Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA.
Northcoast Behavioral Healthcare (Ohio Department of Mental Health and Addiction Services), Northfield, OH, USA.
Int Rev Psychiatry. 2021 Aug;33(5):478-485. doi: 10.1080/09540261.2020.1815666. Epub 2020 Oct 5.
Social deviance refers to actions or behaviours that violate social norms. Since the declassification of homosexuality and development of DSM-III, one of the aims of a definition of mental disorder has been to make explicit the distinction between mental disorder and social deviance. It is well-recognized that psychiatric disorders frequently manifest as violations of social norms, and the validity of the distinction between disorder and deviance has been of great interest to philosophers of psychiatry. This article provides an overview of some of the major conceptual strategies that have been discussed as a means of discriminating between mental disorder and social deviance, and the extent to which these strategies can be said to be philosophically successful. Specifically, we review DSM's definition of mental disorder, notions of dysfunctions (commonsensical, clinical, naturalist), intrinsic and socially constituted distress, disability, 3E perspectives and functional norms, and ethical and political approaches to this question. Current philosophical strategies don't offer a distinct dividing line between disorder and deviance, but they help illuminate the relevant considerations involved. It may be concluded that the distinction between disorder and deviance is not simply discovered but also negotiated between competing values.
社会偏差行为是指违反社会规范的行为或举止。自同性恋去病理化和 DSM-III 的发展以来，精神障碍定义的目标之一就是明确精神障碍和社会偏差之间的区别。人们普遍认识到，精神障碍经常表现为违反社会规范，因此，障碍和偏差之间的区别的有效性一直是精神病哲学关注的焦点。本文概述了一些被认为是区分精神障碍和社会偏差的主要概念策略，以及这些策略在多大程度上可以说是在哲学上成功的。具体来说，我们回顾了 DSM 对精神障碍的定义、功能障碍（常识、临床、自然主义）、内在和社会构成的痛苦、残疾、3E 观点和功能规范，以及对这个问题的伦理和政治方法。目前的哲学策略并没有在障碍和偏差之间划出明确的界限，但它们有助于阐明所涉及的相关考虑因素。可以得出结论，障碍和偏差之间的区别不是简单地发现的，而是在相互竞争的价值观之间进行协商的。
