Abstract

In one of his key publications on the harmful dysfunction analysis of mental disorder (HDA), Jerome Wakefield acknowledged that he has “explored the value element in disorder less thoroughly than the factual element. This is in part because the factual component poses more of a problem for inferences about disorder and in part because the nature of values is such that it requires separate consideration” (Wakefield 1992, 384). More than twenty years have passed since this remark, and yet a thorough consideration of the value component in Wakefield’s HDA is still lacking. Quite a few contributions to this volume promise to change that situation, and ours is one of these. In this contribution, we will analyze the harm or value component and argue that Wakefield’s dealing with it is so problematic that it undermines, at least indirectly, the viability of the HDA. In the first section, we explore Wakefield’s emphasis on the subjective nature of harm and his exclusive focus on social values. The second section is devoted to an analysis of Wakefield’s examples of conditions that are dysfunctional but harmless (fused toes, albinism, reversal of the heart, dyslexia in illiterate societies, etc.). We argue that these examples are quite problematic because they do not exemplify what they are supposed to exemplify. In the third section, we show how these two problems are connected: Wakefield uses the harmfulness of a condition as an implicit criterion to distinguish normal variation from dysfunction. In doing so, he blurs the distinction between the harm component and the dysfunction component, even though this distinction is central to his HDA.