Wakefield on harm, health, and homosexuality
Main Article Content
Abstract
Jerome Wakefield’s recent clarifications of the harm component of his “harmful-dysfunction analysis” of medical disorder lead to three important conclusions. First, the analysis would be improved if he simply deleted all his remarks on the dependence of disorder status on social values. Except when trivial, they rest either on a false environmental relativity of disease, a false cultural-relativist metaethics, or an unacceptable medical ethics. Second, even after this deletion of social values, the harmful-dysfunction analysis still fails to match medical concepts, since it excludes all subclinical disease, as well as many harmless clinical diseases, and it can also find no harm either in essential pathology or in the diseases of nonsentient organisms. Third, the harm-based arguments that Wakefield takes to explain and perhaps justify the 1973 American Psychiatric Association decision to depathologize homosexuality do not stand a moment’s scrutiny. Indeed, by his newly clarified harm test, homosexuality is clearly harmful to all homosexuals. So Wakefield should just drop his harm criterion and admit that disease is mere biological dysfunction.
Keywords:
health, disease, disorder, medicine, psychiatry, homosexuality, harmful-dysfunction analysis, Jerome Wakefield
Article Details
How to Cite
BOORSE, Christopher.
Wakefield on harm, health, and homosexuality.
Medical Research Archives, [S.l.], v. 12, n. 6, july 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5302>. Date accessed: 21 nov. 2024.
doi: https://doi.org/10.18103/mra.v12i6.5302.
Section
Editorial
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Wakefield JC. From Ribot and Dupre to Spitzer and RDoC: Does the harmful dysfunction analysis possess historical explanatory power? Reply to Steeves Demazeux. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and His Critics. Cambridge, MA: MIT Press; 2021:27-46.
2. Boorse C. Health as a theoretical concept. Philosophy of Science 1977:44:542-73.
3. Boorse C. Concepts of health. In VanDeVeer D, Regan T, ed., Health Care Ethics: An Introduction. Philadelphia: Temple University Press; 1987:359-93.
4. Boorse C. A rebuttal on health. In Humber JM, Almeder RF, ed., What is Disease? Totowa, NJ: Humana Press; 1997:1-134.
5. Boorse C. A second rebuttal on health. Journal of Medicine and Philosophy 2014;39: 683-724.
6. Wakefield JC. Disorder as harmful dysfunction: a conceptual critique of DSM-III-R’s definition of mental disorder. Psychological Review 1992;99:232-47.
7. Wakefield JC. Aristotle as sociobiologist: the “function of a human being” argument, black box essentialism, and the concept of mental disorder. Philosophy, Psychiatry, and Psychology 2000;7:17-44.
8. Wakefield JC. Mental disorder as a black box essentialist concept. Journal of Abnormal Psychology 1999;108:465-72.
9. Wakefield JC. Addiction, the concept of disorder, and pathways to harm: comment on Levy. Frontiers in Psychiatry 2013;4:1-2.
10. Wakefield JC. The biostatistical theory versus the harmful dysfunction analysis, part 1: is part-dysfunction a sufficient condition for medical disorder? Journal of Medicine and Philosophy 2014;39:648-82.
11. Wakefield JC. Can the harmful dysfunction analysis distinguish problematic normal variation from disorder? Reply to Andreas De Block and Jonathan Sholl. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and His Critics. Cambridge, MA: MIT Press; 2021:511-36.
12. Wakefield JC. Must social values play a role in the harm component of the harmful dysfunction analysis? Reply to Rachel Cooper. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and His Critics. Cambridge, MA: MIT Press; 2021:553-75.
13. Wakefield JC, Conrad JA. Harm as a necessary component of the concept of medical disorder: reply to Muckler and Taylor. Journal of Medicine and Philosophy 2020;45:350-70.
14. DeBlock A, Sholl J. Harmless dysfunctions and the problem of normal variation. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and His Critics. Cambridge, MA: MIT Press; 2021:495-510.
15. Wakefield JC. The concept of mental disorder: on the boundary between biological facts and social values. American Psychologist 1992;47:373-88.
16. Sumner LW. Welfare, Happiness, and Ethics. NY: Oxford University Press;1996.
17. Wakefield JC. Addiction and the concept of disorder, part 1: why addiction is a medical disorder. Neuroethics 2017;10:39-53.
18. Wakefield JC. Personality disorder as harmful dysfunction: DSM’s cultural deviance criterion reconsidered. Journal of Personality Disorders 2006;20(2):157-69.
