Culture and context in the evolutionary concept of mental disorder

The evolutionary theory of the concept of mental disorder as harmful dysfunction that J. C. Wakefield (1999) proposed (a) does not correspond to how the term disorder is used in psychiatric nosology or in clinicians' everyday practice; (b) does not cover the territory to which the term reasonably could be applied; and (c) is not especially useful for research, clinical, or social purposes. The broad concept of disorder is a polythetic, not a monothetic, concept. As such, there need be no essential characteristic, criterion, or single prototype of disorder. Instead, multiple prototypes with varying features are used to group together a wide range of disparate phenomena by analogy. Useful refinements of our concepts of disorder have come from analyses of the nature of action and intentionality. What are most needed now are careful analyses of the social embedding of our concepts in cultural knowledge and practice.