The concept of mental disorder: diagnostic implications of the harmful dysfunction analysis

What do we mean when we say that a mental condition is a medical disorderrather than a normal form of human suffering or a problem in living? The statusof psychiatry as a medical discipline depends on a persuasive answer to thisquestion. The answers tend to range from value accounts that see disorderas a sociopolitical concept, used for social control purposes, to scientificaccounts that see the concept as strictly factual. I have proposed a hybridaccount, the harmful dysfunction (HD) analysis, that incorporates both valueand scientific components as essential elements of the medical concept ofdisorder, applying to both physical and mental conditions. According to theHD 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 afunction for which it was biologically designed (i.e., naturally selected).The implications of this analysis for the validity of symptom-based diagnosticcriteria and for challenges in cross-cultural use of diagnostic criteria areexplored, using a comparison of the application of DSM diagnostic criteriain the U.S. and Taiwan.