Making Wakefield Warranted: The Hierarchy of Healing Harm and Discerning Dysfunction

The definition of medical ‘disorder’ is a matter of longstanding debate. A leading account is Jerome Wakefield’s ‘harmful dysfunction’ analysis, a hybrid model which merges normative and naturalist elements to propose disorder exists in cases of concurrent harm (value-defined) and dysfunction (defined evolutionarily). Despite significant impact in academia, this has so far failed to affect mainstream medical treatment or discourse, with a major criticism being that this definition doesn’t correctly capture all conditions of medical relevance or actual medical ideals. This paper provides a supplementary structural nuance to better reflect how medical treatment and terminology incorporate naturalistic facts. I argue that Wakefield is right in utilising a hybrid model incorporating naturalism and normativity. However, in understanding how medicine is directed, making the normative and naturalistic equally necessary is problematic, because the imperatives of naturalism and normativity directly impede each other; norms seek to help those who need help, naturalism concentrates on objective facts, but neither can be fulfilled as a coherent goal of medical treatment when combined as equally necessary. Instead, I propose a hierarchical harmful dysfunction model better reflects current medical ideals, where normative values are necessary and sufficient conditions to prescribe treatment, whilst naturalistic knowledge plays a role informing those normative values. This accounts for the edge cases and practise of medicine not fully captured in Wakefield’s account of ‘disorder’.</p

Making Wakefield Workable: The Fitness and Function Framework for Taxonomising Evolutionary Dysfunction

Jerome Wakefield’s ‘Harmful Dysfunction Analysis’ (HDA) recognises biological and psychological disorder exists wherever two conditions are met: concurrent harm, a subjective value component, and dysfunction, an objective component related to the interruption of evolutionarily selected effects. This is arguably the leading definition of disorder, and is prominently referenced in evolutionary psychiatry, yet suffers various criticisms. These particularly concern the ‘dysfunction’ component, which is undermined by the indeterminacy of ancestral function and a range of complex counter-examples, particularly relating to mismatch, by-products and extremes of adaptive spectrums. To tackle these criticisms, I provide a definitional framework which allows clear pathways to dysfunction attribution in the cases problematic for Wakefield. The key move here is distinguishing biological objects with fitness, a fundamentally quantifiable variable, from the selective processes of function and dysfunction which lead to that fitness, which rely on qualitative descriptions, and are much harder to exactly specify and demarcate to the level of precision necessary for the HDA. I also note the importance of specifying framing environments and trait descriptions. The resulting framework solves various problems with Wakefield’s account and leads to a taxonomy of different classes of dysfunction. This is unique amongst existing evolutionary taxonomies of disorder by offering strict demarcation, exclusivity and greater theoretical completeness. By relying ultimately on fitness effects rather than descriptions of dysfunctional processes and recognising distinct possible classes of evolutionary dysfunction, a more tractable direction for scientific investigation into any trait’s dysfunctional status is offered, with the potential to make Wakefield’s HDA workable

Business Implications of Divergences in Multi-Jurisdictional Merger Review by International Competition Enforcement Agencies

Antitrust and competition laws lie at the nexus of international law and business. Since 1890, antitrust law has expanded from its origins of regulating trusts in the United States to what is now a global body of law. However, this expansion has not come without drawbacks. As the number of worldwide competition review and enforcement agencies in both developing and developed nations continues to increase, multinational businesses contemplating mergers are faced with growing uncertainty and transaction costs. These escalating costs have led business community leaders to conclude that greater harmonization of merger law enforcement, at both the substantive and the procedural levels, would be of significant benefit

Creating an integrated payment system: the evolution of Fedwire

Adapted from remarks given before the Seminar on Payment Systems in the European Union in Frankfurt, Germany, on February 27, 1997.Fedwire ; Electronic funds transfers ; Federal Reserve System

Specialised minds: extending adaptive explanations of personality to the evolution of psychopathology

