Wakefield’s harmful dysfunction analysis asserts that the concept of medical disorder includes a naturalistic component of dysfunction and a value component, both of which are required for disorder attributions. Muckler and Taylor, defending a purely naturalist, value-free understanding of disorder, argue that harm is not necessary for disorder. They provide three examples of dysfunctions that, they claim, are considered disorders but are entirely harmless: mild mononucleosis, cowpox that prevents smallpox, and minor perceptual deficits. They also reject the proposal that dysfunctions (...) need only be typically harmful to qualify as disorders. We argue that the proposed counterexamples are, in fact, considered harmful; thus, they fail to disconfirm the harm requirement: incapacity for exertion is inherently harmful, whether or not exertion occurs, cowpox is directly harmful irrespective of indirect benefits, and colorblindness and anosmia are considered harmful by those who consider them disorders. We also defend the typicality qualifier as viably addressing some apparently harmless disorders and argue that a dysfunction’s harmfulness is best understood in dispositional terms. (shrink)

We consider extensions of Peano arithmetic suitable for doing some of nonstandard analysis, in which there is a predicate N(x) for an elementary initial segment, along with axiom schemes approximating ω 1 -saturation. We prove that such systems have the same proof-theoretic strength as their natural analogues in second order arithmetic. We close by presenting an even stronger extension of Peano arithmetic, which is equivalent to ZF for arithmetic statements.

In ‘Rethinking Disease’, Powell and Scarffe1 propose what in effect is a modification of Jerome Wakefield’s2 3 harmful dysfunction analysis of medical disorder. The HDA maintains that ‘disorder’ is a hybrid factual and value concept requiring that a biological dysfunction, understood as a failure of some feature to perform a naturally selected function, causes harm to the individual as evaluated by social values. Powell and Scarffe accept both the HDA’s evolutionary biological function component and its incorporation of a value (...) component. Their proposed ‘new twist’ is to revise the value component: ‘Our proposed definition of disease is as follows: a biomedical state is a disease only if it implicates a biological dysfunction that is, or would be, properly disvalued’. So, they propose that a disorder is a ‘properly disvalued dysfunction’ rather than a ‘harmful dysfunction’, an approach they term ‘thickly normative’ in contrast to the thin normative approach of the HDA. There has been a surge of interest recently in better understanding the ‘harm’ component of the HDA. Powell and Scarffe’s analysis is a helpful contribution to this discussion. We focus here exclusively on their proposal regarding the analysis of the concept of disorder and ignore many important related issues that the authors address, ranging from prioritising resource allocation between disorders and non-disorders to whether the concept of disorder should be replaced by a generic welfarist concept. The resolution of these additional issues depends on first understanding ‘disorder’. The authors’ proposed changes to the HDA also deserve evaluation because the HDA, which has been endorsed by leading nosologists,4 plays an influential role in nosological debate across categories of disorder ranging, for example, from sexual paraphilias5 to psychopathy.6 A basic problem is that Powell and Scarffe misinterpret …. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. In Part 1, I argued that, even if one accepts Lewis’s critique of the brain evidence presented for the brain-disease view, his arguments fail to establish that addiction is not a disorder. Relying on my harmful dysfunction analysis of disorder, I defended the view (...) that addiction is a medical disorder and a brain disorder. In Part 2, I consider some broader philosophical issues raised by Lewis’s arguments: I consider a larger puzzle, at the heart of the neo-Kraepelinian program in contemporary psychiatry, that is raised by Lewis’s argument that addiction is not a disorder because the brain displays no damage but only normal learning: must all mental disorders be brain disorders, or can mental disorders occur in normal brains? I argue that mental disorders can occur in normal brains. I critique Lewis’s response to the evolutionary “novel environment” approach to explaining why addiction is a disorder. Lewis agrees with brain-disease proponents that interpreting addiction as brain disorder relieves addicts of moral censure, but I argue that moral defect and brain disease are not exclusive. Finally, I consider Lewis’s “developmental-learning” account of addiction that encourages positive and empowering narrativizing of addiction, but I argue that the developmental-learning view is vacuous due to use of an overly broad notion of “development.”. (shrink)