19. Wakefield JC. Do the challenges of autism and neurodiversity pose an objection to the harmful dysfunction analysis? Reply to Denis Forest. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and his Critics. Cambridge, MA: MIT Press; 2021:449-67.
20. Engelhardt Jr HT. The Foundations of Bioethics. NY: Oxford University Press;1986.
21. Reznek L. The Nature of Disease. London: Routledge and Kegan Paul;1987.
22. Boorse C. Concepts of health and disease. In Gifford F, ed., Philosophy of Medicine, vol. 12 of Elsevier Handbook of Philosophy of Science. Oxford: Elsevier; 2011:13-64.
23. Boorse C. Reznek on health. Teorema 2021;40(1):23-65.
24. Wakefield JC. Biological function hierarchies and indeterminacy of dysfunction: supplementary reply to Justin Garson. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and His Critics. Cambridge, MA: MIT Press; 2021:385-96.
25. Cooper R. Classifying Madness. Dordrecht: Springer; 2005.
26. Rachels J, Rachels S. The Elements of Moral Philosophy, 9th ed. NY: McGraw-Hill; 2019.
27. Wakefield JC, Conrad JA. Does the harm component of the harmful dysfunction analysis need rethinking? Reply to Powell and Scarffe. Journal of Medical Ethics 2019;45(9):594-6.
28. Powell R, Scarffe E. Rethinking “disease”: a fresh diagnosis and a new philosophical treatment. Journal of Medical Ethics 2019;45(9):579-88.
29. Powell R, Scarffe E. Rehabilitating “disease”: function, value, and objectivity in medicine. Philosophy of Science 2019;86:1168-78.
30. Spitzer RL, Endicott J. Medical and mental disorder: proposed definition and criteria. In Spitzer and R.L. Klein, ed., Critical Issues in Psychiatric Diagnosis. NY: Raven Press; 1978:15-39.
31. Spitzer RL, Wilson PT. Nosology and the official psychiatric nomenclature. In Freedman AM, Kaplan HI, Sadock BJ, ed., Comprehensive Textbook of Psychiatry, vol. 2. Williams and Wilkins; 1975:826-45.
32. Boorse C. Wright on functions. Philosophical Review 1976;85:70-86.
33. Boorse C. Wakefield’s harm-based critique of the biostatistical theory. Forthcoming in Journal of Medicine and Philosophy.
34. Feit N. Harm and the concept of mental disorder. Theoretical Medicine and Bioethics 2017;38:367-85.
35. Feinberg J. Wrongful life and the counterfactual element in harming. Social Philosophy and Policy 1986;4:145-178.
36. Cooper R. How might I have been? Metaphilosophy 2015;46:495-514.
37. Sedgwick P. Illness – mental and otherwise. Hastings Center Studies 1973;1:19-40.
38. Fulford KWM. Moral Theory and Medical Practice. NY: Cambridge University Press; 1989.
39. Kass L. Regarding the end of medicine and the pursuit of health. The Public Interest 1975;40:11-42.
40. Wakefield JC. Evolutionary versus prototype analyses of the concept of disorder. Journal of Abnormal Psychology 1999; 108:374-99.
41. Singer P. Rethinking Life and Death. NY: St. Martin’s Griffin; 1994.
42. Sommerhoff G. Analytical Biology. London: Oxford University Press; 1950.
43. Sommerhoff G. The abstract characteristics of living organisms. In Emery FE, ed., Systems Thinking. Harmondsworth: Penguin; 1959:147-202.
44. Geach PT. Good and evil. Analysis 1956;17:23-42.
45. Anscombe GEM. Modern moral philosophy. Philosophy 1958;33:1-19.
46. von Wright GH. The Varieties of Goodness. London: Routledge and Kegan Paul; 1963.
47. Hursthouse R. On Virtue Ethics. Oxford: Oxford University Press; 1999.
48. Foot P. Natural Goodness. Oxford: Clarendon Press; 2001.
49. Thomson JJ. Goodness and Advice. Princeton, NJ: Princeton University Press; 2001.
50. Nussbaum MC. Frontiers of Justice: Disability, Nationality, Species Membership. Cambridge, MA: Belknap Press of Harvard University; 2006.
51. Thompson M. Life and Action. Cambridge, MA: Harvard University Press; 2012.
52. Varner GE. In Nature’s Interests? Interests, Animal Rights, and Environmental Ethics. NY: Oxford University Press; 1998.
