TWAIN,MARK MEETS DSM-III-R - CONDUCT DISORDER, DEVELOPMENT, AND THE CONCEPT OF HARMFUL DYSFUNCTION

The Diagnostic and Statistical Manual (3rd ed., rev.) (DSM-III-R) diag nosis of conduct disorder assumes that all children who engage in thre e or more criterion antisocial behaviors for 6 months or more suffer f rom a mental disorder. It resists all contextual information about a c hild's developmental history, capacities strengths and circumstances, and assumes that the antisocial behavior necessarily stems from an und erlying disorder. In this review, we use Mark Twain's narrative of the lives of Tom Sawyer and Huckleberry Finn as a point of departure for questioning the reasonableness of this assumption, and for examining n ormal as well as pathological pathways to antisocial behavior. We begi n by reviewing the status of earlier controversies about the mental di sorder concept in the service of documenting the impressive progress o f the field in conceptualizing disorder. Next, we examine Wakefield's (1992a, 1992b) recently introduced ''harmful dysfunction'' concept of mental disorder and employ its criteria to evaluate the hypothesis tha t chronic antisocial behavior in childhood as defined by DSM-III-R is caused by an underlying mental disorder. We also examine some of the d ifficulties in discriminating between disorder- and nondisorder-based antisocial behavior, and consider issues that warrant attention in fut ure theoretical and empirical work. Finally, we explore the pragmatic rather than scientific basis for DSM-III-R's mental disorder claim and argue that regardless of its status as a mental disorder, this most t roubling and harmful behavior syndrome of childhood deserves the inten sive interest, concern, and resources of the scientific and public hea lth communities.