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Friday, January 9, 2015

"The Invisible Line" (on Joel Gold and Ian Gold's Suspicious Minds: How Culture Shapes Madness")

the invisible line

Joel Gold and Ian Gold Suspicious Minds: How Culture Shapes Madness (New York: Free Press, 2014)

While working at the Bellevue Hospital psychiatric emergency room in his first month as a doctor, Joel Gold encountered a seemingly mellow and laid back individual—dressed in a “tie-dyed shirt, cargo shorts, and flip flops,” his long hair held back in a bandana—who seemed to be suffering from a strange delusion: 

                            Albert believed that he was the subject of a TV show 
                            or movie. In describing his experience, he compared it

                            to the acclaimed 1998 film The Truman Show…directed 
                            by Peter Weir. The protagonist, Truman Burbank…is
                            being watched by the whole world. Adopted in utero by
                            a television corporation, Truman lives with every moment
                            of his life being captured by thousands of cameras located
                            around Seahaven, the island community he never leaves
                            until his climatic escape to the “real” world. 

The patient “believed that all of the significant people in his life were involved in a conspiracy to keep him on the air and in the dark about his own show.” At first this strange delusion did not register with Gold as anything but yet another variation of several delusions as outlined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, now, its fifth edition, described as DSM-5, which recognizes twenty-two categories of disorder: “of development, mood, trauma, sex and gender, sleep, drug abuse, and personality, among others.
    Over a number of years, however, Gold, discussing the various delusions with his brother, Ian, who is Associate Professor of Philosophy and Psychiatry at McGill University, began to see the “Truman” delusion as a series of delusions which a substantial number of his patients had developed. And working with his brother, Gold began to catalogue and explore what they called “The Truman Show Delusion,” culminating in their book Suspicious Minds: How Culture Shapes Madness.
     This book, however, uses this delusion—limited, apparently, to individuals who have seen or heard about a popular motion picture—as merely the starting point for the Golds’ exploration of contemporary psychiatry and the problems facing doctors and patients. The field that once focused, given Freud’s influence, on personal discussions with the patience and analysis of problems, has shifted increasingly over the last few decades to become an issue of neuroscience, with drugs and other mind-altering techniques. As the Golds point out, Freud’s activities generally did not to delusions, which he felt were incurable.
     Moreover, what we quickly discern through the writers’ rational explanations of delusions and their possible causes, is that psychiatry and its related activities has yet truly developed into a true science in which one can explain causes and effects. A great deal of what we know about the mind (and even its physical manifestation, the brain) is purely speculative. While the American Psychiatric Association has been able to create a kind of “check-list” delusions, doctors have still no certainty as to how these delusions come about or, even more interestingly, why there are so few delusions when one might imagine that human beings might suffer from several thousand of such abnormal viewpoints. Yet nearly all delusions, no matter how they differ within the specifics, can be said to involve patterns that fall into these few categories.

     Suspicious Minds is not only comprehensible by the layman, but the Golds allow the reader to speculate—through the several various theories they recount of how the brain of sufferers becomes damaged—why.  At the same time, Joel Gold shares several cases, both historical and current, with us, helping us to at least to explore various theories, and even. Imaginatively, “practice” them. Through chapters titled “A Short History of Madness,” “One Hundred Years of Delusion,” “Hell Is Other People,” “Belief Unhinged,” and “Beyond Belief,” the brothers take us through a thumbnail history of the psychiatric profession then and now, detailing the shifts in theories, and outlining new avenues of thought that have recently arisen.
     By allowing us to get a sense of the shape of this field of a future science, the Golds help confirm their theories that not only are the specifics of delusions subject to cultural and social changes, but that delusions themselves arise from our encounters with others, deriving from our need as a species to evaluate our social positioning within our worlds and perceive possible dangers others represent such through deception, jealousy, and numerous other behavioral patterns. Slowly and carefully, the Golds lay out evidence that delusional behavior, and, in particular, schizophrenia, is higher in urban areas and within particular groupings of individuals who have suffered childhood abuse, immigrant adversity, social inferiority, and other forms of stress that heighten our inbuilt “suspicion system” we have developed as a species.
     Although the Golds are perfectly willing to admit that some of these forces may physically alter the brain through, for example, an increase or decrease of dopamine and through other chemical substances created within the body, as well as admitting that certain drugs clearly do alter the behavior of their patients for the better, the brothers also imply that a newer kind psychiatry, far less passive than Freudian analysis, for example, does profoundly effect and sometimes cures their patients. 
    Moreover, the Golds point out that what we might describe as “insane” behavior is often based on seemingly sane solutions to the appearance of danger that have simply gone awry. Delusional patients, they explain, are not much different from healthy individuals except for their delusions from which, with supportive conversations and drugs, patients can be dissuaded. If contemporary “aspirational psychiatry” has, as the Golds write, “hitched its wagon to the star of neuroscience,” they feel that, until we know more specifics of the mind, that psychiatry should open itself to a broad range of therapy. Quite convincingly, it seems to me, the Golds, recognizing that delusions shift as our cultural perspectives change, suggest that biology alone cannot take account of mental illness. 
     In a world in which most of us realize that we are being watched by others, locally, nationally, and internationally, is it a delusion to be slightly paranoid. Perhaps those suffering from a delusion such as “The Truman Show” syndrome are not expressing delusions of grandeur (which seem to be implied by the patients’ feeling that they are being “watched” by everyone) as much as they are attempting to explain their fears that arise in a society where the NSA is capturing nearly every message of their social communications, and where computer communities such as Facebook and Twitter suddenly create complex and sometimes dangerous urban-like groupings that once might have been experienced only in large cities.
       If suspicion can become the source of a dangerous delusion, it can also help to protect us from even more damaging encounters with others in our increasingly global community whom we must daily face. A wise and suspicious e-mail user knows that a letter from an unknown individual who claims he is willing to send millions of dollars to the recipient if only he provides his bank account number, providently deletes the message without answering. But when suspicion begins to inform all of our email encounters it changes the way in which an individual thinks, and surely will alter his or her ability to daily communicate with others. How do most of us “draw that line” between healthy suspicion and a mind infected by general mistrust? 
     The Golds hint that perhaps there is no one “point” at which one has crossed the invisible “line,” between sanity and insanity; just as importantly, they seemingly argue that psychiatry does yet understand why some individuals more easily enter a zone of fear and doubt that puts them into jeopardy. When clinical neuroscience becomes the entire structure through which one approaches mental illness, the Golds argue, it is like looking though a keyhole. Such a narrow viewpoint “misses the wide biological perspective in which living things, humans included, are best understood. The problem with aspirational psychiatry, then, is not that it is too biological. The problem is that it is not biological enough.”  Environment and the social world around us, in short, help us to explain not only what delusions are, but why we develop them, and how we can work to resolve them.

Los Angeles, January 1, 2015

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