Objective & Evaluative Concepts in the Philosophy of Psychiatry

Note: Parts of this piece are adapted from the first chapter of my dissertation, A Welfarist Account of Mental Disorder, which is included in the references.

The philosophy of psychiatry is a rich field that exists at the intersections of science, medicine, value theory, and ethics. Philosophers who work in this field may focus primarily on ethical questions and concerns about psychiatric practice or on conceptual questions about mental disorder as it relates to medical practice. My aim here is to highlight an issue that arises repeatedly in a conceptual debate in the philosophy of psychiatry. Psychiatry concerns itself with the diagnosis and treatment of mental disorder, so it is important to have at least a working concept of mental disorder. One way to approach this question is to determine what kind of thing mental disorder is: whether it is an objective or evaluative concept. I will give some examples of each kind, provide examples of both objective and evaluative accounts of mental disorder, and conclude with some thoughts about where the debate currently stands.

A brief clarificatory note: I hold that mental disorders are brain disorders, in the sense that I am committed to a physicalist understanding of the world. This does not mean that I believe mental disorder, or individual mental disorders, are natural kinds. The conceptual debate I discuss here is not about the mind-body problem. It is about the terms we use to define a particular concept and whether those terms are objective, evaluative, or some combination of both.

I. Objective concepts

Currently I am using a yellow spiral notebook for my note-taking. Now imagine that I have virtually trapped you here in my philosophy classroom and asked you to define my yellow spiral notebook. If you could see it, you might provide these items as a description:

• Yellow
• College-ruled
• 70 pages
• Spiral-bound
• The first page has my name and phone number written on it

These are objective descriptions of my notebook. They are objective because these descriptions do not depend on values or interests. That is, it does not matter what you think of my notebook: it is a 70-page spiral-bound college-ruled yellow notebook with my name and phone number written on the first page. This is something we can define (or describe) in objective terms.

Now, you might add an evaluation of the notebook. For example, it could be that you think it is cute. I happen to agree, because yellow is my favorite color. But someone else might find yellow garish or generally dislike school supplies. These added evaluations do not change what the thing is. They are simply evaluations of an objective concept.

Group concepts may also be objective. You are still trapped in my classroom, and now I am asking you to define notebooks, broadly speaking. Your description is less specific: something with (initially) blank pages that are bound together in some way. Quibbling may ensue, but the description should be able to pick out everything we think is a notebook and exclude the things we do not think are notebooks. So your description should be inclusive enough to include my yellow notebook, but not so broad that it includes, say, a pencil.

Now consider something that is perhaps a bit more interesting than office supplies. In keeping with the back-to-school scheme, consider the flu. Specifically, the influenza virus. The flu is a group concept because there are different strains of the virus, but central to the definition of the flu is the presence of a particular type of virus. The influenza virus exists regardless of what we think of it (though I think we all agree it is an unpleasant thing to catch), but its definition exists independently of what we value or disvalue.

There are many, many more objective concepts. They are not superior to evaluative concepts. They are just different. Next, let us consider some evaluative concepts.

II. Evaluative concepts

An evaluative concept is something that cannot be defined without understanding the values or interests of the people who developed it. I attended the United States Military Academy, where there are many very niche terms and descriptions for things. Consider the term “trou bucket.” Women were not admitted to the Academy until 1976, and their entrance was met with anger by much of the male cadet population. Male cadets referred to their female counterparts as “trou,” perhaps because they did not look the same in the gray uniform trousers as the men. This was a derogatory term and was sometimes used as a modifier for other terms. A trou bucket, or sometimes simply T-bucket, is a pint of ice cream, typically consumed by a female cadet.

This term does not exist independent of human values or interests. It depends on male cadets’ dislike of female cadets (expressed by mocking the fit of their pants) and their disapproval of a behavior they see as gluttonous (eating ice cream). Trou bucket, then, is an evaluative term because you cannot understand it without understanding the values, attitudes, and norms of the people who invented the term.

I propose that mental disorder is an evaluative concept. Certainly there are objective elements associated with it, just as ice cream is an objective element of the term trou bucket, but it cannot be fully defined independent of values.

III. Mental disorder as an evaluative concept

What does an evaluative account of mental disorder look like? I offer that “a mental disorder is a collection of (primarily mental) symptoms that significantly lower well-being” (2026, p. 43). 

