In this post, Amelia Gangemi and Valentina Cardella introduce their new book, Reasoning in Psychopathology (Routledge 2024).
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| Reasoning in Psychopathology |
Rationality can be broadly categorized into two types: rationality of action, which concerns behavior appropriate to achieving one’s goals, and theoretical rationality, which involves conformity to norms, such as logical or social norms. Many philosophers and psychologists argue that a key aspect of mental disorder is a deficiency in rational control over one’s behavior. This notion is consistent with the common view that mental illness involves a lack of discipline or self-control.
Contrary to this view, individuals with mental disorders do not necessarily exhibit impaired rationality. In our book, we present studies of schizophrenia, depression, and anxiety disorders that suggest that individuals with these conditions can reason logically within their symptomatic domains and may even outperform unaffected individuals on certain tasks.
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| Amelia Gangemi |
In the case of depression, for instance, the typical features are the pain for the lost good and the reduction in activity (Welling, 2003). Experiencing pain and expressing it through crying implies that the lost good is still desired and has not become less important after its loss. An important consequence is constant rumination and the inability to think of anything else; in other words, the depressed person is constantly thinking about the lost good (Parkes, 1972).
Essential to this process is also a form of idealization of the lost good, which is seen as perfect and irreplaceable. On the other hand, the reduction in activities is due to a sense of worthlessness; everything is perceived as useless, so there is a lack of desire to engage in any activity. Anhedonia and pessimism play a fundamental role in this case. The question at this point is: How is it possible that a normal and physiological reaction that one might experience after a loss of any kind can turn into one of the most disabling disorders with the highest social costs in the world? How is it possible for a person to continue to desire something that is unattainable and irreplaceable, and to invest cognitive and emotional resources in something that is not there?
Though seemingly irrational, these reasoning patterns are motivated by a desire to avoid further loss. For example, idealizing the lost good is explained as a means of preventing further loss, rather than aiming for recovery, since further separation would increase the sense of loss. Emotional investment aims to preserve what remains of the lost good, even if it cannot be recovered. Pessimistic reasoning, on the other hand, is a strategy for minimizing the risk of investing resources in endeavors without a valid chance of success, consistent with the goal of preserving the lost good.
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| Valentina Cardella |
In addition, depressive reasoning leads to the minimization of outcomes, which also serves the purpose of limiting loss. By evaluating outcomes more critically, individuals reduce the risk of self-deception and further loss. This cautious approach is consistent with the goal of avoiding actions that might exacerbate the sense of loss. Overall, depressive reasoning may appear irrational, yet it serves specific goals for the individual.
Schizophrenia is another disorder we focus on in our book. Since Kraepelin's Dementia Praecox (1919), schizophrenia has always been seen as a breakdown of cognitive ability and intelligence. Schizophrenia certainly impairs cognitive abilities: a number of studies have shown that it can severely affect abilities such as memory, attention, executive function, etc. However, we contend that rationality is not one of the capacities affected in this disorder.
It is true that schizophrenics behave strangely, talk strangely, and believe strange things, but it is not by referring to a defect in rationality that we will be able to understand this strange world. Individuals with schizophrenia may exhibit logical reasoning and resistance to cognitive biases, and they may also develop a kind of hyper-reflexivity, that is, a rational attitude toward the world in order to make sense of it and to compensate for the lack of self-evidence they perceive in ordinary relationships with other people (Sass 2003).
In addition, individuals with anxiety disorders or obsessive-compulsive disorder may engage in expert-level reasoning within their symptomatic domains, using strategies such as better safe than sorry or semi-dialectic reasoning. All strategies are functional to the patients’ goals, i.e., to avoid the catastrophic risk of underestimating danger in the case of anxiety disorders and to disconfirm the risk of being guilty in the case of OCD.
In sum, our book aims to show that mental disorders involve complex interactions between cognitive processes and social factors, challenging traditional notions of rationality as a defining characteristic of mental health. We believe that recognizing the rationality within madness is important not only from a scientific point of view, but also because of its moral and social consequences. People with mental disorders are usually victims of stigma and face discrimination, abuse, dehumanization and loss of identity.
Reframing mental illness means challenging societal attitudes toward mental illness and recognizing the humanity and dignity of people with mental illness, rather than perpetuating stereotypes and discrimination.