Abstract

In lieu of an abstract, here is a brief excerpt of the content:Rationality, Irrationality, and Depathologizing OCDBrent Kious, MD, PhD (bio)Pablo Hubacher argues that some persons with obsessive-compulsive disorder (OCD) do not, in virtue of OCD itself, exhibit what he calls “epistemic irrationality,” which is a matter of violating rational norms related to belief and inquiry (Hubacher, 2023). The argument is complex and meticulous, but ultimately not persuasive. I outline the argument, show how it is unsound, and articulate its most troubling consequences. I end by inquiring about the goal of projects like this, which, I believe, is to examine the rationality of mental illnesses in order to show that they are or are not illnesses.Hubacher starts by noting that (some) persons with OCD appear “doxastically irrational”: when they exhibit obsessions, they err in how they form beliefs. Specifically, they seem to “jump to conclusions,” inferring that a feared outcome is probable or certain from scant evidence. However, psychological research shows that persons with OCD are not more likely to jump to conclusions than others. Hubacher also observes that jumping to conclusions involves the inference, “possibly P, therefore definitely P.” This inference is irrational but not specific to people with OCD, because many of us do it, and an account of the irrationality of OCD should identify OCD-specific deviations. Hubacher concludes that persons with OCD are not doxastically irrational. He next considers whether they exhibit “zetetic” irrationality, which involves violating epistemic norms of inquiry. This might identify the irrationality of OCD, since compulsions like repeatedly checking the stove are basically ways of getting evidence. But Hubacher introduces the phenomenon of sexually focused OCD, or S-OCD. Persons with S-OCD worry about whether they have sexual desires they regard as inappropriate—for instance, incestuous desires or homosexual desires. Hubacher does not think people with S-OCD are zetetically irrational, however. Their endless doubts are actually reasonable, since it is possible—even common—for people to have repressed sexual desires when those desires are stigmatized. If a person with S-OCD worries about having incestuous desires, the bare fact that he does not feel those desires in the usual way should not be reassuring to him: those desires could simply be repressed. Hubacher adds that [End Page 151] people with OCD have high intolerance of uncertainty, which he takes to mean that they approach inquiries with high standards for confirmation; they are not satisfied with evidence others would see as compelling. He concludes that people with S-OCD are neither zetetically nor doxastically irrational, and so not epistemically irrational.This is a surprising conclusion, but it results from an unsound argument. An initial problem is his assumption that the only way persons with OCD can be doxastically irrational is by jumping to conclusions. This ignores other possible ways of being doxastically irrational. For instance, it would be irrational to retain beliefs that have been disconfirmed by evidence (Hubacher might call this zetetic irrationality, but surely, my beliefs can be disconfirmed without active inquiry). Irrationally retaining disconfirmed beliefs might even capture what happens in OCD: the person with OCD thinks something awful is likely to be true, even though she gets copious disconfirming evidence.A second problem is in Hubacher’s interpretation of the psychological evidence about whether persons with OCD jump to conclusions. He cites two studies involving a very specific psychological test, the bead task, wherein a subject is asked to determine whether a random sequence of colored beads have been drawn from a jar with a preponderance of one color or another. A “jumping to conclusions bias” is taken to be an inclination to guess the jar after no more than two beads are revealed (Huq & Garety et al., 1988). Although a few studies have shown that persons with OCD do not have this jumping to conclusions bias, we cannot conclude that they do not often jump to conclusions in real life. One might imagine, for instance, that people with OCD are still quite likely to jump to conclusions with respect to their obsessions (i.e., things that are highly anxiety-provoking, where the anxiety affects the conclusions drawn). And most people with OCD are not obsessed about the colors of beads.A third...