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A Critique and Refinement of the Wakefieldian Concept of Disorder: An Improvement of the Harmful Dysfunction Analysis.

One way in which bioethicists can benefit the medical community is by clarifying the concept of disorder. Since insurance companies refer to the DSM for whether a patient should receive assistance, one must consider the consequences of one's concept of disorder for who should be provided with care. I offer a refinement of Jerome Wakefield's hybrid concept of disorder, the harmful dysfunction analysis. I criticize both the factual component and the value component of Wakefield's account and suggest how they might be improved. I propose that the factual component should be statistical variation analyzed in multilevel and chronological compilations of physiological data. I propose that the value component should prioritize the individual's authority regarding the experience of suffering from a physiological condition. My account preserves the insight of using a factual and a value component while avoiding the problems that Wakefield's original account faces.