Montréal.

Denis Forest

Denis Forest is Professor of Philosophy of Science in the Department of Philosophy at Paris 1 Panthéon-Sorbonne and Member of the IHPST (Institute of History and Philosophy of Science and Technique), Paris.

Introduction
Denis Forest and Luc Faucher
Wakefield Critiques: Introductory Comments
Jerome Wakefield
IOn Conceptual Analysis
1DSM in the Light of HDA (and Conversely)
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Introduction
Denis Forest and Luc Faucher
Wakefield Critiques: Introductory Comments
Jerome Wakefield
IOn Conceptual Analysis
1DSM in the Light of HDA (and Conversely)
Steeves Demazeux
2From Ribot and Dupré to Spitzer and RDoC: Does the Harmful Dysfunction Analysis Possess Historical Explanatory Power? Reply to Steeves Demazeux
Jerome Wakefield
3Facts, Facts, Facts: HD Analysis Goes Factual
Luc Faucher
4Do the Empirical Facts Support the Harmful Dysfunction Analysis? Reply to Luc Faucher
Jerome Wakefield
5Against the Disorder/Nondisorder Dichotomy
Leen De Vreese
6Do Clinicians Understand the Harmful Dysfunction Analysis of Mental Disorder? Reply to Leen De Vreese
Jerome Wakefield
7Doing without “Disorder” in the Study of Psychopathology
Harold Kincaid
8Quinian Qualms, or Does Psychiatry Really Need the Harmful Dysfunction Analysis? Reply to Harold Kincaid
Jerome Wakefield
IIThe Demarcation Problem
9Psychiatric Disorders and the Imperfect Community: A Nominalist HDA
Peter Zachar
10Can a Nonessentialist Neo-Empiricist Analysis of Mental Disorder Replace the Harmful Dysfunction Analysis? Reply to Peter Zachar
Jerome Wakefield
IIIThe Dysfunction Component
11Is the Dysfunction Component of the “Harmful Dysfunction Analysis” Stipulative?
Maël Lemoine
12Is the Harmful Dysfunction Analysis Descriptive or Stipulative, and Is the HDA or BST the Better Naturalist Account of Dysfunction? Reply to Maël Lemoine
Jerome Wakefield
13Function and Dysfunction
Dominic Murphy
14Can Causal Role Functions Yield Objective Judgments of Medical Dysfunction and Replace the Harmful Dysfunction Analysis’s Evolutionary Component? Reply to Dominic Murphy
Jerome Wakefield
15Do the Works of Carl Craver or Marcel Weber Explain How Causal Role Functions Can Provide Objective Medical Judgments of Dysfunction? Supplementary Reply to Dominic Murphy
Jerome Wakefield
16The Developmental Plasticity Challenge to Wakefield’s View
Justin Garson
17Does Developmental Plasticity Pose a Challenge to the Harmful Dysfunction Analysis? Reply to Justin Garson
Jerome Wakefield
18Biological Function Hierarchies and Indeterminacy of Dysfunction: Supplementary Reply to Justin Garson
Jerome Wakefield
19Harmful Dysfunction and the Science of Salience: Adaptations and Adaptationism
Philip Gerrans
20Are Cognitive Neuroscience and the Harmful Dysfunction Analysis Competitors or Allies? Reply to Philip Gerrans
Jerome Wakefield
21Autistic Spectrum, Normal Variation, and Harmful Dysfunction
Denis Forest
22Do the Challenges of Autism and Neurodiversity Pose an Objection to the Harmful Dysfunction Analysis? Reply to Denis Forest
Jerome Wakefield
23Naturalism and Dysfunction
Tim Thornton
24Is Indeterminacy of Biological Function an Objection to the Harmful Dysfunction Analysis? Reply to Tim Thornton
Jerome Wakefield
IVThe Harmful Component
25Harmless Dysfunctions and the Problem of Normal Variation
Andreas De Block and Jonathan Sholl
26Can the Harmful Dysfunction Analysis Distinguish Problematic Normal Variation from Disorder? Reply to Andreas De Block and Jonathan Sholl
Jerome Wakefield
27On Harm
Rachel Cooper
28Must Social Values Play a Role in the Harm Component of the Harmful Dysfunction Analysis? Reply to Rachel Cooper
Jerome Wakefield
29Are There Naturally Selected Disorders? Supplementary Reply to Rachel Cooper
Jerome Wakefield
Contributors
Index
List of Illustrations
Figure 9.1Visual representation of a latent variable model.
Figure 9.2A causal network model for major depressive disorder.
Figure 9.3A causal network mode for the comorbidity of depression and generalized anxiety disorder.
Figure 21.1The Titchener Illusion. Context sensitivity leads to errors of judgments (the circles at the center are judged to have a different size). Autistic people do not succumb to this illusion (Happé 1999).
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