The concept of mental disorder. On the boundary between biological facts and social values.
Although the concept of mental disorder is fundamental to theory and practice in the mental health field, no agreed on and adequate analysis of this concept currently exists. I argue that a disorder is a harmful dysfunction, wherein harmful is a value term based on social norms, and dysfunction is a scientific term referring to the failure of a mental mechanism to perform a natural function for which it was designed by evolution. Thus, the concept of disorder combines value and scientific components. Six other accounts of disorder are evaluated, including the skeptical antipsychiatric view, the value approach, disorder as whatever professionals treat, two scientific approaches (statistical deviance and biological disadvantage), and the operational definition of disorder as "unexpectable distress or disability" in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987). The harmful dysfunction analysis is shown to avoid the problems while preserving the insights of these other approaches.
Wakefield
J C
JC
Columbia University School of Social Work, New York, NY 10025.
D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D019965:Neurocognitive Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D012307:Risk Factors; D012931:Social Environment; D012945:Social Values