Does the harm component of the harmful dysfunction analysis need rethinking?: Reply to Powell and Scarffe

Do the Challenges of Autism and Neurodiversity Pose an Objection to the Harmful Dysfunction Analysis? Reply to Denis Forest

“…Though desirable, and in principle consistent with the HDA, a theory of harm that would apply universally to the human case is elusive and philosophically highly controversial. Moreover, in the human case, the appeal to a culture-transcendent standard for harm that resembles current Western philosophical views but is to be applied universally in medical diagnosis raises worrisome issues of implicit Western triumphalism and of turning medicine into another battlefield in culture wars in which some people's needs are ignored because their condition is not deemed to be truly harmful (for an example of this danger, see Powell and Scarffe 2019;Wakefield and Conrad 2019). I tend to think that the social values addendum suitably broadly interpreted remains relatively benign and useful, that what are claimed by critics to be culture-transcendent "factual" human values are implicit in every human cultural value system, and that many of the harms human beings suffer are pro tanto harms related to their social roles and expectations.…”

Must Social Values Play a Role in the Harm Component of the Harmful Dysfunction Analysis? Reply to Rachel Cooper

“…There is nothing sacred about the precise way I formulated the harm criterion. I am open to rethinking and amending it if an alternative approach can be cogently elaborated and defended so that it is not an arbitrary imposition that is simply an expression of Western triumphalism (for discussion of some of the inevitable dangers of such an attempt, see Wakefield and Conrad 2019). I argue below that Cooper fails to provide any such rationale.…”

“…It thus remains to be demonstrated that attention to the harm requirement is in fact important in safeguarding the validity of DSM psychiatric diagnosis in the way that attention to the dysfunction criterion is manifestly critical. Caution is warranted because there is a danger that premature attempts to impose a culturally transcendent harm criterion to "provide a barrier against medicalization" without any systematic account of harm can lead to tendentious diagnostic constraints that block treatment of culturally specific direct pro tanto harms (Powell and Scarffe 2019;Wakefield and Conrad 2019).…”

“…As Cooper observes, with a few recent exceptions (Wakefield 2013;Wakefield and Conrad 2019;Wakefield and First 2013), I have written relatively little about the HDA's harm component other than to defend the necessity of a harm criterion against pure (Wakefield 2014). One reason for this emphasis is that the HDA is intended partly as a response to antipsychiatric claims that mental disorder judgments are nothing but social value judgments, so I have focused on explaining how disorder judgments go beyond social value judgments via the dysfunction criterion, yielding some degree of scientific objectivity and locating them within a legitimate medical domain that is partly factually anchored.…”