Evolutionary history versus current causal role in the definition of disorder: Reply to McNally

The harmful dysfunction (HD) analysis (Wakefield, American Psychologist 47 (1992a) 373) asserts that 'disorder' means 'harmful dysfunction', where 'harm' is a value concept anchored in social values and 'dysfunction' is a factual concept referring to failure of a mechanism to perform a natural function. Additionally, the HD analysis claims that a mechanism's natural functions are its naturally selected effects. McNally (Behaviour Research and Therapy (2000) pp. 309-314) argues to the contrary that 'dysfunction' is a value concept referring to negative failures of function, that 'function' refers to current causal roles and not evolutionarily designed causal roles, and that 'disorder' consequently means 'harmful failure of a mechanism to perform a valued current causal role.' I reply by showing that McNally's proposals lack the HD analysis's power to explain common judgments about function, dysfunction, and disorder. 'Dysfunction' cannot be a negative value concept because many dysfunctions are positive or neutral; 'function' cannot refer to current causal roles because many current causal roles are not functions and some functions are not current causal roles; and 'disorder' cannot refer to harmful failures of current causal roles because that definition allows almost any negative condition whatever to be a disorder and thus fails to explain the distinctions we make between disorder and non-disorder. Copyright (C) 2001 Elsevier Science Ltd.