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Can we define mental disorder by using the criterion of mental dysfunction?

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Abstract

The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation.

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Notes

  1. Jerome Wakefield’s analysis of the notion of disorder [1] resembles Boorse’s in that he also sees dysfunction as a necessary criterion of disease. However, he does not see it as sufficient and adds a harm criterion. Although this addition is irrelevant for the purposes of my paper, I focus on Boorse as a way to start from a theory of the pathological. In addition, Wakefield has a different account of function, which therefore raises concerns other than those raised by Boorse’s account. These issues will be addressed in later sections. For an interesting critique of disease theories that are based on the concept of dysfunction, see [2].

  2. I also repeatedly refer to 'mental disorder', which is, of course, the official psychiatric notion.

  3. I am not certain if McLaughlin would like to be included under this umbrella. On the one hand, his account seems to diverge from rigorously scientific ones, but on the other hand, he refers to self-reproductive systems, which seems less of a value-perspective.

  4. Evolutionary psychology is a flourishing field of study and the literature has become unmanageable. One of the best introductory texts still is [12]. For two recent critical appraisals, see [13, 14].

  5. A precursor is Chomsky's review of Skinner's behaviourism [17]. Chomsky himself cannot be considered an evolutionary psychologist, though. The reference to ‘mental modules’ is due to Fodor [18]. Again, he is also critical of the adaptationist programme of evolutionary psychology, though he shares some of its assumptions.

  6. To be sure, there is some debate about the timeline that accounts for function and also about when traits cease to be functional [23, pp. 887–888].

  7. In fairness to the aetiological camp, I should mention that I have brushed over more complex variants, e.g., the modern history approach [33] and the propensity view [34].

  8. To be sure, there are more recent variants of functionalism, which do not support the computer model of the mind. However, computational functionalism has been very influential, especially as far as cognitive psychology is concerned.

  9. To clarify, I don't want to imply that, according to this model, dysfunctions prevent a good life. A reduction of opportunities does not mean their complete absence.

  10. I should point out that this is a contested claim. For a critique see, for instance, [41].

  11. Wakefield’s addition of a harm criterion to his functional analysis of mental disorder is therefore not redundant. Dysfunction does not by itself explain the harmfulness, if any, of disorder.

  12. This seems to imply a circular argument: Health is defined via function and function is (partly) defined by the good of human beings, of which health is an aspect. I hope it is clear from what I have said in this paper that I do not regard this circle as a vicious one.

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Acknowledgements

A shorter version of this paper was presented at the 31st International Congress of the International Academy of Law and Mental Health in New York City. I would like to thank the British Academy for supporting me with an Overseas Conference Grant, as well as Mark Bedau, Chris Boorse, David Buller, and Ulrich Krohs for helpful comments. I would also like to acknowledge the support by the School of Health Science, Swansea University, UK, where I was employed during work on this paper.

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    Thomas Schramme

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Schramme, T. Can we define mental disorder by using the criterion of mental dysfunction?. Theor Med Bioeth 31, 35–47 (2010). https://doi.org/10.1007/s11017-010-9136-y

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