Chapter

Normality, disorder, and evolved function: the case of depression

Daniel Nettle

in Maladapting Minds

Published on behalf of Oxford University Press

Published in print March 2011 | ISBN: 9780199558667
Published online February 2013 | e-ISBN: 9780191754647 | DOI: http://dx.doi.org/10.1093/med/9780199558667.003.0008

Series: International Perspectives in Philosophy & Psychiatry

Normality, disorder, and evolved function: the case of depression

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About suffering they were never wrong, The Old Masters; how well, they understoodIts human position; how it takes placeWhile someone else is eating or opening a window or just walking dully along;

W.H. Auden, Musée des Beaux Arts

Following the work of Emil Kraepelin, many philosophers and psychiatrists firmly believe that it is possible to distinguish neatly between normality and disorder. In this chapter, I scrutinize this belief while focusing on the difference between (normal) low mood and depression. My main argument is that evolutionary thinking cannot guide us in discriminating between low mood and depression, even though it helps us understand the many functions of depressive symptoms. Evolutionary considerations cannot help us here because determining whether one's mood system is dysfunctional requires an assessment of the proportionality of a mood reaction, which in turn requires a deep idiographic understanding of one's cognitive and ecological context. And yet such practical difficulties pale before the observation that there is substantial individual variation in the threshold of activation for the human mood system, which eventually implies that the individual is the ultimate benchmark on which to distinguish between health and disease. But why should we even bother to find (or draw) a fine line between health and disease, or between function and dysfunction? One of the arguments behind our obsession with this issue, I argue, is that it is held to have important implications for psychiatric practice. After all, don't we need a way of distinguishing normality from disorder in order to determine who needs treatment, and who doesn't? In a final section, I note that even if we would be able to discriminate (mental) function from (mental) dysfunction, it would be of limited use, because it would lead us to treat people who seek no treatment, and to deny treatment to people who want to be treated. On this view, subjective distress is a better guide in allocating aid.

Chapter.  7796 words.  Illustrated.

Subjects: Psychiatry

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