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.     

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.     

Knowledge in an evolutionary context

The theory of evolution justifies neither optimistic nor pessimistic inferences regarding human knowledge. Darwinian accounts of knowledge would show the adaptive virtues of beliefs, but this is independent logically and practically of their truth. But equally, considerations derived from evolution should not support a downgrading of the manifest image in favour of the scientific image. As embodied beings our first and most certain interactions with the world are and must remain those of everyday life.     

Depression in an evolutionary context

Sadness and low levels of depression are adaptive since they lead the individual to try and make up a loss. By contrast, severe or clinical depression is not adaptive, but can be thought of as sadness having become malignant.     

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.     

Harm and the concept of medical disorder

According to Jerome Wakefield’s harmful dysfunction analysis (HDA) of medical disorder, the inability of some internal part or mechanism to perform its natural function is necessary, but not sufficient, for disorder. HDA also requires that the part dysfunction be harmful to the individual. I consider several problems for HDA’s harm criterion in this article. Other accounts on which harm is necessary for disorder will suffer from all or almost all of these problems. Comparative accounts of harm imply that one is harmed when one is made worse off, that is, worse off than one otherwise would have been. Non-comparative accounts imply that one is harmed when one is put into some kind of condition or state that is, in some way, bad in itself. I argue that whether harm is construed comparatively or non-comparatively, HDA’s harm criterion is problematic. I tentatively conclude that an analysis of medical disorder should not make use of the concept of harm.     

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.     

Evolutionary versus prototype analyses of the concept of disorder.

The harmful dysfunction (HD) analysis of the concept of disorder (J. C. Wakefield, 1992a) holds that disorders are harmful failures of internal mechanisms to perform their naturally selected functions. S. O. Lilienfeld and L. Marino (1995) proposed instead that disorder is a Roschian prototype concept without defining properties. Against the HD analysis, they argued that many disorders are not failures of naturally selected functions because they are either designed reactions (e.g., fever) or failures of functions that are not naturally selected (e.g., reading disorder). The HD analysis is defended here against these and other objections and compared with the Roschian account. It is argued that the objections are based on conceptual confusions and can be turned around to provide strong new support for the HD analysis. A series of conceptual experiments demonstrates the superior explanatory power of the HD analysis and disconfirms the Roschian account.     

Attitudes and the attribution of mental disorder

Among the problems of understanding mental pathology through a labeling perspective is the need to understand more about the attributional process itself. It is postulated that characteristics of observers, in particular their attitudes, influence the attribution of mental disorder to individuals manifesting deviant behavior. Questionnaire items were factor analyzed to produce several dimensions of attitudes and types of deviance. Tests of seven sub‐hypotheses provide support for the major hypothesis that the probability mental disorder will be attributed by an observer to an actor is positively related to the degree an actor's behavior (implying beliefs or attitudes) differs from the beliefs and attitudes of the observer.     

The concept of a person in the context of abortion

The paper investigates the significance of the question of the fetus's status as a person for resolving the moral issues of abortion. It considers and evaluates several proposed solutions to this question. It also attempts to explain how different questions about the permissibility of abortion are appropriate to discussions at different levels of decision-making: the pregnant woman, the health professional, and the social policy level. The author's own conclusions to all these questions are offered along with other popular views.     

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.     

Defining mental disorder. Exploring the 'natural function' approach

Due to several socio-political factors, to many psychiatrists only a strictly objective definition of mental disorder, free of value components, seems really acceptable. In this paper, I will explore a variant of such an objectivist approach to defining metal disorder, natural function objectivism. Proponents of this approach make recourse to the notion of natural function in order to reach a value-free definition of mental disorder. The exploration of Christopher Boorse's 'biostatistical' account of natural function (1) will be followed an investigation of the 'hybrid naturalism' approach to natural functions by Jerome Wakefield (2). In the third part, I will explore two proposals that call into question the whole attempt to define mental disorder (3). I will conclude that while 'natural function objectivism' accounts fail to provide the backdrop for a reliable definition of mental disorder, there is no compelling reason to conclude that a definition cannot be achieved.     

Antidepressant discontinuation in the context of cognitive behavioral treatment for panic disorder.

Cognitive behavioral treatment (CBT) has been shown to reduce risk for adverse reactions (e.g., rebound panic) following benzodiazepine taper for patients with panic disorder (PD). This study evaluated the effects of antidepressant discontinuation for patients with PD in the context of CBT. Patients with PD (n=21) on a stable dose of antidepressants completed a 12-week group CBT treatment and were randomly assigned to discontinue antidepressants during week 8 of the treatment. There were no statistically significant differences between groups at posttreatment or 6-month follow-up. Data indicate no apparent immediate or long-term adverse effects for antidepressant discontinuation for patients with PD receiving CBT.     

Culture and mental retardation

The Psychological Record -     

Emotion context insensitivity in major depressive disorder

The present study tested 3 competing views of how depression alters emotional reactivity: positive attenuation (reduced positive), negative potentiation (increased negative), and emotion context insensitivity (ECI; reduced positive and negative). Normative and idiographic stimuli that elicited happy, sad, and neutral states were presented to currently depressed, formerly depressed, and healthy control individuals while experiential, behavioral, and autonomic responses were measured. Currently depressed individuals reported less sadness reactivity and less happiness experience across all conditions than did the other participants, and they exhibited a more dysphoric response to idiographic than to normative stimuli. Overall, data provide partial support for the positive attenuation and ECI views. Depression may produce mood-state-dependent changes in emotional reactivity that are most pronounced in emotion experience reports.     

Mental disorder as a black box essentialist concept.

This is a reply to commentaries on the target article (J. C. Wakefield, 1999) on the evolutionary foundations of the concept of mental disorder in defense of the harmful dysfunction analysis (HDA) of disorder. The author argues that the HDA is adequate to explain disorder and nondisorder judgments and is not disconfirmed by any of the claimed counterexamples put forward by the commentators; the commentators' proposed alternatives to the HDA are inadequate to explain disorder and nondisorder judgments; and the concept of natural function is a factual, scientific concept, contrary to K. W. M. Fulford's (1999) claim that it is inherently evaluative. The foundations of the HDA are clarified by providing a black box essentialist analysis (H. Putnam, 1975; J. C. Wakefield, 1997, in press) of the concept of natural function that underlies the concept of disorder.     

Culture, context, and behavior

In this article I propose a model that posits three major sources of influence on behavior-basic human nature (via universal psychological processes), culture (via social roles), and personality (via individual role identities) and argue that individual behaviors are the products of the interaction between the three. I discuss how culture emerges from the interaction of basic human nature and the ecological contexts in which groups exist, and how social roles are determined by culture-specific psychological meanings attributed to situational contexts. The model further suggests that situational context moderates the relative contributions of the three sources in influencing behavior. I provide examples of apparent contradictory findings in the study of emotion that can be explained by the model proposed.