In the first part of this article, I argue that Christopher Megone's natural-kind interpretation of Aristotle's argument that "the function of a human being is reason" does not resolve major puzzles about the argument, specifically the puzzles of why a human being has a function and why reason is that function. I attempt to resolve these puzzles by supplementing the natural-kind account with the doctrine that reason is the master regulatory natural function by which individuals enter into social life. In (...) the second half, I critique Megone's value account of function and argue for a nonevaluative, causal-explanatory account of function and teleological explanation. (shrink)

The harmful dysfunction (HD) analysis of "disorder" holds that disorders are harmful failures of "designed" (that is, naturally selected) functions. Murphy and Woolfolk (2000) present a series of proposed counterexamples to the HD analysis to support their claim that it fails to provide a necessary condition for disorder. They argue that disorder can exist where there is no failed function, as in failed spandrels and inflamed vestigial organs, and that there can be disorders when everything is working as designed, as (...) in environment--design mismatches and disorders acquired through normal learning processes. They also argue that the HD analysis suffers from methodological problems, including value-ladenness of dysfunction judgments and unwarranted assumptions about the nature of internal mechanisms and their functions. -/- In this paper, each of these objections is critically evaluated. Reanalysis of the proposed counterexamples is argued to reveal strong support for the HD analysis. For example, failed spandrels are considered disorders when and only when they imply failures of designed functions; dysfunctions of vestigial organs involve failures of function at the tissue level, not the organ level; mechanism-environment mismatches are not considered disorders; and conditions acquired through normal learning processes can involve dysfunctions and are considered disordered only when they do. Murphy and Woolfolk's methodological objections are found to be based on a misinterpretation of the HD analysis. It is concluded that Murphy and Woolfolk fail to offer a cogent objection to the HD analysis. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. Addiction is currently classified as a medical disorder in DSM-5 and ICD-10. It is further labeled a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Lewis argues that the changes result instead from normal neuroplasticity (...) and learning in response to the intense rewards provided by addictive substances, thus that addiction is not a brain disease and by implication not a medical disorder at all. I argue that even if one accepts Lewis’s reinterpretation of the brain evidence, his conclusions do not follow. Relying on my harmful-dysfunction analysis of medical disorder, I defend the view that substance addiction is in fact a medical disorder and a brain disorder. In Part 1, I identify five arguments Lewis puts forward against the brain-disease view and evaluate them as arguments that addiction is not a disorder: Addiction is not a chronic, relapsing condition; There is no clear boundary between addiction and other strong desires; Negative consequences are not unique to disorders; The brain disease model does not account for behavioral addictions; and, Addiction is like love. I argue that Lewis’s arguments are invalid because they fail to take account of the context of addiction and its relation to biological design. (shrink)

Pierre-Henri Castel provides a short but richly argued precis of his recently published two-volume 1,000-page masterwork on the history of obsessive-compulsive disorder. Having not read the as-yet-untranslated books, I write this commentary from Plato’s cave, trying to infer the reality of Castel’s analysis from expository shadows. I am unlikely to be more successful than Plato’s poor troglodytes, so I apologize ahead of time for any misunderstandings. Moreover, I cannot assess Castel’s detailed evidential case for his substantive theses.1 I thus focus (...) on some key philosophical issues that impinge on an area of my concern, the concept of mental disorder. Castel is a rare breed of French.. (shrink)

