"Where are the hidden cameras?" How culture affects mental illness

by Sylvain Comeau

"Maybe I'm going out of my mind, but I get the feeling that the world revolves around me somehow."

-- The Truman Show

Can our culture be making us crazy?

That's one of the provocative questions raised in Suspicious Minds: How Culture Shapes Madness, a new book by McGill Canada Research Chair in Philosophy & Psychiatry Ian Gold, BA'84, MA'87, and his brother, Joel Gold, MDCM'95, a clinical associate professor at the New York University School of Medicine.

The book has been attracting plenty of attention. The New Republic praises it as "contrarian, insightful, and important." The Boston Globe describes the book as "clear, witty, and engaging; the tone is by turns entertaining and alarming."

The springboard for Suspicious Minds is the Truman Show Delusion, which affects a small, but growing, number of psychiatric patients who become convinced that they are the unwilling subjects of a reality TV show. The name of the condition refers to the 1998 hit movie starring Jim Carrey, in which a man stumbles unto the fact that his every action is being filmed for a television audience.

Joel Gold first encountered the delusion in one of his patients 11 years ago. When other patients emerged with the same symptoms -- and when some of Gold's colleagues mentioned that they had treated similar cases -- he knew something was up. The Golds collaborated on a case study describing the condition in 2012, but decided that a book might better explore the broader implications. They believe the delusion has a lot to say about today's society.

"I do think that today's society and culture could be affecting everyone's mental health, to some degree," says Ian Gold. "Not everyone will become delusional, but many people today feel that their mental health is under assault."

Gold draws an analogy with the noxious effects of pollution.

"To the extent that the environment is becoming increasingly toxic, more people are becoming sick as a result. It doesn't mean everyone will develop lung cancer. Similarly, our culture may be increasingly toxic in some respects, but not everyone will have Truman Show Delusion. But everyone will feel the effects to some degree."

One of the central tenets of the book is the brothers' theory that the human brain has developed what they call a "Suspicion System", an ancient survival mechanism which looks for signs of danger and various kinds of threats posed by those around us.

"Human cognition evolved, to a certain extent, under the pressure of social living. When you live with others, this has benefits, but also risks and potential threats. And we believe that the human mind has evolved to adapt to these risks," explains Gold. "To the extent that the social world becomes more threatening, we think that will put pressure on human mental life."

In the book, the Golds explain that a healthy Suspicion System makes social life safer through “heightened responses to subtle, uncertain, and ambiguous signs of social danger.” However, a poorly functioning Suspicion System “will sound the alarm without good reason and detect evidence poorly -- that is, see malign intent where there is none.”

They further hypothesize that an era of hyper-swift technological and social changes, coupled with information overload, provides exactly the kind of environment that could overwhelm some people's Suspicion System. "Delusional beliefs are not real, but they have a basis in reality," notes Gold. "We live in a culture with cameras in public places, where governments sometimes spy on their citizens, and someone could reveal your secrets on Facebook. People who are predisposed to certain kinds of mental illness are very sensitive to fears of being watched and manipulated by others. So our culture could be pushing these people over the edge."

The brothers hope that their book will help to restore some balance to psychiatry, which they feel strongly emphasizes biological causes for mental illness, while neglecting the role played by social influences.

"We would never say that cancer is [simply] a biological illness, so it doesn't matter whether or not you smoke. But, in psychiatry, certainly in the case of severe mental illness, the causal role of the environment is considered very secondary." The book points to evidence, for instance, that urban dwellers face a slightly larger risk of developing psychosis than their small-town counterparts.

Though schizophrenics are often regarded as living in their own imaginary world, the irony is that their delusions are often the result of hyper-sensitivity to the realities of today's society.

"Schizophrenia is often characterized as a break with reality," says Gold. "But these people are, in fact, very sensitive to the ideas in the environment. Unsurprisingly, when the possibility of real threats emerge in the culture, it will be latched onto by people with schizophrenia or other psychotic illnesses."

In the past, the mentally ill were dismissed as "the other," a breed apart from us, locked away in asylums and forgotten. While they were once seen as having a spiritual malady, now they are seen as having a physical illness -- a view which still encourages a sense of otherness.

"When we see how the environment is playing a role, that challenges our view of the boundary between us and people with severe mental illness," says Gold. "We have more in common with [the mentally ill] than we like to think. Sanity is a continuum; there is no clear separation between sanity and madness. For example, we all have crazy ideas at times. Psychosis is just the extreme end of that continuum, and not something that is qualitatively different."