53. Taylor PW. Respect for Nature: A Theory of Environmental Ethics. Princeton: Princeton University Press; 1986.
54. McShane K. Against etiological function accounts of interests. Synthese 2021;198 (4):3499-3517.
55. Basl J, Sandler R. The good of non-sentient entities: organisms, artifacts, and synthetic biology. Studies in History and Philosophy of Biological and Biomedical Sciences 2013;44(4):697-705.
56. Basl J, Sandler R. Three puzzles regarding the moral status of synthetic organisms. In Kaebnick GE, Murray TH, eds, Synthetic Biology and Morality: Artificial Life and the Bounds of Nature. Cambridge, MA: MIT Press; 2013.
57. Basl J. The Death of the Ethic of Life. Oxford: Oxford University Press; 2019.
58. Dussault AC. Welfare, health, and the moral considerability of nonsentient biological entities. Ateliers de l’éthique/The Ethics Forum 2018;13:184-209.
59. FitzPatrick WJ. Teleology and the Norms of Nature. NY: Garland Publishing; 2000.
60. Dussault AC. Wakefield’s harmful dysfunction analysis of disorder and the problem of defining harm to nonsentient organisms. Theoretical Medicine and Bioethics 2021;42:211-31.
61. Muckler D, Taylor JS (2020). The irrelevance of harm for a theory of disease. Journal of Medicine and Philosophy 45:332-49.
62. Dussault AC. The harmful-dysfunction account of disorder, individual versus social values, and the interpersonal variability of harm challenge. Medicine, Health Care and Philosophy 2021;24:453-67.
63. Kripke S. Naming and Necessity. Cambridge: Harvard University Press; 1980.
64. Parfit D. Reasons and Persons. Oxford: Clarendon Press; 1984.
65. Nordenfelt L. On the Nature of Health. Dordrecht: Reidel; 1987.
66. Nordentelt L. Holistic theories of health as applicable to non-human living beings. In Kincaid H, McKitrick J, ed., Establishing Medical Reality. NY: Springer; 2007.
67. Crisp R. Reasons and the Good. Oxford: Clarendon Press; 2006.
68. Fletcher G. The Philosophy of Well-Being: An Introduction. London: Routledge; 2016.
69. Lutz M. Moral naturalism. Stanford Encyclopedia of Philosophy. www.plato.stanford.edu.
70. Rice CM. Well-being and animals. In Fletcher G, ed., The Routledge Handbook of Philosophy of Well-being. NY: Routledge; 2015: 378-88.
71. Odenbaugh J. Nothing in ethics makes sense except in the light of evolution? Natural goodness, normativity, and naturalism. Synthese 2017;194:1031-55.
72. Varner GE. Review of Nicholas Agar, Life’s Intrinsic Value: Science, Ethics, and Nature. Environmental Ethics 2003;25:413-16.
73. webmd.com. Anal sex safety: what to know. Accessed January 22, 2024.
74. Pliny the Elder. Natural History. Book X, ch. 83.
75. Amoretti MC, Lalumera E. Harm should not be a necessary criterion for mental disorder: some reflections on the DSM-5 definition of mental disorder. Theoretical Medicine and Bioethics 2019;40(4):321-37.
2. Boorse C. Health as a theoretical concept. Philosophy of Science 1977:44:542-73.
3. Boorse C. Concepts of health. In VanDeVeer D, Regan T, ed., Health Care Ethics: An Introduction. Philadelphia: Temple University Press; 1987:359-93.
4. Boorse C. A rebuttal on health. In Humber JM, Almeder RF, ed., What is Disease? Totowa, NJ: Humana Press; 1997:1-134.
5. Boorse C. A second rebuttal on health. Journal of Medicine and Philosophy 2014;39: 683-724.
6. Wakefield JC. Disorder as harmful dysfunction: a conceptual critique of DSM-III-R’s definition of mental disorder. Psychological Review 1992;99:232-47.
7. Wakefield JC. Aristotle as sociobiologist: the “function of a human being” argument, black box essentialism, and the concept of mental disorder. Philosophy, Psychiatry, and Psychology 2000;7:17-44.
8. Wakefield JC. Mental disorder as a black box essentialist concept. Journal of Abnormal Psychology 1999;108:465-72.
9. Wakefield JC. Addiction, the concept of disorder, and pathways to harm: comment on Levy. Frontiers in Psychiatry 2013;4:1-2.
10. Wakefield JC. The biostatistical theory versus the harmful dysfunction analysis, part 1: is part-dysfunction a sufficient condition for medical disorder? Journal of Medicine and Philosophy 2014;39:648-82.