This book consists of a focused and systematic analysis of Freud’s implicit argument for unconscious mental states. The author employs the unique approach of applying contemporary philosophical methods, especially Kripke-Putnam essentialism, in analyzing Freud’s argument. The book elaborates how Freud transformed the intentionality theory of his Cartesian teacher Franz Brentano into what is essentially a sophisticated modern view of the mind. Indeed, Freud redirected Brentano's analysis of consciousness as intentionality into a view of consciousness-independent intentionalism about the mental that in (...) effect set the agenda for latter-twentieth-century philosophy of mind. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Makes a Mental Disorder Mental?Jerome C. Wakefield (bio)Keywordsharmful dysfunction, mental disorder, intentionality, mental dysfunction, mental functioning, phenomenality, somatic disorderWhat makes a medical disorder mental rather than (exclusively) somatic or physical? Psychiatry to some extent depends for its existence as a medical specialty on the distinction between mental and somatic disorders, yet the history of this distinction presents a bewildering array of puzzling judgments, radical shifts, and seemingly (...) arbitrary distinctions. The historical observation that putative mental disorders are often reclassified as physical disorders as soon as their physiologic basis is understood further confuses matters. Moreover, recent debates about such classifications often seem to reflect desires to protect professional turf or obtain optimal reimbursement for treatment more than they do the application of a coherent conceptual distinction. No wonder that Brülde and Radovic (2006) disarmingly admit at the outset of their exploration of this question that there is a case to be made that their topic is relatively unimportant or even meaningless intellectually, a rare way to start an inquiry!Could there nonetheless be a cogent conceptual distinction lurking here? Brülde and Radovic usefully invite us to reframe the question, in effect as follows: Suppose we pay attention to professional and lay judgments as evidence but at the same time try to avoid being ensnared by the distortions resulting from turf issues and other pragmatic motives and constraints. Can we then identify some principled distinction in this domain that is worth making and that interestingly corresponds to the distinction generally made between mental disorders and strictly somatic disorders? Brülde and Radovic do not come to any confident or compelling conclusion about this.My answer, based on my harmful dysfunction analysis of disorder (Wakefield, 1992a, 1992b, 1999a, 1999b), is that a mental disorder is a harmful mental dysfunction, where a mental dysfunction is a failure of the capacity of some mental mechanism to perform a function for which it was biologically designed. I argue that, owing to a series of logical missteps, Brülde and Radovic needlessly reject this view. After some preliminary comments and clarifications, I defend the internal dysfunction approach from the objections posed by Brülde and Radovic, and then conclude by elaborating this view in some new ways. Note that Brülde and Radovic critique something they call the "internal cause view" of what makes a disorder mental, and they name others who hold that view. However, my work figures prominently in their discussion, and for expository simplicity, I will presume to simply construe their arguments as aimed at the harmful dysfunction analysis. [End Page 123]Clarifying the QuestionIt is easy to misconstrue the question "What makes a mental disorder mental" as demanding a precise account of the mental, an error to which Brülde and Radovic succumb in their repeated complaints that various writers do not present principled accounts of the mental but rely on lists of prototypical mental states or tentative guidelines to fix the reference of mental. We would need a precise definition of mental if the problem were how to classify cases in which it is ambiguous whether some phenomenon is mental or physical. We might imagine, for example, someone being genuinely puzzled as to whether inability to sleep is failure of a mental function or process. But this sort of puzzle about the boundaries of the mental is not the problem with which Brülde and Radovic are concerned; anyway, ambiguous cases may just be inherently ambiguous. The problem, which a crisp definition of mental will not resolve, is what relation mental states or mechanisms must have to a disorder to make it a mental disorder; must there be mental symptoms, or mental dysfunctions, or either one, and so on? But, even if a precise resolution of the nature of the mental is not needed, some notion of the mental domain is essential in pursuing this discussion. We can pick out the mental ostensively, by pointing to lots of examples (e.g., perception, motivation, emotion, thought, and sensation) much more confidently than we can define it in a principled way. But because Brülde and Radovic find fault in such ostensive reference fixing, let me... (shrink)

