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.