Rethinking the neurodiversity debate from the harmful dysfunction perspective: The implications of DSM category evolutionary heterogeneity

Neurodiversity advocates argue that psychiatry mistakenly classifies certain normal psychological variations as mental disorders. These arguments raise fundamental issues about psychiatric diagnosis and classification and tend to be broadly revisionist in claiming that entire DSM categories are in fact normal "neurodiverse" conditions. This chapter evaluates these arguments within the framework of Jerome Wakefield's evolutionary "harmful dysfunction analysis" of mental disorder and with a focus on disorders involving the expression of emotion. The authors argue that the considerable heterogeneity of most DSM categories suggests the likelihood that each category is a mix of true disorders caused by dysfunctions and miscategorized normal neurodiversity. They explore several standard DSM categories, each of which has implications for emotional processes, including psychopathy, premenstrual dysphoric disorder, attention-deficit hyperactivity disorder, and autistic spectrum disorder, to illustrate how heterogeneity can both warrant and limit neurodiversity claims.