This looks like an excellent and important book - we too often neglect the cultural context of "madness."
The science behind America's deepening disturbance
By Martha Stout
July 31, 2014 | The New Republic
A young friend recently shared with me her experience of being stopped by the police on an otherwise uneventful Tuesday morning. With one arm protectively wrapped around her shoulder bag because it had a broken latch, she’d been walking along a city street. Unbeknownst to her at the time, a shooting had occurred the previous day in the same neighborhood. Three police officers, two male and one female, approached her. They demanded to know whether she had a gun under her arm, took her bag from her, and looked inside. No gun. They checked her identification. No record. (As far as I know, this young woman hasn’t so much as a traffic ticket.) She was completely cooperative throughout.
The female officer then patted her down, which my friend said she tolerated by deliberately becoming a little dissociative—“spacing out”—until the stranger’s hands finally finished their journey over her body. Then, though there was no gun in it, the two male officers decided to search her shoulder bag again, item by item. Riffling through her wallet, they found a condom, and that discovery grabbed their attention.
“Oh look. We’ve got a young slut here,” said one, waving the condom. All three officers laughed.
My friend, very scared by now, said nothing.
Finally, they let her go. As she walked away, the female officer called after her, “Guess you came here ready to fuck anyone you wanted to, didn’t you?”
I find this officer’s parting salvo grimacingly ironic.
These days, mind-spinning stories of misogyny assail us from all over our country, and indeed, this account is hardly the worst. But knowing the victim personally, and understanding that she will carry the hateful essence of this ridicule with her for a long time to come, I was especially saddened. And for me, one of the most disheartening features of this incident was the fact that the young woman who endured it was not even taken aback. Far from being shocked and outraged, she was not even surprised. When I asked her about her reaction, she explained, “I was very upset, but no, I wasn’t surprised. If you walk around alone, you kind of expect this sort of thing to happen. It’s really only a matter of time.”
Is this frightening belief about the world a symptom of paranoia on her part? And, as the old saw goes, are you paranoid when they’re really out to get you? Most of her twenty-something years have been spent in a nation beset by furious cultural and political forces on a course to push back the legal standing and social status of women by half a century. As but two illustrations, there are Supreme Court actions such as the recent Hobby Lobby ruling and state-level abortion-restriction laws that are designed to make certain of women’s medical procedures as costly and humiliating as possible.
How much of an influence has the traumatized and reactive culture of a post-September 11 United States had on the mental status of this young citizen—and for that matter, on the mental status of the police officers who bullied her? And in general, how much, and in what ways, do events in the wider world affect our individual personalities? Societal factors clearly influence our observable behavior—what we will and won’t do in public on a day-to-day basis—but can societal, cultural, political, and even technological factors soak into our very psyches, infiltrate our inner cores and make lasting changes to who we are? This is a fascinating and in some cases alarming question, and is the basis of Joel and Ian Gold’s book, Suspicious Minds: How Culture Shapes Madness.
Suspicious Minds: How Culture Shapes Madness,
by Joel Gold and Ian Gold. Free Press.
Joel Gold, MD, Clinical Associate Professor of Psychiatry at the NYU School of Medicine, and his brother, Ian Gold, Ph.D., Associate Professor of Philosophy and Psychiatry at McGill University, discuss a number of psychotic patients who all have the same delusion—that the people in their lives are acting out a script, much like the family and friends of Jim Carrey’s character in the 1998 movie, The Truman Show. Juxtaposing recent research on schizophrenia with page-turning case studies of these paranoid patients, the Golds argue that psychotic delusions (not to mention mesmeric movie plots) are the result of interactions between the brain and the sociocultural world, and they bring to light the discipline-altering fact that culture has a role to play in the development of psychopathology generally.
If you happen not to be a psychiatrist or a psychologist, you might reasonably imagine that mental health professionals have written many other books on this crucial and intriguing question: Can zeitgeist have an enduring negative effect on the individual psyche? But the startling fact is that most of the relevant scholarly writings by psychopathologists are quite new (post-2001), and discussions for nonprofessionals are rare. Over the past 40 years or so, psychology has attempted to divvy up the causes of pathological conditions between two now-famous categories, “nature” (as transmitted genetically) and “nurture” (environmental influences). For various psychopathologies, including paranoid schizophrenia, and also normal “personality traits” (introversion/extraversion, conservatism/liberalism, rigidity/adaptability, and several dozen more), research has yielded remarkably consistent results, indicating that these differences among human beings are accounted for by genetic and environmental factors in more or less equal measure, with genetics sometimes edging out environment by a point or two (51 versus 49 percent, in some instances). This research has been indispensable to our growing appreciation of the role of genetics both in normal personality and in the mental illnesses.
