The importance and limits of harm in identifiying mental disorder

Jerome C. Wakefield, Michael B. First

    Research output: Contribution to journalReview article

    Abstract

    The In Review articles in this issue on normality and disorder by Dr Rachel Cooper and Dr Derek Bolton explore the importance of a value component of harm in the concept of mental disorder. They focus on the Diagnostic and Statistical Manual of Mental Disorder's clinical significance criterion, requiring that symptoms cause significant distress or role impairment, as the expression of the harm component. As Dr Bolton argues, harm in the form of distress or role impairment has always been intimately tied to the concept of disorder and treatment decisions; as Dr Cooper argues, without the harm requirement, any disliked anomaly may be labelled a disorder. Moreover, as Cooper argues, a harm requirement is not incompatible with a natural kinds approach to distinguishing among disorders or to a categorical approach to disorder; the lack of zones of rarity on the harm continuum does not preclude categorical underlying causal processes. However, neither paper systematically develops arguments regarding the other component of disorder, the requirement that the harm must be caused by underlying dysfunction. The dysfunction component distinguishes disorders from the many other negative conditions in life. Cooper's identification of dysfunction with symptom severity ignores the fact that normal suffering can be severe, and Bolton's attempt to encompass risk of harm within harm yields an implausibly expansive conception of disorder. While the harm component is essential, clarifcation of the dysfunction component of the concept of disorder, pursued in part 2 of this In Review in the December 2013 issue, is also essential to establishing a coherent and plausibly limited domain of psychiatric disorder within the broader arena of harmful conditions.

    Original languageEnglish (US)
    Pages (from-to)618-621
    Number of pages4
    JournalCanadian Journal of Psychiatry
    Volume58
    Issue number11
    DOIs
    StatePublished - Jan 1 2013

    Fingerprint

    Psychological Stress
    Mental Disorders
    Diagnostic and Statistical Manual of Mental Disorders
    Psychiatry
    Therapeutics

    Keywords

    • Clinical significance
    • Diagnosis
    • Diagnostic and statistical manual of mental disorders-fifth edition
    • DSM-5
    • Dysfunction
    • False positives
    • Harmful dysfunction
    • Mental disorder definition
    • Validity

    ASJC Scopus subject areas

    • Psychiatry and Mental health

    Cite this

    The importance and limits of harm in identifiying mental disorder. / Wakefield, Jerome C.; First, Michael B.

    In: Canadian Journal of Psychiatry, Vol. 58, No. 11, 01.01.2013, p. 618-621.

    Research output: Contribution to journalReview article

    Wakefield, Jerome C. ; First, Michael B. / The importance and limits of harm in identifiying mental disorder. In: Canadian Journal of Psychiatry. 2013 ; Vol. 58, No. 11. pp. 618-621.
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