Dysfunction as a factual component of disorder

The harmful dysfunction (HD) analysis holds that disorder, mental or physical, requires harm, a value criterion, and dysfunction, a factual criterion referring to failure of a mechanism to perform a naturally selected function. Houts' arguments that the HD analysis does not offer an adequate factual account of dysfunction are examined and shown to be invalid. For example, his claim that the HD analysis confuses function with purpose, a value concept, ignores the analysis'account of function in terms of the value-free notion of effect-explanation; and his argument that functions imply norms (e.g., what mechanisms are 'supposed to' do) falsely assumes that such norms are evaluative. The HD analysis of function is analogous in logical structure to the functional analyst's factual behavioral notion of function. Houts' value account of disorder is inconsistent with people's classificatory judgments, as his own examples demonstrate.     

Evolutionary history versus current causal role in the definition of disorder: reply to McNally

The harmful dysfunction (HD) analysis (Wakefield, American Psychologist 47 (1992a) 373) asserts that "disorder" means "harmful dysfunction", where "harm" is a value concept anchored in social values and "dysfunction" is a factual concept referring to failure of a mechanism to perform a natural function. Additionally, the HD analysis claims that a mechanism's natural functions are its naturally selected effects. McNally (Behaviour Research and Therapy (2000) pp. 309-314) argues to the contrary that "dysfunction" is a value concept referring to negative failures of function, that "function" refers to current causal roles and not evolutionarily designed causal roles, and that "disorder" consequently means "harmful failure of a mechanism to perform a valued current causal role." I reply by showing that McNally's proposals lack the HD analysis's power to explain common judgments about function, dysfunction, and disorder. "Dysfunction" cannot be a negative value concept because many dysfunctions are positive or neutral; "function" cannot refer to current causal roles because many current causal roles are not functions and some functions are not current causal roles; and "disorder" cannot refer to harmful failures of current causal roles because that definition allows almost any negative condition whatever to be a disorder and thus fails to explain the distinctions we make between disorder and non-disorder.     

Essentialism revisited: evolutionary theory and the concept of mental disorder.

J. C. Wakefield's (1999) elaboration of his harmful dysfunction analysis (HDA) of mental disorder does little to address previous criticisms (S. O. Lilienfeld & L. Marino, 1995) and instead reveals further conceptual weaknesses in his position. The authors demonstrate that (a) a Roschian analysis can account for the results of all of Wakefield's conceptual experiments and predicts a number of judgments of disorder not predicted by the HDA, (b) the HDA is incapable in many cases of providing a scientifically nonarbitrary distinction between disorder and nondisorder, and (c) the HDA cannot account for failures of cultural ex adaptations, mismatches between evolutionary design and novel environments, or defenses against threat. The authors argue that the HDA has been convincingly falsified and discuss the failure of essentialistic concepts to resolve controversies in other domains of biological science.     

Horsefeathers: a commentary on "evolutionary versus prototype analyses of the concept of disorder".

J. C. Wakefield's (1999) article further develops his harmful dysfunction (HD) model for disorder concepts. This commentary focuses on three areas. The first notes the imbalance in the debate between the Lilienfeld and Marino (1995) Roschian model and the HD model for disorder concepts. The second claims that Wakefield's purposes for the HD model have changed over the years and progressed toward irrelevance to psychopathology in general and toward irrelevance to actual nosologic, reimbursement, and sociopolitical controversies about disorder status. Further discussion is on how certain structural elements in Wakefield's arguments and current limitations of evolutionary theory permit a superficially attractive model for psychopathology. These arguments and limitations, however, harbor serious problems when confronted with actual disputes about disorders. The conclusion notes some virtues to Wakefield's inquiry, in style and substance.     

Harmful dysfunction, disorder, disease, illness, and evolution.

Can psychiatric disorders be conceptualized as "harmful dysfunctions" (J. C. Wakefield, 1992a, 1992b, 1999; S. O. Lilienfeld & L. Marino, 1995)? Wakefield's (1992a) central concept of disorder as "harmful dysfunction" is discussed by placing it in the context of a complementary discussion of disease, illness, the sick role, and evolution (D. F. Klein, 1978). S. O. Lilienfeld and L. Marino (1995) contended that proper biological function cannot be determined. This argument obscures the key significance of involuntary impairment of evolved functions. The claim that the Roschian concept has no counterpart in reality is incorrect and does not support the conclusion that dysfunctions are irreducibly evaluative and therefore arbitrary. J. C. Wakefield's (1999) views in this area are supplemented. The role of monothetic and polythetic categorization, extremal terms, and the concept of normality in nosology is considered. This analysis refutes the implication that deviance and illness are equivalent. The resolution of this debate is practically relevant to emphasizing areas of research investment, such as therapeutics.     