Traditional evolutionary theory invoked natural and sexual selection to explain species- and sex-typical traits. However, some heritable inter-individual variability in behaviour and psychology – personality – is probably adaptive. Here we extend this insight to common psychopathological traits. Reviewing key findings from three background areas of importance – theoretical models, non-human personality and evolved human social dynamics – we propose that a combination of social niche specialisation, negative frequency-dependency, balancing selection and adaptive developmental plasticity should explain adaptation for individual differences in psychology – ‘specialised minds’ – explaining some variance in personality and psychopathology trait dimensions, which share various characteristics. We suggest that anthropological research of behavioural differences should be extended past broad demographic factors (age and sex) to include individual specialisations. As a first step towards grounding psychopathology in ancestral social structure, we propose a minimum plausible prevalence, given likely ancestral group sizes, for negatively frequency-dependent phenotypes to be maintained as specialised tails of adaptive distributions – below the calculated prevalence, specialisation is highly unlikely. For instance, chronic highly debilitating forms of autism or schizophrenia are too rare for such explanations, whereas attention-deficit-hyperactivity disorder and broad autism phenotypes are common enough to have existed in most hunter-gatherer bands, making adaptive explanations more plausible

Changing perspectives on autism: Overlapping contributions of evolutionary psychiatry and the neurodiversity movement

Perspectives on autism and psychiatric conditions are affected by a mix of scientific and social influences. Evolutionary psychiatry (EP) and the neurodiversity movement are emerging paradigms that reflect these distinct influences, with the former grounded in scientific theory and the latter driven by political and social principles. Despite their separate foundations, there is a significant overlap between EP and neurodiversity that has not been explored. Specifically, both paradigms reframe disorders as natural cognitive differences rather than disease; expand the concept of "normal" beyond that implied in modern psychiatry; focus on relative strengths; recognize that modern environments disadvantage certain individuals to cause functional impairment; emphasize cognitive variation being socially accommodated and integrated rather than treated or cured; and can help reduce stigmatization. However, in other ways, they are distinct and sometimes in conflict. EP emphasizes scientific explanation, defines "dysfunction" in objective terms, and differentiates heterogenous cases based on underlying causes (e.g. autism due to de novo genetic mutations). The neurodiversity movement emphasizes social action, removes barriers to inclusion, promotes inclusive language, and allows unrestricted identification as neurodivergent. By comparing and contrasting these two approaches, we find that EP can, to some extent, support the goals of neurodiversity. In particular, EP perspectives could be convincing to groups more responsive to scientific evidence and help achieve a middle ground between neurodiversity advocates and critics of the movement

Accommodative dysfunction in patients with cerebral palsy: Appropriate nearpoint prescribing

This study was designed to inform the eyecare practitioner of accommodative dysfunction in patients with Cerebral Palsy (CP), and more importantly, to give guidelines for successful prescribing of nearpoint lenses. Files were obtained from the Oregon School for the Blind, in association with the Oregon Lions Statewide Low Vision Clinic. Inclusion criteria included a diagnosis of CP, a Monocular Estimate Method (MEM) retinoscopy finding indicating an accommodative dysfunction, and a nearpoint lens prescription prescribed. Surveys were sent to the vision teachers of these patients to assess the effect of the nearpoint lenses on daily activities. The results were analyzed and discussed; two successful examples were presented. It was found that patients who had the greatest success functioned on a higher cognitive level, received initial training with the prescription and continued support, and in addition, were given adequate time to adapt to the prescription. It was also shown that even though the patient may not appear to appreciate the aid a near prescription provides, a nearpoint lens should be attempted for those who are found to have CP with accommodative dysfunction

What’s in a Name: Exposing Gender Bias in Student Ratings of Teaching

Student ratings of teaching play a significant role in career outcomes for higher education instructors. Although instructor gender has been shown to play an important role in influencing student ratings, the extent and nature of that role remains contested. While difficult to separate gender from teaching practices in person, it is possible to disguise an instructor’s gender identity online. In our experiment, assistant instructors in an online class each operated under two different gender identities. Students rated the male identity significantly higher than the female identity, regardless of the instructor’s actual gender, demonstrating gender bias. Given the vital role that student ratings play in academic career trajectories, this finding warrants considerable attention

What’s in a Name: Exposing Gender Bias in Student Ratings of Teaching

Student ratings of teaching play a significant role in career outcomes for higher education instructors. Although instructor gender has been shown to play an important role in influencing student ratings, the extent and nature of that role remains contested. While difficult to separate gender from teaching practices in person, it is possible to disguise an instructor’s gender identity online. In our experiment, assistant instructors in an online class each operated under two different gender identities. Students rated the male identity significantly higher than the female identity, regardless of the instructor’s actual gender, demonstrating gender bias. Given the vital role that student ratings play in academic career trajectories, this finding warrants considerable attention