Monday, 20 February 2017

Agency in Madness

I have a piece in the March edition of The Psychologist on the history of thinking about agency in psychosis. It is meant to be a brief whisk through of some of the literature (fictional and psychiatric) on the issue.

However, there is an intriguing conundrum nearby that I don't really get into: the question of whether it is actually possible to think yourself into a psychosis. If, like me, you are tempted to answer "no," then it is worth wondering why. Two obvious thoughts: 1. Psychosis seems, at least in part, to be a matter of predisposition. 2. Most people experience psychosis as something that happens to them. But these are not knock down arguments

First, a predisposition needn't entail something's being entirely passive. Many talents are probably (partly) a matter of predisposition, but you can't express a talent without agency. Does it ever make sense to say that someone has a talent for psychosis? Second, experiencing something as though it were passive is not the same as its actually being so. We can be mistaken about mental agency, as psychologists well know.

Part of why this question is interesting is that the non-standard answer (the one that violates our traditional intuitions) would seem to vindicate some peoples' experiences. I once asked someone in the recent aftermath of a psychosis how they had found their antipsychotic medications. Did their thinking feel clearer? It certainly seemed (from the outside) as though it was. They agreed their thoughts were clearer, but disavowed a role for the medicine, saying they had done it themselves.

Medication in this instance looked like the most plausible proximal cause, but if psychosis is more likely to emerge under certain cognitive conditions, might it be that medications provide the conditions, and that the patient does the rest? Outcomes in psychosis are very variable. Could agency be an overlooked piece of the puzzle?