A major obstacle to formulating a broad-content intentional psychology is the occurrence of ''Frege cases'' - cases in which a person apparently believes or desires Fa but not Fb and acts accordingly, even though "a" and "b" have the same broad content. Frege cases seem to demand narrow-content distinctions to explain actions by the contents of beliefs and desires. Jerry Fodor ( The elm and the expert: Mentalese and its semantics , Cambridge, MA: MIT Press, 1994) argues that an explanatorily (...) adequate broad-content psychology is nonetheless possible because Frege cases rarely occur in intentional-explanatory contexts, and they are not systematically linked to intentional laws in a way that demands intentional explanation. Thus, he claims, behaviors associated with Frege cases can be considered ceteris-paribus exceptions to broad-content intentional laws without significantly decreasing the explanatory power of intentional psychology. I argue that Frege cases are plentiful and systematically linked to intentional laws in a way that requires intentional explanation, specifically in the explanation of why certain actions are not performed. Consequently, Frege-case behaviors cannot be construed as ceteris-paribus exceptions to intentional laws without significantly eroding the explanatory power of intentional psychology and reducing the rationality of the agent. Fodor thus fails to save broad-content psychology from the prima facie objections against it based on Frege cases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Moral Responsibility:Disorders of Personhood as Harmful Dysfunctions, With Special Reference to AlcoholismJerome C. Wakefield (bio)Keywordsalcohol dependence, philosophy of psychiatry, mental disorder, harmful dysfunction, psychiatric diagnosis, person, moral responsibilityIn his paper, Ethical Decisions in the Classification of Mental Conditions as Mental Illness, Craig Edwards grapples with a profound problem: why is it that when we classify a mental condition as a mental disorder, that tends to take (...) the condition out of the sphere of moral responsibility or virtuousness of character? For example, it is not uncommon when someone commits suicide and the question is raised as to why he or she did it, that instead of a reason or character trait that would place the act within a moral calculus, one is offered the explanation "she was clinically depressed" or "he was bipolar," and this tends to terminate discussion and make reasons and moral evaluation superfluous. Why does such a comment have that effect?As Edwards notes, this can get complicated as the moral and the disordered interact. Certainly people are sometimes morally responsible for acting on their disordered impulses (as in pedophilia), and they are responsible for putting themselves in the way of disorder, as when someone imbibes in a way likely to lead to alcoholism. But at the normal/disorder divide, there seems to be a consistent lifting of some responsibility, reflecting the application of the sick role. For example, the rough equivalent of our current category of post-traumatic stress disorder (PTSD) was recognized as a disorder in earlier wars ("shell shock," "war neurosis"), but often considered an expression of cowardice; the cowardice was morally evaluable as a failure of virtue (even if, like many personality traits, being a coward is not within the person's direct voluntary control) and led to contempt for those with PTSD, but nonetheless—except in cases thought to be malingering—the PTSD that resulted constituted a disorder for which the individual was [End Page 91] not in the same direct sense blameworthy. This moral shift requires explanation.This topic also has important social ramifications. Relief from responsibility may sound like a good thing, and it is trumpeted by mental health advocates as a reason for supporting the classification of many conditions as disorders. But as Edwards is aware, it is a two-edged sword. Disordered status may allow escape from censure and offer the protections of the sick role, but it also changes the relationship of the agent to his or her own actions and imposes the responsibility of the sick role on the individual to attempt to change ("get better"). The sick role allows for no defense of an idiosyncrasy based on normal variation ("It takes all kinds…") or the individual's eccentric vision or steadfast integrity, for that vision or sense of integrity are now seen as pathological and not morally legitimate. The individual is subjected to endless entreaties to seek help and it is implied that not to do so is irresponsible, so that a decision to embrace one's nature and remain as one is becomes illegitimate. Moreover, the sick role allows for no explanation in terms of the individual's normal defensive response to unjust, deprived, or challenging social or environmental circumstances, thus weakening the motives for social change rather than individual intervention.In sum, there is an inevitable sense in which being placed in the sick role inherently stigmatizes the "sick" condition in virtue of the special moral attitudes extended to the disordered. Cultures can thus easily exploit the sick role and its much-touted relief from responsibility to extend the reach of social control processes. This is one reason why the distinction between disorder and non-disorder is so important, and why it is crucial to identify when non-disordered conditions are mislabeled as disorders—as when, for example, psychiatry gets it wrong about the distinction between normal and disordered sadness (Horwitz and Wakefield, 2007). Such overpathologization can redefine the boundaries of our moral universe on mistaken grounds.Edwards offers two provocative answers—not entirely at ease with each other—to the question of why mental disorders relieve the patient from moral responsibility: (1) mental disorders are... (shrink)

