Hey. Thanks for your response.

I did find something in the archives about this topic...
:-)

> There is probably no dependable relationship between what a person does and what is called crazy.

Wakefield maintains that the DSM criteria is over inclusive. The DSM allows that dysfunction can be purely behavioural whereas Wakefield maintains that harmful behaviour must be caused by malfunctioning inner mechanisms. One example of this would be if there were two people who similarly met criteria for a reading disorder. If one person met behavioural criteria because they had malfunctioning inner mechanisms that prevented their being able to read then they would (intuitively) have a mental disorder. Of one person met behavioural criteris because they had never had sufficient instruction in how to read, then they would not (intuitively) have a mental disorder. Wakefield maintains that person-environment mismatches that aren't caused by malfunctioning inner mechanisms may well constitute 'problems in living' that can benefit from treatment. He also maintains that those individuals aren't mentally disordered, however.

My intuitions go with him on that... But battles of the intuitions can be tricky...

> People are institutionalized if:

1) They are poor
2) They are bizaare
3) They have no supportive family
4) They are deficient in self care.

All four are required, have one of them intact and you will likely remain free.

There have been many abuses of psychiatry... Wakefield would maintain that while we might well instututionalise a person if they are poor, if their behaviour is bizarre, if they have no supportive family, if htey are deficient in self care whether or not they actually are mentally disordered is determined by whether they have malfunctioning inner mechanisms.

I guess there are a variety of things we want a psychiatric nosology (taxonomy) to do:

1) Provide natural kind categories that are useful for scientific research
2) Provide some indication of which treatments are likely to benefit (related to but seperate from the first condition)
3) Provide some indication of who we should treat and / or who is / is not responsible for their conduct (related to but seperate from the second condition)

I'm interested in the prospects for developing a science of psychiatry / psychopathology (the first project).

A few things that I find interesting about Wakefield's account:

- How do we specify the relevant (bio-medical) function of mental mechanisms?

One problem here would be when mechanisms are selected by evolution for one function but when those mechanisms are maintained in the population for another function. E.g., the mechanisms that subserve language.

If the appendix doesn't have a function then it seems that the appendix can't malfunction in Wakefield's sense (which seems counter-intuitive). Problems of spandrels and vestigal organs - if their are mental spandrels / vestigal organs then these can't malfunction... Wakefield maintains that while the appendix can't malfunction at the organ level it can malfunction at the tissue level. What level of analysis (biological, psychological etc) is relevant for function / malfunction?

Wakefield is trying to capture our realist intuitions about mental disorder. Realist intuitions being the idea that there is such a thing as mental illness and whether a person is mentally ill or not is determined by facts about that person.

If realist intutions are wrong then whether someone is mentally disordered or not would be determined on the basis of the judgements we make about the inappropriateness or undesirability of their behaviour. The anti-psychiatry movement seems to think that this is what actually happens and when they say 'there is no such thing as mental illness' they seem to be denying that there are facts about the person that determine whether they are mentally ill or not.