Can the Harmful Dysfunction Analysis Explain Why Addiction is a Medical Disorder?: Reply to Marc Lewis

Excerpt

In a target article [1] in a previous issue of this journal, Marc Lewis argued that addiction is a manifestation of the brain’s normal capacities for pleasure-seeking and habit formation, and therefore is not a brain disorder as is commonly claimed but rather a learning-developmental phenomenon. In two papers in that issue [2, 3], based on my evolutionary “harmful dysfunction” conception of disorder, I argued that addiction is a medical disorder because addictive sensitization is to substances or other stimuli that the brain was not biologically designed to handle. (In [1], I explained why, given Marc’s goals and the semantics of disorder and disease, it is justified to shift the focus from the question of whether addiction is a brain disease to the broader question of whether it is a medical disorder.) In his reply [4] Marc posed fundamental questions about the viability of an evolutionary approach to the concept of disorder and raised provocative issues about the disorder status of various sexual practices and orientations, and these points require comment. …