The Intuitive Rational-Choice Theory of Madness
The Fallen Empires of Psychoanalysis,
Medical Models and Drug Companies
With the scientific collapse of psychoanalysis (e.g., see Kihlrstom, 2015), especially due to the refutation of the concept of repression by numerous studies (e.g., McNally, Clancy, & Barrett, 2004; Piper, Lillevik, & Kritzer, 2008; Rofé, 2008), which is the "cornerstone on which the whole structure of psychoanalysis rests" (Freud, 1914, p. 16), the belief that brain disease is the underlying cause of behavioral disorders became the most dominant approach in psychopathology (e.g., see Wakefield, 1999).
However, clinical and research data indicate that medical models gained this reputation not because of the strength of their data, rather because of the weaknesses of psychological theories. This claim is not only applied to neurotic disorders, which are now attributed to neurological impairments, but also to schizophrenia, which became universally accepted as a brain disease. For example, it is difficult to see how these models can explain the large variability within each disorder. Which neurological defects, that supposedly are responsible for schizophrenia, can cause the Unabomber to become a serial killer (Graysmith, 1996), John Nash (Nasar, 1998) to display sophisticated bizarre behaviors with symbolic meanings, and others to show senseless disorganized speech (e.g., Schwartz, 2000, pp. 370-411)? How is it that schizophrenic patients often completely recover from their "neurological disease", such as Mr. X (Karon, 2008), Joanne Greenberg, the bestselling author of I Never Promised You A Rose Garden, Catherine Penney, a mental health nurse (see the documentary movie by Daniel Mackler, The Broken Wings), and Carol, a 26-year college student (Bradshaw, 1998), without medications. Moreover, after more than a century of research, during which they applied, through trial and error, horrible therapeutic methods, such as lobotomy and shock insulin, medical models ended up with a seemingly scientific breakthrough of antipsychotics. However, as testified by numerous studies, not only did these drugs have poor recovery prospect, but similar to their old "therapeutic" interventions, they inflict serious physical and psychological damages, such as cardiovascular disease and shrinking of the brain.
As an alternative, a new theory, termed Psycho-Bizarreness Theory (PBT) (Rofé, 2000, 2015, 2016, Rofé & Rofé, 2013, 2015; see also Lester, 2002; Sarma & Garfield, 2001, which is called also The Intuitive Rational-Choice Theory of Madness (Rofé 2017), claims that when individuals are confronted with extreme levels of stress, regardless of whether the source of the stress is environmental or neurological impairments that prevent them to satisfy one's basic needs, their behavioral options become limited. While some individuals prefer to remain depressed, commit suicide, become drug abusers or use aggression to eliminate the stressor, a minority of people intuitively choose certain mad behaviors that serve their coping needs. Madness is defined by five major diagnostic criteria, where the behavior intensively preoccupies the individual's attention and disrupts his daily functioning (criterion 1); Onset occurs in the absence of observable events that are uniquely associated with and can explain this behavioral change (criterion 2); It is extremely rare (criterion 3); The patient is unaware of the underlying causes for the behavioral change (criterion 4); and it is socially stigmatized as abnormal or bizarre (criterion 5). Two additional secondary criteria, which should only be used in ambiguous cases, are depression and stress.
Madness is seen primarily as a repressive coping mechanism, which enables patients to block the accessibility of stress-related thoughts. The choice of a specific behavior is determined by the same three principles which guide the consumer's decision-making process when purchasing a certain product. The major principal is the need for the specific product/symptom, which in madness is controllability. The specific behavior must increase the patient's ability to exercise control over the stressor and\or provide certain desired privileges. The second guiding principle is availability, which indicates that the choice of a specific symptom is affected by various channels of information, such as the media, personal experiences, neurological factors, family and peers. The third principle is cost-benefit analysis, which states that a mad behavior may only be chosen if the individual intuitively feels that it will reduce the level of his or her emotional distress.
Although the decision to implement the intuitive/unconscious choice is conscious, patients become unaware of the Knowledge of Self-Involvement (KSI), or the True Reason (TR) for acting bizarrely, through a variety of cognitive processes that disrupt the encoding of this knowledge and memory-inhibiting mechanisms that cause its forgetfulness. Subsequently, utilizing their socially internalized beliefs regarding the causes of psychological disorders, patients develop a self-deceptive belief which attributes the cause of their symptoms to factors beyond their conscious control, and thus stabilizes the unawareness of KSI/TR.
PBT already proved its ability to integrate all therapeutic methods pertaining to neurosis into one theoretical framework (Rofé, 2010), explaining all data relevant to the development and treatment of conversion disorder, including neurological findings, which seemingly support the medical explanation of this disorder (Rofé & Rofé, 2013), and resolves the theoretical confusion regarding the explanation of phobia by distinguishing between a bizarre phobia (e.g., agoraphobia, and chocolate phobia) and non-bizarre phobia, such as dog phobia (Rofé, 2015). Robert Aumann, the Nobel Prize-winning economist, noted in a letter of recommendation to publishers of the present book (2017),
Rofé's theory fits very well with the concept of rationality as understood in economics, where a person's behavior is considered "rational" if under his circumstances, it advances his goals. In turn, this well rooted in evolutionary theory; under the doctrine of 'survival of fittest,' the behavior of organisms has evolved in order to serve the organism's interests. Thus, Rofé's theory, revolutionary as it sounds, fits well into the frameworks of economics, game theory, and evolution.