Can Culture Drive Us Mad?


By Samantha Spoto

Photo courtesy of Patrik Nygren.

In the early 2000s at New York City’s Bellevue Hospital, a handful of patients explained to Dr. Joel Gold that they believed their lives were being recorded secretly for reality television. Like the 1998 film The Truman Show, in which every aspect of Jim Carrey’s life is scripted unbeknownst to him, Gold’s patients convinced themselves that they were merely pawns in a vast, staged scheme. The manifestations of this anxiety led Dr. Gold, who practices psychotherapy and medication management, and his brother Ian, a philosopher, to coin the psychological concept known as the Truman Show delusion.

The Golds’ recently released book, Suspicious Minds: How Culture Shapes Madness, delves into the Truman Show delusion and aims to decipher the nature of this phenomenon, amongst others. BTR spoke with Dr. Gold about the roots of madness and psychosis.

In order to understand the origins of psychosis–when an individual loses contact with reality–Dr. Gold explains that we must first define delusions. Delusions tend to be unusual and false beliefs that contradict rationality. According to Dr. Gold, those who experience these misconceptions hold onto them tenaciously.

In our society, delusions are commonly viewed as a result of biological factors. Dr. Gold tells BTR that people have primarily understood psychotic illness as a neurological problem. However, the Golds point to existing evidence that suggests that non-biological factors contribute to the development of delusions. The environment plays a large role in psychosis and may serve as a catalyst to those with a genetic predisposition.

Dr. Gold suggests three well-established categories serve as risk factors in psychosis and may inhibit the onset of delusions. First, he points to adverse childhood experiences such as abuse (physical, verbal, sexual, etc) or the loss of a parent. In addition, growing up as an immigrant or child of an immigrant heightens the probability of developing symptoms of psychosis. Lastly, living in an urban environment increases the chance of schizophrenia and other mental illnesses.

Along with their discussion of societal factors, the Golds present a theory to explain the mechanics of how the mind creates delusions. They point to what they refer to as the Suspicion System, a function of the brain that alerts individuals and allows them to recognize when danger is imminent.

“We believe that we all have the Suspicion System,” says Dr. Gold. “We think that part of our brain is used to negotiate the social world and the people in the environment who mean us harm.”

With a functioning Suspicion System, people can scan the environment for threat and recognize social dangers.

“You don’t want to wait until the gun is pointed at your head to let that person cause you harm,” Dr. Gold reasons. “You want to see the bulge in someone’s jacket, recognize they have a gun, and leave the room before they act.”

However, for others, the Suspicion System fails to act in a rational manner. Some brains might detect threats when none actually exist. Dr. Gold believes that when this misperception of hazard occurs, delusions come into being.

Like many components of the human body, Dr. Gold explains that the brain’s Suspicion System is a product of human evolution.

“As our communities have gotten bigger, there are more unknown others,” Dr. Gold tells BTR. “If we think of technology as a big city, it can be overwhelming. That might trigger paranoia or other delusions in people who at another time in history might not have become psychotic.”

For those who experience the Truman Show delusion, the current world in which we live largely impacts their brain. With consideration to the internet, we may choose to accept that we are living in a world in which nearly seven billion people have the capacity to watch and monitor our individual steps. With social media, reality television, and the Nation Security Agency (NSA) all prevalent in our society, people at risk of psychosis are being gravely impacted–more so than ever before.

When considering the level of connectivity that technology has ushered, the Suspicion System can become inundated and thus enable delusions to develop more prominently.

The Golds are not suggesting that people who have no known genetic predisposition to psychosis will become psychotic simply because they utilize the internet. They believe that given said genetic predispositions, certain circumstances might stimulate psychosis and delusion.

In today’s digital era of rapidly developing technology, it does not seem like much can be done in terms of primary psychosis prevention.

“The internet isn’t going away and the NSA isn’t going away,” admits Dr. Gold. “I suppose you can make the argument that none of us should be online as much as we are.”

Although much in the way of treatment still needs to be developed, the Golds’ study of psychosis and delusion has initiated a significant conversation in the field of mental health. To look at only the biological elements that give rise to psychosis would be imperceptive. The Golds are merely suggesting that the roles of culture and social interaction must be examined in order to gain a better understanding of how delusions progress.