11. Wakefield JC. Can the harmful dysfunction analysis distinguish problematic normal variation from disorder? Reply to Andreas De Block and Jonathan Sholl. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and His Critics. Cambridge, MA: MIT Press; 2021:511-36.
12. Wakefield JC. Must social values play a role in the harm component of the harmful dysfunction analysis? Reply to Rachel Cooper. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and His Critics. Cambridge, MA: MIT Press; 2021:553-75.
13. Wakefield JC, Conrad JA. Harm as a necessary component of the concept of medical disorder: reply to Muckler and Taylor. Journal of Medicine and Philosophy 2020;45:350-70.
14. DeBlock A, Sholl J. Harmless dysfunctions and the problem of normal variation. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and His Critics. Cambridge, MA: MIT Press; 2021:495-510.
15. Wakefield JC. The concept of mental disorder: on the boundary between biological facts and social values. American Psychologist 1992;47:373-88.
16. Sumner LW. Welfare, Happiness, and Ethics. NY: Oxford University Press;1996.
17. Wakefield JC. Addiction and the concept of disorder, part 1: why addiction is a medical disorder. Neuroethics 2017;10:39-53.
18. Wakefield JC. Personality disorder as harmful dysfunction: DSM’s cultural deviance criterion reconsidered. Journal of Personality Disorders 2006;20(2):157-69.
19. Wakefield JC. Do the challenges of autism and neurodiversity pose an objection to the harmful dysfunction analysis? Reply to Denis Forest. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and his Critics. Cambridge, MA: MIT Press; 2021:449-67.
20. Engelhardt Jr HT. The Foundations of Bioethics. NY: Oxford University Press;1986.
21. Reznek L. The Nature of Disease. London: Routledge and Kegan Paul;1987.
22. Boorse C. Concepts of health and disease. In Gifford F, ed., Philosophy of Medicine, vol. 12 of Elsevier Handbook of Philosophy of Science. Oxford: Elsevier; 2011:13-64.
23. Boorse C. Reznek on health. Teorema 2021;40(1):23-65.
24. Wakefield JC. Biological function hierarchies and indeterminacy of dysfunction: supplementary reply to Justin Garson. In Faucher L, Forest D, ed., Defining Mental Disorder: Jerome Wakefield and His Critics. Cambridge, MA: MIT Press; 2021:385-96.
25. Cooper R. Classifying Madness. Dordrecht: Springer; 2005.
26. Rachels J, Rachels S. The Elements of Moral Philosophy, 9th ed. NY: McGraw-Hill; 2019.
27. Wakefield JC, Conrad JA. Does the harm component of the harmful dysfunction analysis need rethinking? Reply to Powell and Scarffe. Journal of Medical Ethics 2019;45(9):594-6.
28. Powell R, Scarffe E. Rethinking “disease”: a fresh diagnosis and a new philosophical treatment. Journal of Medical Ethics 2019;45(9):579-88.
29. Powell R, Scarffe E. Rehabilitating “disease”: function, value, and objectivity in medicine. Philosophy of Science 2019;86:1168-78.
30. Spitzer RL, Endicott J. Medical and mental disorder: proposed definition and criteria. In Spitzer and R.L. Klein, ed., Critical Issues in Psychiatric Diagnosis. NY: Raven Press; 1978:15-39.
31. Spitzer RL, Wilson PT. Nosology and the official psychiatric nomenclature. In Freedman AM, Kaplan HI, Sadock BJ, ed., Comprehensive Textbook of Psychiatry, vol. 2. Williams and Wilkins; 1975:826-45.
32. Boorse C. Wright on functions. Philosophical Review 1976;85:70-86.
33. Boorse C. Wakefield’s harm-based critique of the biostatistical theory. Forthcoming in Journal of Medicine and Philosophy.
34. Feit N. Harm and the concept of mental disorder. Theoretical Medicine and Bioethics 2017;38:367-85.
35. Feinberg J. Wrongful life and the counterfactual element in harming. Social Philosophy and Policy 1986;4:145-178.
36. Cooper R. How might I have been? Metaphilosophy 2015;46:495-514.
37. Sedgwick P. Illness – mental and otherwise. Hastings Center Studies 1973;1:19-40.
38. Fulford KWM. Moral Theory and Medical Practice. NY: Cambridge University Press; 1989.
39. Kass L. Regarding the end of medicine and the pursuit of health. The Public Interest 1975;40:11-42.
40. Wakefield JC. Evolutionary versus prototype analyses of the concept of disorder. Journal of Abnormal Psychology 1999; 108:374-99.