Introduction to the special section on the concept of disorder.

Despite the absence of a consensual definition of disorder, considerable research and clinical work is based on the categorization and diagnosis of mental disorder. This article introduces a special section of the Journal of Abnormal Psychology that expands the debate between J. C. Wakefield (1999), who has proposed a "harmful dysfunction" analysis of disorder and S. O. Lilienfeld and L. Marino (1995, 1999), who offer an alternative "Roschian" or prototype analysis. This introduction summarizes the main arguments of Wakefield's target article and 8 critiques and discusses the conceptual value of the debate, especially an integration of diverse viewpoints and stimulation to further consideration of this important topic.     

Conceptual Role Semantics and the Reference of Moral Concepts

This paper examines the prospects for a conceptual or functional role theory of moral concepts. It is argued that such an account is well‐placed to explain both the irreducibility and practicality of moral concepts. Several versions of conceptual role semantics for moral concepts are distinguished, depending on whether the concept‐constitutive conceptual roles are (i) wide or narrow (ii) normative or non‐normative and (iii) purely doxastic or conative. It is argued that the most plausible version of conceptual role semantics for moral concepts involves only ‘narrow’ conceptual roles, where these include connections to motivational, desire‐like, states. In the penultimate section it is argued, contrary to what Wedgwood, Enoch and others have claimed, that such an account of moral concepts cannot plausibly be combined with the claim that moral concepts refer to robust properties.     

Harmful dysfunction and the DSM definition of mental disorder.

Physicians, including psychiatrists, give a lot of thought in their everyday work to answer the question of whether or not a particular patient has a disorder; they rarely give much thought to the broader issue of what constitutes a disorder. Remarkably, and consistent with the harmful dysfunction (HD) analysis, there is a broad consensus in both the general public and the medical and health professions as to what conditions are disorders--even though there is no consensus definition of disorder. The HD analysis is a substantial advance over previous attempts to define disorder in specifying the nature of what is not working in the individual (the dysfunction). The adoption of the HD analysis in DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.) would probably have little if any effect on the list of categories of mental disorders. Its main value would be in helping make revisions in the diagnostic criteria more valid as true indicators of disorder.     

The abduction of disorder in psychiatry.

The evolutionary cornerstone of J. C. Wakefield's (1999) harmful dysfunction thesis is a faulty assumption of comparability between mental and biological processes that overlooks the unique plasticity and openness of the brain's functioning design. This omission leads Wakefield to an idealized concept of natural mental functions, illusory interpretations of mental disorders as harmful dysfunctions, and exaggerated claims for the validity of his explanatory and stipulative proposals. The authors argue that there are numerous ways in which evolutionarily intact mental and psychological processes, combined with striking discontinuities within and between evolutionary and contemporary social/cultural environments, may cause nondysfunction variants of many widely accepted major mental disorders. These examples undermine many of Wakefield's arguments for adopting a harmful dysfunction concept of mental disorder.     

The Concept of Abnormality in Medical Genetics

This paper explores usage of the concept ofabnormality in medical genetics and proposesdirectives for more careful usage of this concept.The conceptual difficulties are first explored, thena model is developed to assess actual usage, followedby analysis of a sample of genetic textbooks andgenetics literature. It appears that fact andvaluation are often intermingled, that referencestandards used to define 'genetic abnormalities' areoften not clear and that the concept of abnormality isoften used independent of the degree of certainty withwhich the altered genetype develops into a (seriously)harmful phenotype. On the basis of these findings itis argued that more restraint and more careful use ofthe concept of genetic abnormality of medical geneticsis appropriate as well as more agreement on the use ofreference standards.     

