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Hi, Awais,

Yes, that is a thoughtful paper, and I agree that a purely monistic functionalist or dysfunctionalist paradigm of psychopathology is not helpful. I think you are wise, however, to caution against monistic functionalist paradigms of a "Szaszian" nature.

Perhaps we need 3 terms to analyze these issues: functional, dysfunctional, and eufunctional. (The latter two combine Greek (dys-) and Latin (functionem) roots, but this is very common in medical terminology).

"Functional" would denote merely that a particular entity, trait or condition acts toward the completion of a specific goal; e.g., "A functional gallbladder stores and concentrates bile." A dysfunctional gallbladder fails to do so. And a eufunctional gallbladder stores and concentrates bile to the right degree, in the right amount, with the right amount of flow into the small intestine, etc., so as to achieve optimal breakdown of dietary fats.

Psychological dispositions, traits, defenses, etc. could be similarly analyzed. For example: A functional fear response alerts the organism to a realistic external danger. A dysfunctional fear response fails to do so and often mistakenly alerts the organism to a "false" or non-existent threat (what we would call "anxiety" in the therapeutic context). A eufunctional fear response alerts the organism to a realistic danger at the right time, to the right degree and duration, in a manner that best ensures the organism's survival. (Fans of Aristotle will recognize my language as mirroring his description of the "good tempered" person).**

It follows from this trichotomy that few if any aspects of, say, chronic schizophrenia could reasonably be considered "eufunctional", and are almost always dysfunctional--even though they may have "functions"; e.g., a delusional belief that the CIA has implanted a broadcasting device in one's brain may serve the function of "making sense" of the person's auditory hallucinations. Technically, the belief is "functional," but describing this delusion as "functional" in the sense that some critics of psychiatry use the term is deeply misleading, eliding the tremendous suffering and incapacity associated with this disease. The delusion is, in fact, quintessentially dysfunctional (leading, e.g., to social isolation, chronic anxiety, rumination, etc.)

The best analysis of these issues, in my view, is found in Silvano Arieti's classic (1974) work, Interpretation of Schizophrenia. Arieti recognizes how psychotic defenses "function" without in any way construing these defenses as eufunctional, as I have defined the term.


**  "...the good tempered are angry 'at the right things and towards the right people, and also in the right way, at the right time and for the right length of time." [Nicomachean Ethics]

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