Abstract
<p>The definition of medical ‘disorder’ is a matter of longstanding debate. A leading account is Jerome Wakefield’s ‘harmful dysfunction’ analysis, a hybrid model which merges normative and naturalist elements to propose disorder exists in cases of concurrent harm (value-defined) and dysfunction (defined evolutionarily). Despite significant impact in academia, this has so far failed to affect mainstream medical treatment or discourse, with a major criticism being that this definition doesn’t correctly capture all conditions of medical relevance or actual medical ideals. This paper provides a supplementary structural nuance to better reflect how medical treatment and terminology incorporate naturalistic facts. I argue that Wakefield is right in utilising a hybrid model incorporating naturalism and normativity. However, in understanding how medicine is directed, making the normative and naturalistic equally necessary is problematic, because the imperatives of naturalism and normativity directly impede each other; norms seek to help those who need help, naturalism concentrates on objective facts, but neither can be fulfilled as a coherent goal of medical treatment when combined as equally necessary. Instead, I propose a hierarchical harmful dysfunction model better reflects current medical ideals, where normative values are necessary and sufficient conditions to prescribe treatment, whilst naturalistic knowledge plays a role informing those normative values. This accounts for the edge cases and practise of medicine not fully captured in Wakefield’s account of ‘disorder’.</p>
Hunt, Adam