Personality disorder and antisocial deviance: comments on the debate on the structure of the psychopathy checklist-revised

The recent debate on the structure of the Psychopathy Checklist-Revised (PCL-R: Hare, 1991; 2003) has been presented primarily as a statistical issue, but underlying it are longstanding conceptual issues about the relationship of personality concepts to deviant behavior and of psychopathy to criminality and personality disorder. I discuss these issues in this paper. The antisocial items of the PCL-R seem to reflect a propensity to commit crimes that has long been of interest to criminology. This disposition overlaps with, but differs conceptually from personality dispositions, but these surface dispositions do not provide a causal account of criminality. I present data that indicate that the core personality characteristics of psychopathy are more closely related to narcissistic and histrionic personality disorders than to antisocial personality disorder. Overemphasis on involvement in crime has obscured the nature of psychopathy as a disorder of personality characterised by interpersonally harmful behavior that need not necessarily take criminal form.     

Concepts as Pluralistic Hybrids

In contrast to earlier views that argued for a particular kind of concept (e.g. prototypes), several recent accounts have proposed that there are multiple distinct kinds of concepts, or that there is a plurality of concepts for each category. In this paper, I argue for a novel account of concepts as pluralistic hybrids. According to this view, concepts are pluralistic because there are several concepts for the same category whose use is heavily determined by context. In addition, concepts are hybrids because they typically link together several different kinds of information that are used in the same cognitive processes. This alternative view accounts for the available empirical data, allows for greater cognitive flexibility than Machery's recent account, and overcomes several objections to traditional hybrid views.     

Conceptual analysis and special-interest science: toxicology and the case of Edward Calabrese

One way to do socially relevant investigations of science is through conceptual analysis of scientific terms used in special-interest science (SIS). SIS is science having welfare-related consequences and funded by special interests, e.g., tobacco companies, in order to establish predetermined conclusions. For instance, because the chemical industry seeks deregulation of toxic emissions and avoiding costly cleanups, it funds SIS that supports the concept of “hormesis” (according to which low doses of toxins/carcinogens have beneficial effects). Analyzing the hormesis concept of its main defender, chemical-industry-funded Edward Calabrese, the paper shows Calabrese and others fail to distinguish three different hormesis concepts, H, HG, and HD. H requires toxin-induced, short-term beneficial effects for only one biological endpoint, while HG requires toxin-induced, net-beneficial effects for all endpoints/responses/subjects/ages/conditions. HD requires using the risk-assessment/regulatory default rule that all low-dose toxic exposures are net-beneficial, thus allowable. Clarifying these concepts, the paper argues for five main claims. (1) Claims positing H are trivially true but irrelevant to regulations. (2) Claims positing HG are relevant to regulation but scientifically false. (3) Claims positing HD are relevant to regulation but ethically/scientifically questionable. (4) Although no hormesis concept (H, HG, or HD) has both scientific validity and regulatory relevance, Calabrese and others obscure this fact through repeated equivocation, begging the question, and data-trimming. Consequently (5) their errors provide some undeserved rhetorical plausibility for deregulating low-dose toxins.     

Implicit measures of association in psychopathology research

Studies obtaining implicit measures of associations in Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision; American Psychiatric Association, 2000) Axis I psychopathology are organized into three categories: (a) studies comparing groups having a disorder with controls, (b) experimental validity studies, and (c) incremental and predictive validity studies. In the first category, implicit measures of disorder-relevant associations were consistent with explicit beliefs for some disorders (e.g., specific phobia), but for other disorders evidence was either mixed (e.g., panic disorder) or inconsistent with explicit beliefs (e.g., pain disorder). For substance use disorders and overeating, expected positive and unexpected negative associations with craved substances were found consistently. Contrary to expectation, implicit measures of self-esteem were consistently positive for patients with depressive disorder, social phobia, and body dysmorphic disorder. In the second category, short-term manipulations of disorder-relevant states generally affected implicit measures as expected. Therapeutic interventions affected implicit measures for one type of specific phobia, social phobia, and panic disorder, but not for alcohol use disorders or obesity. In the third category, implicit measures had predictive value for certain psychopathological behaviors, sometimes moderated by the availability of cognitive resources (e.g., for alcohol and food, only when cognitive resources were limited). The strengths of implicit measures include (a) converging evidence for dysfunctional beliefs regarding certain disorders and consistent new insights for other disorders and (b) prediction of some psychopathological behaviors that explicit measures cannot explain. Weaknesses include (a) that findings were inconsistent for some disorders, raising doubts about the validity of the measures, and (b) that understanding of the concept "implicit" is incomplete.     

