August 2014

James Orbesen


Suspicious Minds: How Culture Shapes Madness by Ian and Joel Gold

Madness has a long history in literature. Cassandra, gifted and cursed with visions of Troy's fate, was judged insane and tucked away in the chambers of King Priam. Imagine all the raised eyebrows and whispered snickers of the Trojans whenever she showed up at a banquet, prophesizing doom for the city. "That's just Cassandra, being Cassandra," someone must have tittered between sips of wine. But she wasn't crazy, she was right. It was her culture that judged her as the former.

In Joel and Ian Gold's book Suspicious Minds: How Culture Shapes Madness, this problem is examined in detail. What makes someone mad? Is it an intrinsic trait that this person has? Or is it falling beyond the Pale that defines what makes us mad? Their tricky central thesis splits hairs:

It must be said, though, that the "normal" individual with a deeply paranoid worldview and the truly paranoid person are not always easy to distinguish. As in all areas of medical and social judgment, there are borderline cases where the difference between "normal" and "ill" is fundamentally arbitrary.

The Gold brothers, Joel, a clinician with vast experience at New York's Bellevue, and Ian, a philosophy professor at McGill University, dive into this issue and present an engaging study of how mental illness is plastic, responding to the pressures of the time.

Reaching back centuries, the Golds paint a picture of mental illness as always being in flux, yet constantly adhering to a strict set of rules. The content of delusions may change, but the forms remain the same. This can be reassuring. People aren't getting crazier, as our culture changes. The stuff populating these delusions is just getting more and more familiar. The loon raving about the Freemasons a century ago, became the sidewalk shouter yelling about the CIA fifty years ago, who transformed into today's Internet blog writer fearing black helicopters. Sure, these rants might seem mad, but there's a cultural pressure pushing individuals already on the edge to these conclusions. As with all lies, a grain of truth exists within.

Perhaps what unsettles the reader most about this book is statements like, "Mental illness is just a frayed, weakened version of mental health. In researching and writing this book, we came to understand just how little separates the mentally ill from the mentally fit." You mean I (me, of all people!?) can be a contemporary Cassandra, viewed as insane but speaking the truth? Well, yes, I (and you) can be. This is what will provoke the most discussion about this book and mental illness, as well as passages such as:

Human beings hold an awful lot of beliefs that other humans take to be nonsense. All things being equal, however, no one will consider you mentally ill because you believe your team is better behaved than the opposition or that the president was born in Kenya. But tell your psychiatrist that you caused the flood in New Orleans or that Jon Stewart is sending you coded messages during The Daily Show, and you are almost certain to get a diagnosis of a psychotic disorder.


Moreover, someone who believes that he has been abducted by the US military and been subjected to mind-control experiments will likely get a psychiatric diagnosis, but someone who believes that other people are being abducted by the military for mind-control experiments will not.

And also:

On the face of it, these are pretty similar thoughts, but only one of them is a delusion. Which of the myriad irrational beliefs that people have are delusional? In our view, this is the most important ignored question in the study of delusion.

So madness is a tricky thing to diagnose. That's what makes it so maddening. And that's often what I find so maddening about this book: there's too fine a line between what makes someone delusional and what makes someone like your odd cousin at a family shindig who just wants you to hear him out, a guy with issues. The equivalency between a delusion that you caused a hurricane that hurt a lot of (mostly black) people and questioning a (mostly black) president on his country of birth is troubling. One's totally crazy, but the other might be acceptable. While culture can, and does, as the Gold brothers successfully argue, contribute to mental illness, it doesn't excuse the culture.

Individuals with mental illness are not to be blamed. These are people, friends, family, lovers, who deserve our attention, understanding, and care. But, what it is about our culture that gets replicated in these delusions. This is something that I wanted more attention brought to. It's like the argument about media violence. Of course, depictions of violence are not the cause of actual violence. But, and this is the kicker, what does our appetite for violence, provided to us in a smorgasbord of televised and screened instances, say about us? This is the troubling and untouched issue left behind by the Golds. If culture shapes madness, as their subtitle suggests, then what it is about our culture that causes mental illnesses to take this shape? What can be done to rectify our society so that we can care and better attend to those afflicted?

The person who believes President Obama wasn't born in the United States is startlingly close to the person who believes President Obama is a socialist-communist-fascist Muslim from Kenya who is both a calculating tyrant and a Chris Farley-esque buffoon. The question never asked is why the content of this delusion exists. The form, being dominated from above, is as old as time. If it is our culture then it must be interrogated. Why has this president been so vilified, both from those with delusions and those who, apparently, are without? Why, even when the president's birth certificate was released, did belief in his foreign origins increase significantly, a statistic cited by the book? Why did militant organizations drastically increase in number over the past several years?

This might be an issue outside the scope of the book. The Golds are simply examining how culture dictates the shape of our delusions, and how our deep-set beliefs are often cattycorner to those. In this way, this is a very post-modern method of examining the human brain. And that's great. And it's convincing. I get it. But, as a study in culture, our shared contemporary culture, it seems to be a misstep to not poke and prod the roots of prevalent delusions. Of course, as mentioned, defining delusions is difficult. The line is razor thin. But, I would assume, defining what exists on each side of the razor, our shared legacy of paranoia, racism, sexism, and militarism would be in order.

As said before, literature knows madness quite well. What makes this book an excellent, if challenging, read is attention to issues such as this: "The reality is, the vast majority of psychiatrists have not experienced psychosis, and over the long history of mental illness, this non-understanding has been a major barrier to treatment of those who have it."

To read is to know another mind, at least, that's my belief (or delusion). The Golds are kind souls. Their experience treating and researching those with mental illnesses showcases their willingness to extend a helping hand. Despite their efforts, or lack thereof, to question why our culture gives rise to these delusions, it is important to understand the insights revealed to the reader. Much like Cassandra, we might be ignored or misunderstood. However, with the work of Joel and Ian Gold increasingly appreciated, those who suffer in silence, regardless of their prophecies, won't, hopefully, have to suffer for much longer.

Suspicious Minds:How Culture Shapes Madness by Ian and Joel Gold
Free Press
ISBN: 978-1439181553
352 Pages