41. Singer P. Rethinking Life and Death. NY: St. Martin’s Griffin; 1994.
42. Sommerhoff G. Analytical Biology. London: Oxford University Press; 1950.
43. Sommerhoff G. The abstract characteristics of living organisms. In Emery FE, ed., Systems Thinking. Harmondsworth: Penguin; 1959:147-202.
44. Geach PT. Good and evil. Analysis 1956;17:23-42.
45. Anscombe GEM. Modern moral philosophy. Philosophy 1958;33:1-19.
46. von Wright GH. The Varieties of Goodness. London: Routledge and Kegan Paul; 1963.
47. Hursthouse R. On Virtue Ethics. Oxford: Oxford University Press; 1999.
48. Foot P. Natural Goodness. Oxford: Clarendon Press; 2001.
49. Thomson JJ. Goodness and Advice. Princeton, NJ: Princeton University Press; 2001.
50. Nussbaum MC. Frontiers of Justice: Disability, Nationality, Species Membership. Cambridge, MA: Belknap Press of Harvard University; 2006.
51. Thompson M. Life and Action. Cambridge, MA: Harvard University Press; 2012.
52. Varner GE. In Nature’s Interests? Interests, Animal Rights, and Environmental Ethics. NY: Oxford University Press; 1998.
53. Taylor PW. Respect for Nature: A Theory of Environmental Ethics. Princeton: Princeton University Press; 1986.
54. McShane K. Against etiological function accounts of interests. Synthese 2021;198 (4):3499-3517.
55. Basl J, Sandler R. The good of non-sentient entities: organisms, artifacts, and synthetic biology. Studies in History and Philosophy of Biological and Biomedical Sciences 2013;44(4):697-705.
56. Basl J, Sandler R. Three puzzles regarding the moral status of synthetic organisms. In Kaebnick GE, Murray TH, eds, Synthetic Biology and Morality: Artificial Life and the Bounds of Nature. Cambridge, MA: MIT Press; 2013.
57. Basl J. The Death of the Ethic of Life. Oxford: Oxford University Press; 2019.
58. Dussault AC. Welfare, health, and the moral considerability of nonsentient biological entities. Ateliers de l’éthique/The Ethics Forum 2018;13:184-209.
59. FitzPatrick WJ. Teleology and the Norms of Nature. NY: Garland Publishing; 2000.
60. Dussault AC. Wakefield’s harmful dysfunction analysis of disorder and the problem of defining harm to nonsentient organisms. Theoretical Medicine and Bioethics 2021;42:211-31.
61. Muckler D, Taylor JS (2020). The irrelevance of harm for a theory of disease. Journal of Medicine and Philosophy 45:332-49.
62. Dussault AC. The harmful-dysfunction account of disorder, individual versus social values, and the interpersonal variability of harm challenge. Medicine, Health Care and Philosophy 2021;24:453-67.
63. Kripke S. Naming and Necessity. Cambridge: Harvard University Press; 1980.
64. Parfit D. Reasons and Persons. Oxford: Clarendon Press; 1984.
65. Nordenfelt L. On the Nature of Health. Dordrecht: Reidel; 1987.
66. Nordentelt L. Holistic theories of health as applicable to non-human living beings. In Kincaid H, McKitrick J, ed., Establishing Medical Reality. NY: Springer; 2007.
67. Crisp R. Reasons and the Good. Oxford: Clarendon Press; 2006.
68. Fletcher G. The Philosophy of Well-Being: An Introduction. London: Routledge; 2016.
69. Lutz M. Moral naturalism. Stanford Encyclopedia of Philosophy. www.plato.stanford.edu.
70. Rice CM. Well-being and animals. In Fletcher G, ed., The Routledge Handbook of Philosophy of Well-being. NY: Routledge; 2015: 378-88.
71. Odenbaugh J. Nothing in ethics makes sense except in the light of evolution? Natural goodness, normativity, and naturalism. Synthese 2017;194:1031-55.
72. Varner GE. Review of Nicholas Agar, Life’s Intrinsic Value: Science, Ethics, and Nature. Environmental Ethics 2003;25:413-16.
73. webmd.com. Anal sex safety: what to know. Accessed January 22, 2024.
74. Pliny the Elder. Natural History. Book X, ch. 83.
75. Amoretti MC, Lalumera E. Harm should not be a necessary criterion for mental disorder: some reflections on the DSM-5 definition of mental disorder. Theoretical Medicine and Bioethics 2019;40(4):321-37.