Free Thinking for Expressivists

Abstract

This paper elaborates and defends an expressivist account of the claims of mind-independence embedded in ordinary moral thought. In response to objections from Zangwill and Jenkins it is argued that the expressivist ‘internal reading’ of such claims is compatible with their conceptual status and that the only ‘external reading’ available doesn't commit expressivisists to any sort of subjectivism. In the process a ‘commitment-theoretic’ account of the semantics of conditionals and negations is defended.     

Temporal course and structural relationships among dimensions of temperament and DSM-IV anxiety and mood disorder constructs

The temporal stability and directional relations among dimensions of temperament (e.g., neuroticism) and selected Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) disorder constructs (depression, generalized anxiety disorder, social phobia) were examined in 606 outpatients with anxiety and mood disorders, assessed on 3 occasions over a 2-year period. Neuroticism/behavioral inhibition (N/BI) and behavioral activation/positive affect (BA/P) accounted for the cross-sectional covariance of the DSM-IV constructs. Although N/BI evidenced the most change of the constructs examined, initial levels of N/BI predicted less improvement in 2 of the 3 disorder constructs. Unlike the DSM-IV disorder constructs, the temporal stability of N/BI increased as a function of initial severity. Moreover, N/BI explained all the temporal covariation of the DSM-IV disorder constructs. The results are discussed in regard to conceptual models of temperament that define N/BI and BA/P as higher order dimensions accounting for the course and covariation of emotional disorder psychopathology.     

The return of the nativist

Radical Concept Nativism (RCN) is the doctrine that most of our concepts are innate. In this paper I will argue in favour of RCN by developing a speculative account of concept acquisition that has considerable nativist credentials and can be defended against the most familiar anti-nativist objections. The core idea is that we have a whole battery of hard-wired dispositions that determine how we group together objects with which we interact. In having these dispositions we are effectively committed to an implicit conceptual scheme and acquiring concepts is a matter of labelling the elements of that scheme.     

Cognitive impairments and disordered speech in schizophrenia: thought disorder, disorganization, and communication failure perspectives

This article posits that basic cognitive impairments in schizophrenia are more highly related to speech disorder measured as communication failures than speech disorder measured as thought disorder or disorganization. The author tested 47 schizophrenia patients and 36 control participants for sustained attention, sequencing, and conceptual sequencing ability. Their speech was also rated for communication failures, thought disorder, and conceptual disorganization. Attention and sequencing impairments, examined hierarchically, explained a substantial 38% of the variance in the communication measure of speech disorder but little of the variance in formal thought disorder or conceptual disorganization. The author concludes that (a) impairments in attention and sequencing abilities contribute substantially to schizophrenic communication failures, and (b) it is important to consider lower level cognitive "3rd variables" when examining higher level cognitive associates of speech disorder.     

Anxiety sensitivity within the anxiety disorders: disorder-specific sensitivities and depression comorbidity

The tendency to perceive anxious states as aversive and harmful is hypothesized to confer vulnerability to the development of anxiety disorders. The most commonly used measure of anxiety sensitivity, the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson, R.A., Gursky, D.M., & McNally R.J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behavior Research and Therapy, 24, 1-8], is composed of multiple lower-order factors, assessing fear of physical symptoms, fear of publicly observable anxious symptoms, and fear of cognitive dyscontrol. This study examined the convergent validity of the lower-order anxiety sensitivity dimensions in DSM-IV diagnosed anxiety disorders. Participants with primary diagnoses of panic disorder with agoraphobia, social phobia, and generalized anxiety disorder (GAD) completed the ASI and measures of anxiety and depression severity. Support was found for the convergent validity of all ASI dimensions in reference to thematically related anxiety disorders and in the identification of patients presenting with and without secondary major depressive disorder (MDD). The ASI-fear of cognitive dyscontrol dimension displayed strong and nonredundant associations with GAD, dimensional depression scores, and secondary diagnoses of MDD. The conceptual implications of the shared importance of fear of cognitive dyscontrol in GAD and MDD are discussed.     

Apologizing for Who I Am

Philosophical discussions of apologies have focused on apologizing for wrong actions. Such a focus overlooks an important dimension of moral failures, namely, failures of character. However, when one attempts to revise the standard account of apology to make room for failures of character, two objections emerge. The first is rooted in the psychology of shame. The second stems from the purported social function of apologies. This paper responds to these objections and, in so doing, sheds further light both on why we apologize (when we are in the wrong) and on why we accept apologies (when others are).