Harm as a Necessary Component of the Concept of Medical Disorder: Reply to Muckler and Taylor

Jerome C. Wakefield, Jordan A. Conrad

Research output: Contribution to journalArticlepeer-review


Wakefield's harmful dysfunction analysis asserts that the concept of medical disorder includes a naturalistic component of dysfunction (failure of biologically designed functioning) and a value (harm) component, both of which are required for disorder attributions. Muckler and Taylor, defending a purely naturalist, value-free understanding of disorder, argue that harm is not necessary for disorder. They provide three examples of dysfunctions that, they claim, are considered disorders but are entirely harmless: mild mononucleosis, cowpox that prevents smallpox, and minor perceptual deficits. They also reject the proposal that dysfunctions need only be typically harmful to qualify as disorders. We argue that the proposed counterexamples are, in fact, considered harmful; thus, they fail to disconfirm the harm requirement: incapacity for exertion is inherently harmful, whether or not exertion occurs, cowpox is directly harmful irrespective of indirect benefits, and colorblindness and anosmia are considered harmful by those who consider them disorders. We also defend the typicality qualifier as viably addressing some apparently harmless disorders and argue that a dysfunction's harmfulness is best understood in dispositional terms.

Original languageEnglish (US)
Pages (from-to)350-370
Number of pages21
JournalJournal of Medicine and Philosophy (United Kingdom)
Issue number3
StatePublished - May 21 2020


  • anosmia
  • colorblindness
  • commensal virus
  • concept of medical disorder
  • concept of mental disorder
  • conceptual foundations of medicine
  • cowpox
  • definition of disorder
  • disease
  • disorder
  • harm
  • harmful dysfunction
  • mononucleosis
  • naturalism
  • normativism
  • philosophy of medicine

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Philosophy


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