There is an objective element here: the set of symptoms. But the account of well-being I offer is value-dependent, and the criteria for significance also depend on a subjective view of individual welfare. I limit my account to mental disorder, but other theorists offer definitions of disorder or disease broadly speaking and then apply this to mental disorder as well.

Rachel Cooper, for example, also offers an evaluative, or normative, account of disorder. She provides three criteria for a condition to count as a disease: it is “a bad thing to have, that is such that we consider the afflicted person to have been unlucky, and that can potentially be medically treated” (2002, p. 271).

Critics of accounts like mine and Cooper’s argue that they are overly inclusive or vague. That is, they might pick out things that are not disorders (like a definition of notebooks that includes pencils), or they are not specific enough to pick out anything at all.

Accounts with more robust objective criteria, or no evaluative criteria whatsoever, claim to solve these problems.

IV. Objective accounts & problems

A famous hybrid account of mental disorder comes from Jerome Wakefield: “According to the HD analysis, a disorder is a harmful dysfunction, where ‘harmful’ is a value term, referring to conditions judged negative by sociocultural standards, and ‘dysfunction’ is a scientific factual term, referring to [the] failure of biologically designed functioning” (2007, p. 149, emphasis in original).

On his account, a biological dysfunction must be present for something to count as a disorder, meaning both the objective and evaluative criteria need to be met to classify a disorder. But for some, this evaluative element is still too vague to satisfy theorists. Christopher Boorse offers a completely value-free concept of health, which is the absence of disease from a given organism. A disease, according to Boorse, is a condition that interferes with a “species-typical contribution to survival and reproduction” and “is not simply in the nature of the species” (1976, pp. 62–63). He does offer that illnesses (later termed “systemic disease”) are diseases that must satisfy additional evaluative criteria but maintains that determining whether a person is healthy, mentally or physically, at any given point requires no value judgments.

But eliminating values from our definition fails to capture what we intuitively think deserves our attention. Take Premenstrual Dysphoric Disorder (PMDD), for example. We have increasing evidence for this as a disorder with scientific validity. Problems with DSM-5-TR notwithstanding, consider this criterion for PMDD: “Marked irritability or anger or increased interpersonal conflicts” (American Psychiatric Association, 2022, p. 197). The presence of this symptom cannot be determined independent of human values, interests, or norms.

Theorists such as Boorse and Wakefield might say that identifying evaluative symptomology for mental disorder does not preclude the presence of biological dysfunction or some atypical statistical functioning of the species. In fact, the DSM-5-TR asserts that a mental disorder reflects “a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (2022, p. 14). Dysfunction appears to be a recurring theme across objective conceptions of mental disorder. In the case of the DSM definition, though, dysfunction appears to serve roughly the same role as the word “disorder,” since there is a range of possibilities for what functioning might represent. Boorse and Wakefield hold distinct views about biological dysfunction, but the DSM offers that dysfunction might occur in psychological or developmental domains as well. Any of these theories must demonstrate how their account of function or dysfunction does not rely on values, norms, attitudes, etc. to maintain their claim to be value-free.

V. Where the debate stands

The question becomes whether we should assume there are yet-to-be-discovered objective criteria that will one day flesh out a value-free account of disorder or commit to building an evaluative account that requires us to identify and explicate the relevant values, norms, and attitudes that humans possess. Certainly, it is a worthy pursuit to better understand human biology, particularly neurobiology, as it relates to our understanding of mental disorder. This work can continue without relying on it to form the basis of an account that informs both diagnosis and treatment.

Philosophers on both sides of the debate made and continue to make valuable contributions to this field. It is important that the discussion continue, and we should not let fear of ill-defined values lead us to abandon that line of thinking. Defining evaluative concepts might appear messy and vague at first, but it is a uniquely human endeavor that deserves our attention.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787 

Boorse, C. (1976). What a theory of mental health should be. Journal for the Theory of Social Behaviour, 6(1), 61–84.

Cooper, R. (2002). Disease. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences, 33(2), 263–282. https://doi.org/10.1016/S0039-3681(02)00018-3

Duke, A. R. (2026). A welfarist account of mental disorder [Doctoral dissertation, Duke University]. ProQuest Dissertations & Theses.

Wakefield, J. C. (2007). The concept of mental disorder: Diagnostic implications of the harmful dysfunction analysis. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 6(3), 149–156.