Psychosis as a form of rationalism

I think when we talk about psychosis, we immediately think of irrationalism. And there is something true about that instinct. For how should we understand seeing things that are not there (visual hallucinations), hearing things that are not there (auditiory hallucinations), and believing in things that are not there (delusions)? We like to put reason in one place, and psychosis in a different place, and for good reason: for if someone is unable to differentiate between the unreal and the real, which is a fairly characteristic definition of psychosis, we need some marker, some way of highlighting this distinction, between the person who is psychotic and the person who is sane. Without the marker, we do not understand the integrity of the illness. We conflate, and in doing so, we cause diagnostic and other errors and people get hurt.

What I want to suggest in this blog post is that relegating psychosis to the irrationalism dustbin is not an example of good thinking. And it is not a good example for this reason: to reason is to make inferences, and someone who is psychotic makes inferences. When you are psychotic, you make inferences like any sane person does. The only difference is that the inferences you make are faulty. Psychosis is not an example of irrationalism, defined as holding that essential aspects of experience cannot be understood by evidence alone. For psychosis in a strange way is an argument for rationalism, for normativity, because a psychotic person, like any rational person, is still seeking different forms of evidence, is still trying to make sense of their beliefs, is still wrestling with how things ought to be. But the evidence they find and use for verification and justification is faulty. If knowledge is verified true belief, then someone who is psychotic has mastered the "verified" and the "belief," just not the truth aspect. (This is one reason why, contra Richard Rorty, we need the concept of truth very much.)

Why does this matter, and what does this mean? I think it matters because conceptually we have to think differently about psychosis if we are to come to a better understanding of it. Psychosis tends to be something that scares people. It is something dark, something unknown, and something that is also sensationalized in our culture. Anyone with a schizophrenia-spectrum illness who watched the "Six Schizophrenic Brothers" documentary probably knows what I'm talking about. I only made it through one episode - it was horribly sensationalized, and it played on people's fears, using a true crime lens to talk about the illness. When these tactics are employed, illnesses that involve psychosis get plowed under ideas that might not be totally germane to what such illnesses actually entail for the majority of those living with them. The everyday gets eclipsed, and the reality of the illness snowed under. And this is where the specter of irrationalism comes into play, and in doing so plays on people's fears.

Psychosis is a form of reasoning, not reasoning's antithesis. It is just a faulty form of reasoning. When someone is psychotic, in an odd way they are also reasonable, because they are responding to stimuli that provoke equally extreme responses. When I was experiencing auditory hallucinations, for example, I interpreted these hallucinations as telepathic messages. At the level of content, of course - the "what" of the illness - this can seem very strange, and it is strange. But at the level of the "how," I don't think it is that strange, because psychosis, like sanity, involves interpretation, involves hermeneutics.

What is the hermeneutics of psychosis? We can enlist some help to answer this question from Robert Brandom in A Spirit of Trust: A Reading of Hegel's Phenomenology and John McDowell's Mind and World, both of whom argue, in their separate ways, for forms of rationalism - Brandom in his emphasis on conceptual realism, and McDowell in his writing on second nature and the myth of the given. Conceptual realism is the idea that the world is conceptually structured in a non-psychological way. A square is not a circle. Gold is not bronze. A bear is not an invertebrate. The world is determinate - and it is determined by relations of incompatibility and consequence, or what Hegel calls determinate negation. This is the meaning of "conceptual realism" - that the world (realism) is structured conceptually. Because the world is conceptually structured, we can make sense of it - conceptual realism is connected to objective idealism, that the world needs us in some sense to put its conceptual structure into a vocabulary, a language. But because the world is structured conceptually, we also make errors - there is something that we come up against and can get wrong. Experience, for Hegel and Brandom, is rationally recollective - we are constantly sharpening our ability to understand the world, and this sharpening, this honing, this experience, has to involve error to be experience. We do not use our concepts to shape the world, because the world is already shaped. We do use our concepts to understand and express the world. McDowell argues similarly that the myth of the given is harmful because there is no boundary to our concepts. "Thus the idea of conceptually structured operations of receptivity puts us in a position to speak of experience as openness to the layout of reality. Experience enables the layout of reality itself to exert a rational influence on what s subject thinks." McDowell continues,

This image of openness to reality is at our disposal because of how we place the reality that makes its impression on a subject in experience. Although reality is independent of our thinking, it is not to be pictured as outside an outer boundary that encloses the conceptual sphere. That things are thus and so is the conceptual content of an experience, but if the subject of the experience is not misled, that very same thing, that things are thus and so, is also a perceptible fact, an aspect of the perceptible world. (26)

Psychosis cannot change that things are thus and so. But it can interpret wrongly, and it can resist insight involuntarily. Psychosis could be defined as an involuntary form of error, but because it is error, it is interpretive, it is hermeneutical, and it is, in a faulty way, rational. What I'm trying to say is that it is human. But why does it matter if we call psychosis irrational, if it is indeed a form of rational error? And how do we differentiate between psychotic error and error that occurs when we are sane?

I think "irrational" is not a helpful term, because it suggests that psychosis occurs outside the space of reasons. And this move, this way of conceptually mapping what psychosis is, is a form of conceptual exclusion, and therefore a form of stigmata. Even worse, it is not correct - meaning that psychosis does occur in the space of reasons, because it does involve inferences, except the inferences are faulty. A la McDowell, there is an "unboundedness of the conceptual." This seems to me to be a difference that makes a difference.

When we are sane and we make errors - that stick is bent, aha, the stick was in the water - we notice that what is true in itself is not true for us. The stick is not bent (how we saw it initially), the stick is straight. The only difference between sanity and insanity is that sanity has something built in it that allows for more immediate insight and correction, while insanity is harder to correct, harder to experience insight inside of. Sanity involves less projection, insanity involves more projection. In the parlance of Hegel and Brandom, what is true for consciousness when psychotic, is not true in itself. But this exists along a spectrum, and not in some different, alien conceptual space. All mental illness exists on a spectrum. I have been floridly psychotic, and then had the insight that I am floridly psychotic. Other people tragically are unable to reach this insight. It is all on a human spectrum.

Another way of saying this is, in McDowell's words, "Conceptual capacities are already operative in the deliverances of sensibility themselves." This is just as true of psychosis as it is for sanity, only the inferences are faulty. I'm not even sure when psychotic that the concepts are different, though the interpretation of the concepts are. The world is still the case when a person is ill. But how they interpret the world does change.

Another way of saying this is to say with Donald Davidson in "A Coherence Theory of Truth and Knowledge" that "if a coherence theory of truth is acceptable, it must be consistent with a correspondence theory of truth." Psychosis is an example of coherence without correspondence. Davidson again: "the truth of an utterance depends on just two things: what the words as spoken mean, and how the world is arranged." This is to say that meaninglessness, in some sense, like irrationalism, is impossible, but error is not. Sanity is error that in some way is voluntary and shared; psychosis is error that is involuntary and therefore unshared and tragic.