The concept of mental disorder: diagnostic implications of
the harmful dysfunction analysis |
| |
Authors: | JEROME C WAKEFIELD |
| |
Institution: | 1.School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA |
| |
Abstract: | What do we mean when we say that a mental condition is a medical disorder
rather than a normal form of human suffering or a problem in living? The status
of psychiatry as a medical discipline depends on a persuasive answer to this
question. The answers tend to range from value accounts that see disorder
as a sociopolitical concept, used for social control purposes, to scientific
accounts that see the concept as strictly factual. I have proposed a hybrid
account, the harmful dysfunction (HD) analysis, that incorporates both value
and scientific components as essential elements of the medical concept of
disorder, applying to both physical and mental conditions. According to the
HD analysis, a condition is a disorder if it is negatively valued ("harmful")
and it is in fact due to a failure of some internal mechanism to perform a
function for which it was biologically designed (i.e., naturally selected).
The implications of this analysis for the validity of symptom-based diagnostic
criteria and for challenges in cross-cultural use of diagnostic criteria are
explored, using a comparison of the application of DSM diagnostic criteria
in the U.S. and Taiwan. |
| |
Keywords: | Psychopathology diagnosis nosology philosophy of psychiatry mental disorder harmful dysfunction cross-cultural diagnosis validity of diagnostic criteria false positives |
|
|