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[[File:Wakefield's 2008 Lecture.jpg|thumb|Jerome C. Wakefield]]
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=== Defining Harm ===
“‘Harmful’ is a value term, referring to conditions judged negative by sociocultural standards.”<ref>{{Cite journal |last=Wakefield |first=Jerome C. |date=2007 |title=The concept of mental disorder: diagnostic implications of the harmful dysfunction analysis |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC2174594/ |journal=World psychiatry: official journal of the World Psychiatric Association (WPA) |volume=6 |issue=3 |pages=149–156 |issn=1723-8617 |pmc=2174594 |pmid=18188432}}</ref>
In the context of HDA, harm refers to negative consequences experienced as a direct result of dysfunction. Importantly, whether something is considered harmful depends on the prevailing cultural norms of the environment in which the person lives.
Wakefield originally proposed that ‘harm’ be interpreted broadly, encompassing any condition viewed negatively within a particular culture.<ref>{{Cite journal |last=Wakefield |first=Jerome C. |date=2007
=== Defining Dysfunction ===
“A failure of some internal mechanism to perform a function for which it was biologically designed.”<ref>{{Cite journal |last=Wakefield |first=Jerome C. |date=2007 |title=The concept of mental disorder: diagnostic implications of the harmful dysfunction analysis |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC2174594/ |journal=World psychiatry: official journal of the World Psychiatric Association (WPA) |volume=6 |issue=3 |pages=149–156 |issn=1723-8617 |pmc=2174594 |pmid=18188432}}</ref>
Dysfunction in HDA refers to a system's inability to serve the purpose it evolved for. This idea draws on [[natural selection]], which explains that the traits present in living organisms emerged because they contributed to the organism's survival and reproductive success. According to Wakefield, the "dysfunction" component is intended to be the factual aspect of mental disorder, being a purely scientific description.
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HDA holds that both harm and dysfunction must be present for a condition to be a mental disorder. The dysfunction element of the theory provides an objective basis for diagnosis, while the harm element allows diagnoses to remain culturally sensitive. As a result, not every dysfunction is a mental disorder, and not every harmful condition is a mental disorder.
An example Wakefield uses to prove this is dyslexia.<ref>{{Cite journal |last=Wakefield |first=Jerome |date=2021-02-16 |title=Can the Harmful Dysfunction Analysis Distinguish Problematic Normal Variation from Disorder? Reply to Andreas De Block and Jonathan Sholl |url=https://direct.mit.edu/books/oa-edited-volume/5015/chapter-standard/2812074/Can-the-Harmful-Dysfunction-Analysis-Distinguish |journal=MIT Press |language=en |doi=10.7551/mitpress/9949.003.0032}}</ref> Essentially, a failure of the language-processing system in the brain, dyslexia counts as a dysfunction. However, whether it is considered a mental disorder depends on the cultural context. In a literate society, where reading is indispensable to daily life, dyslexia leads to clear disadvantages and would therefore be a disorder. In a pre-literate society where reading is not a necessary skill, it would not result in harm or be viewed as a disorder. Wakefield describes such cases as “harmless dysfunctions”, biological failures that do not produce socially meaningful problems.<ref>{{Cite journal |last=Wakefield |first=Jerome C. |date=2014-12-01 |title=The Biostatistical Theory Versus the Harmful Dysfunction Analysis, Part 1: Is Part-Dysfunction a Sufficient Condition for Medical Disorder? |url=https://academic.oup.com/jmp/article-abstract/39/6/648/2743603?redirectedFrom=fulltext&login=true |journal=The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine |volume=39 |issue=6 |pages=648–682 |doi=10.1093/jmp/jhu038 |issn=0360-5310}}</ref> Wakefield also highlights other conditions like criminality and illiteracy, which are harmful but do not stem from dysfunction. This illustrates that harm alone is insufficient.
== Criticisms ==
=== On Dysfunction ===
Critics of the dysfunction requirement argue that it is often difficult, if not impossible, to identify the evolved function of complex mental mechanisms.<ref>{{Cite journal |last=McNally |first=Richard J |date=2001-03-01 |title=On Wakefield's harmful dysfunction analysis of mental disorder |url=https://www.sciencedirect.com/science/article/abs/pii/S0005796700000681?via=ihub |journal=Behaviour Research and Therapy |volume=39 |issue=3 |pages=309–314 |doi=10.1016/S0005-7967(00)00068-1 |issn=0005-7967}}</ref><ref>{{Cite journal |last=Aftab |first=Awais |last2=and Rashed |first2=Mohammed Abouelleil |date=2021-07-04 |title=Mental disorder and social deviance |url=https://www.tandfonline.com/doi/full/10.1080/09540261.2020.1815666 |journal=International Review of Psychiatry |volume=33 |issue=5 |pages=478–485 |doi=10.1080/09540261.2020.1815666 |issn=0954-0261 |pmid=33016793}}</ref> Many mental functions may have arisen as by-products of other adaptations or evolved to serve multiple purposes, making it challenging to pinpoint a single, clearly ‘designed’ function.
Philosopher Maël Lemoine questioned whether the dysfunction component is genuinely value-free, suggesting that it may inherently involve assumptions and interpretations about what counts as a function rather than being purely descriptive.<ref>{{Cite journal |last=Lemoine |first=Maël |date=2021-02-16 |title=Is the Dysfunction Component of the “Harmful Dysfunction Analysis” Stipulative? |url=https://direct.mit.edu/books/oa-edited-volume/5015/chapter/2812058/Is-the-Dysfunction-Component-of-the-Harmful |journal=MIT Press |language=en |doi=10.7551/mitpress/9949.003.0016}}</ref> Further, Justin Garson points to developmental plasticity, the
=== On Harm ===
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