Internal inconsistency can be objectively measured: "you said you wanted pizza but now you are ordering a burger". I would argue that internal inconsistency is the opposite of rational behavior. Therefore, if mental illness causes internal inconsistencies, it is causing irrational behavior.
Having a mental illness doesn't mean that purported goals cease to exist. You can still ask a person with schizophrenia "what do you want", and they will give you an answer, because they are a person and not an animal.
Taking this back to TempleOS: Terry seemed to want to be known as the greatest programmer on earth. At the same time, his mental illness caused frequent outbursts that were off-putting to many people. It is hard to have a positive reputation as the greatest programmer when your behavior pushes people away from you. I would qualify such an inconsistency as "irrational", would you not? Using racial slurs in an online outburst is not "rational" behavior if your goal is to be respected as an amazing programmer.