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Is OCD Epistemically Irrational?

Today’s post is by Pablo Hubacher Haerle on his recent paper “Is OCD Epistemically Irrational?” (Philosophy, Psychiatry and Psychology 2023). Pablo Hubacher Haerle is a PhD student at the University of Cambridge. His thesis is on the epistemology and metaphysics of the mind. He is particularly interested in desire, inquiry and the philosophy of psychiatry.

Pablo Hubacher Haerle

On the mainstream picture of obsessive-compulsive disorder (OCD), people experiencing OCD have intrusive thoughts which lead them to form epistemically irrational beliefs. Consider this classic example: 

Amelia is driving in their car. Suddenly, she hears a weird noise which she can’t identify. She forms the belief that she’s run someone over and spends hours looking for the supposed victim.

But it is true that Amelia must have a belief that she’s run someone over? Following recent advances in the literature (Kampa 2020; Taylor 2021), I consider it much more plausible to construe Amelia’s recurrent thoughts as what if questions. This matters for the assessment of rationality, since the rationality conditions for questions are different from those for beliefs. Imagine that you discover an unknown spoor while hiking in the wild. Here, it seems rationally permitted to ask the question whether this means that a bear is near, even though it would be unreasonable to believe that a bear is, in fact, near. Moreover, given how high the stakes are, it might even be mandated to ask that question. 

This doesn’t mean that questions can never be irrational, though. As Jane Friedman (2019) convincingly argues, sometimes reality is so obvious it would be ridiculous to question it. If you’re directly looking at me, it doesn’t make sense for you to ask where I am. But even if you were to think that people like Amelia are irrational because they’re inquiring into questions whose answers are just completely obvious, there are other instances of OCD where the grounds for a charge of epistemic irrationality are much weaker. Consider this case, adapted from a clinical case study (Bhatia and Kaur 2015; Williams and Wetterneck 2019):

For four years, Joseph has had uncontrolled repetitive thoughts about being gay. He is constantly distressed about this. He constantly has doubts about his sexual orientation.

Joseph suffers from the condition of sexual obsessive-compulsive disorder where the object of endless inquiry is not something in the external world, but instead the patient’s own desires. This complicates the assessment of rationality since now we’re not guaranteed an objective viewpoint on how much evidence for this hypothesis Joseph actually has. He might have repressed desires. Moreover it’s unclear we can trust his own testimony because he might be affected by motivated reasoning as a result of homosexuality still being heavily sanctioned in our societies. Thus, it’s not true that Joseph’s inquiry is irrational in virtue of questioning the completely obvious.  

I conclude that so far we don’t know what’s epistemically irrational about this specific kind of OCD. It might be that OCD isn’t irrational after all, or that its irrationality is merely practical, or that there isn’t one form of irrationality common to all cases of OCD. Personally, I believe that what makes OCD epistemically irrational is the fact that it induces unsuccessful inquiries. But whatever conclusion will be reached in this debate, it’s clear that—in line with research by Lisa Bortolotti (2020) and Sahanika Ratnayake (2021)—also in the case of OCD we cannot distinguish between the pathological and the non-pathological by appeal to epistemic irrationality alone.

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