It is a hallmark of a good model to make accurate a priori predictions to new conditions (Busemeyer & Wang, 2000). This study compared 8 decision learning models with respect to their generalizability. Participants performed 2 tasks (the Iowa Gambling Task and the Soochow Gambling Task), and each model made a priori predictions by estimating the parameters for each participant from 1 task and using those same parameters to predict on the other task. Three methods were used to evaluate the (...) models at the individual level of analysis. The first method used a post hoc fit criterion, the second method used a generalization criterion for short‐term predictions, and the third method again used a generalization criterion for long‐term predictions. The results suggest that the models with the prospect utility function can make generalizable predictions to new conditions, and different learning models are needed for making short‐versus long‐term predictions on simple gambling tasks. (shrink)

The Post-Information Age will see the merger of humans and their technologies, perhaps creating an entirely new species.

: Jerry Fodor proposes a solution to Quine's inscrutability–of–reference problem for certain naturalized semantic theories, thereby defending such theories from charges that they cannot discriminate meanings finely enough. His proposal, combining elements of informational and inferential–role semantics, is to eliminate non–standard interpretations by testing predicate compatibility relations. I argue that Fodor's proposal, understood as primarily aimed at Mentalese, withstands Ray's and Gates's objections but nonetheless fails because of unwarranted assumptions about ontological homogeneity of target language predicates, and problems with Fodor's (...) reliance on predicate conjunction to resolve ambiguity. Naturalized semantics thus remains without an answer to the inscrutability objection. (shrink)

Current symptom-based DSM and ICD diagnostic criteria for mental disorders are prone to yielding false positives because they ignore the context of symptoms. This is often seen as a benign flaw because problems of living and emotional suffering, even if not true disorders, may benefit from support and treatment. However, diagnosis of a disorder in our society has many ramifications not only for treatment choice but for broader social reactions to the diagnosed individual. In particular, mental disorders impose a sick (...) role on individuals and place a burden upon them to change; thus, disorders decrease the level of respect and acceptance generally accorded to those with even annoying normal variations in traits and features. Thus, minimizing false positives is important to a pluralistic society. The harmful dysfunction analysis of disorder is used to diagnose the sources of likely false positives, and propose potential remedies to the current weaknesses in the validity of diagnostic criteria. (shrink)

Miriam solomon resuscitates a famous proposal of George Engel's to classify normal grief as a medical disorder. She has two main arguments justifying such a reclassification, one based on Engel's "wound analogy" and another a "Humpty Dumpty"-type argument that 'disorder' is a technical term that we can redefine any way we please. I consider them in turn.Solomon says: "I suggest that we allow a concept of "psychological injury" that is analogous to the concept of physical injury." Of course, we already (...) have a whole chapter of the Diagnostic and Statistical Manual of Mental Disorders devoted to psychological injuries in the form of "trauma- and stressor-related disorders" (this is where the new... (shrink)

Jerry Fodor (1994) proposes a solution to Quine's inscrutability–of–reference problem for certain naturalized semantic theories, thereby defending such theories from charges that they cannot discriminate meanings finely enough. His proposal, combining elements of informational and inferential–role semantics, is to eliminate non–standard interpretations by testing predicate compatibility relations. I argue that Fodor's proposal, understood as primarily aimed at Mentalese, withstands Ray's (1997) and Gates's (1996) objections but nonetheless fails because of unwarranted assumptions about ontological homogeneity of target language predicates, and problems (...) with Fodor's reliance on predicate conjunction to resolve ambiguity. Naturalized semantics thus remains without an answer to the inscrutability objection. (shrink)

Three reservations about Keller & Miller's (K&M's) argument are explored: Serious validity problems afflict epidemiological criteria discriminating disorders from non-disorders, so high rates may be misleading. Normal variation need not be mild disorder, contrary to a possible interpretation of K&M's article. And, rather than mutation-selection balance, true disorders may result from unselected combinations of normal variants over many loci. (Published Online November 9 2006).

