The Rationality of Psychological Disorders: Psychobizarreness Theory

In The Rationality of Psychological Disorders, Yacov Rofé presents arguments against the existing biological and psychoanalytic models of psychiatric disease and presents a new paradigm, which he calls psychobizarreness theory. This is a fairly bold argument, given recent biological advances in the understanding of neuropsychiatry, psychology, and neurology. Aided by advances in neuroimaging, genetics, and neurobiology, the newer hypotheses about the pathophysiology of psychiatric illness more commonly implicate deficits in neurotransmitters, structural anomalies, and genetics. Nevertheless, Rofé critiques the biological model as well as the psychoanalytic model.

Given that Rofé subscribes to neither the biological nor the psychoanalytic paradigms, it is not surprising that he quotes Kuhn's (1962) and Conant's (1948) arguments that "existing theories are overthrown by better theories" and "the decision to reject one paradigm is simultaneous with the decision to accept another." It is intriguing to observe how Rofé systematically "overthrows" existing models of psychiatric illness, citing numerous studies that compel him to arrive at psychobizarreness theory.

Rofé presents a non-Freudian description of repression, which he posits as "the cornerstone of psychobizarreness theory." Freud viewed repression as the cause of neuroticism or psychosis. In addition, Freud placed the repressed thoughts or desires in the unconscious self. Rofé argues that repression exists in the realm of the conscious and is not the cause of neurotic or psychotic behavior, but rather the consequence of such behavior.

He asserts that the patient uses psychotic or neurotic behavior to distract himself from the true cause of his difficulties. Patients who display psychopathology are burdened by poor coping skills and hence use their symptoms to distract themselves from real or presumed failures, shortcomings, and misfortunes. Here, psychobizarreness theory states that symptoms are used to avoid painful knowledge about oneself.

How does psychobizarreness theory account for the differences between neurosis and psychosis? Rofé asserts that the difference is in the inherent psychological strength of the patient. Patients with better coping skills use neurotic symptoms as their method. Psychotic patients are cursed with poorer coping skills and hence use more extreme methods. One is reminded of Sullivan's concept (3) of "selective inattention" as a major defense mechanism in psychosis as one reads through Rofé's work. Sullivan, too, focused more on "awareness"—or how patients should avoid what is in their potential awareness—than emphasizing the unconscious. Rofé adds that the patient makes the choice of symptom by attempting to exert some control over an otherwise unacceptable situation.

As far as treatment is concerned, Rofé equates pharmacotherapy with painkillers—something that can reduce the symptoms without getting at the true cause. Rofé does offer a therapeutic approach that he terms "theoretical eclecticism." This approach selects a therapeutic intervention by matching "the patient's specific symptoms and needs to a given therapeutic approach."

Thus Rofé is not out to revolutionize the treatment of bizarre behaviors but wishes to draw a greater understanding to their development and cause. He basically recommends borrowing techniques from biologic and dynamic approaches applied according to the paradigm of psychobizarreness theory.

The Rationality of Psychological Disorders will be of interest to all mental health professionals who are intrigued by the nature of and the causality behind psychotic and neurotic symptoms. The notion that persons with these symptoms are individuals with poor coping skills who are distracting themselves from a particular crisis or overall downward trend in their lives seems reasonably humanistic. The author's recommendations for treatment seem practical and undogmatic.

Dr. Sarma is a psychiatric resident and Dr. Garfield is professor of psychiatry at the Finch University of Health Sciences-Chicago Medical School in Chicago.