Contrastingly, our conception of environmental influences has been biased and narrow. We have tended to think of “nurture” only in the familial sense: In mental health research, “environment” tends to mean child-rearing factors, which is to say the personalities and actions of parents and, to a lesser degree, siblings. That an individual’s personality or mental illness might be affected by environmental factors outside the home has been largely overlooked. Take the study of sociopathy, which is another profound form of psychopathology—this one characterized not by delusions but by the complete absence of conscience. Research indicates that the factors involved in sociopathy, like those in many other mental illnesses, are about 50 percent genetic and 50 percent environmental. But researchers have been perplexed because they have been unable to find specific child-rearing variables that would consistently account for the environment’s half in cultivating sociopaths. I maintain (in my book The Sociopath Next Door) that this half consists primarily of larger societal factors, and this idea would seem to be supported by the fact that the incidence of diagnosed sociopathy is significantly lower in certain East Asian countries (most notably Taiwan and Japan) than in North America. It seems likely that, in the United States especially, any genetic predisposition to sociopathy will be nurtured and shaped by a single-mindedly competitive and individualistic culture that regards “winning” and domination as the ultimate goods.
Why have psychologists who study pathology tried to divide up the causality universe between inborn tendencies and the family environment, and turned a mostly blind eye to influences from the wider world? One answer is that a cultural hypothesis frustrates prevention: Though correcting the child-rearing practices of a large group of people would be a tall order, setting out to alter the entrenched belief systems of an entire society is even more daunting and might eventually involve taking a political stance, something many clinical psychologists and psychiatrists are loathe to do.
Gold and Gold make it clear that psychiatry is dispensing with the possibility of cultural factors in mental disorder even more summarily than psychology has done. They write, “The social world is at the heart of our theory of delusions, and this puts us at odds with much of mainstream psychiatry.” Mental illness, they explain, “at least severe mental illness—is nothing more than genetic and neural dysfunction,” according to psychiatric dogma. They point to the large and growing number of psychiatrists who aspire to understand and treat mental disorders as brain disorders, and convincingly illuminate the losses that psychiatry may suffer on account of this new reductionism.
The central argument in Suspicious Minds derives from the increasingly accepted “social brain hypothesis,” the idea that the primary function of enlarged primate (and therefore human) brains is to deal with the cognitive challenges of living in groups. In reference to paranoid disorders in particular, Gold and Gold ask the question—“What sort of cognitive system is required to enable one to be sensitive to social threats?” In answer, they propose that the human brain contains an adaptive “Suspicion System,” which is “the solution that evolution came up with to enable us to pick up evidence of infidelity and other social threats for the purpose of early detection and defense.” In other words, courtesy of natural selection, we are all biologically prepared to be leery. They hypothesize that a healthy Suspicion System makes social life safer through “heightened responses to subtle, uncertain, and ambiguous signs of social danger,” but that a malfunctioning or overloaded Suspicion System “will sound the alarm without good reason and detect evidence poorly—that is, see malign intent where there is none.” Over time, an overreactive Suspicion System may inaugurate “an idiosyncratic belief that is firmly maintained despite rational argument or evidence to the contrary”—i.e., a paranoid delusion. The authors point out that the persecutory delusions of clinical paranoia are by far the most prevalent form of delusion the world over.
The delusions of psychotic patients—that their lives are scripted, and that their friends are mere actors—recall the plot of The Truman Show.
Gold and Gold conclude that the “Truman Show delusions” of their paranoid patients express those patients’ fears of being controlled by what other people know about them: “Truman Show is a delusion of control in the age of surveillance.” They declare, “Reductionism in psychiatry constrains theory to operate within the skull or the skin. Our bet is that the outside world is going to matter as well.”
Suspicious Minds is a contrarian, insightful, and important book. Gold and Gold do not take on the more politically involved and incendiary aspects of our society, such as run-amok individualism—or the abuse of power and the national upsurge in misogyny that plagued my young friend on that demoralizing Tuesday morning. Nonetheless, their analysis of culture-linked paranoia comprises an effective argument that our seemingly endless struggle to align our society with our more enlightened ideals may be a fight for our very minds.
~ Martha Stout, Ph.D., is the author of The Myth of Sanity: Divided Consciousness and the Promise of Awareness, The Paranoia Switch: How Terror Rewires Our Brains and Reshapes Our Behavior--and How We Can Reclaim Our Courage, The Sociopath Next Door, and an upcoming book, The Sociopath Files.