In psychiatry's transformation from an asylum-based to a community-oriented profession, false positive diagnoses became a major challenge to the validity of the diagnostic system. The shift to descriptive, symptom-based operationalized diagnostic criteria of DSM-III further exacerbated this difficulty because of the contextually based nature of the distinction between normal distress and mental disorder. Through selected examples, the degree of success with which DSM-III and DSM-IV have attended to the challenge of avoiding false positive diagnoses is examined. Conceptual analysis of selected (...) criteria sets, with a focus on counterexamples to the claim that DSM criteria imply disorder, is performed. Psychiatry has so far failed to systematically confront the problem of false positives. Flaws in criteria, which can be recognized even by lay people, remain unaddressed, despite the fact that the issue is purely conceptual and is not sensitive to any new research information. (shrink)

Andrews et al.'s analysis suffers from a series of conceptual confusions they inherit from Gould's work. Their proposal that adaptations can be distinguished from exaptations essentially by specific design criteria fails because exaptations are often maintained and secondarily adapted by natural selection and therefore, over evolutionary time, can come to have similar levels of design specificity to adaptations.

The authors of It Is Right and Just bring to the public’s attention serious questions of political thought and practice. That they do so from the standpoint of theology provides an opportunity for a fresh look at the American founding and the American regime. Though the questions raised are important, the authors unfortunately do not provide a helpful foundation for fruitful reflection. Instead, the book makes sweeping claims without adequate evidence. It Is Right and Just will disappoint any serious student (...) of American politics and, worse, may mislead well-intended American Catholics searching for a more just polity for themselves and their children. (shrink)

This chapter examines traditionalists’ arguments why Dungeons Dragons (DD) is good for us first, and then discusses the cases where it could be bad for us. The irony for Christian critics of DD, such as Schnoebelen, is that the philosophical and theological arguments of Christian traditionalists, such as Thomas Aquinas and J.R.R. Tolkien, provide some of the strongest arguments in favor of DD role‐playing. However, to be fair, these same arguments can be used to argue that a particular DD game, (...) under certain circumstances, can be bad. “Postmodernists” refers loosely to a group of philosophers and thinkers who question, if not outright reject, the core tenets of the traditionalists. If the traditionalists have the correct metaphysics about the real world, then it follows that DD is good, but that care must be taken to make sure the game does not become morally objectionable. (shrink)

I argue that John Searle's (1980) influential Chinese room argument (CRA) against computationalism and strong AI survives existing objections, including Block's (1998) internalized systems reply, Fodor's (1991b) deviant causal chain reply, and Hauser's (1997) unconscious content reply. However, a new ``essentialist'' reply I construct shows that the CRA as presented by Searle is an unsound argument that relies on a question-begging appeal to intuition. My diagnosis of the CRA relies on an interpretation of computationalism as a scientific theory about the (...) essential nature of intentional content; such theories often yield non-intuitive results in non-standard cases, and so cannot be judged by such intuitions. However, I further argue that the CRA can be transformed into a potentially valid argument against computationalism simply by reinterpreting it as an indeterminacy argument that shows that computationalism cannot explain the ordinary distinction between semantic content and sheer syntactic manipulation, and thus cannot be an adequate account of content. This conclusion admittedly rests on the arguable but plausible assumption that thought content is interestingly determinate. I conclude that the viability of computationalism and strong AI depends on their addressing the indeterminacy objection, but that it is currently unclear how this objection can be successfully addressed. (shrink)