I was reading a different book when I decided to take a brief look at Suspicious Minds. It was so engaging, informative, and thoughtful, I ended up postponing the other book and diving into this one.

Authors Joel Gold, a psychiatrist, and Ian Gold, a philosopher, are brothers. Joel started working at Bellevue Hospital in New York City in 1995, and begins by describing the variety of people who walked through the doors in psychiatric emergency. In 1998, The Truman Show premiered, he writes, and in the years that followed, individuals began to present as if they were living examples of the protagonist. In the film, the lead character, Truman, finds out he was adopted in utero by a television production company and has been the unwitting center of a reality show about his life.

Joel noticed the pattern, he writes, after the fourth patient presented as feeling Truman-like. (Considering the variety and intensity and numbers of people who came to Bellevue, it is a wonder he noticed at all.)

The trend gave Joel the motivation to look beyond our current reductionist view of mental illness as strictly neurological and to examine how culture and the environment affect how we go mad.

The brothers examine madness throughout history, beginning about four thousand years ago. Initially, they write, delusions and madness were seen as punishments from the gods. For the Greeks, madness was an illness caused by imbalances in bodily humors. In 1796, they write, James Tilly Matthews felt people were being controlled by animal magnetism using machines called Air Looms. (This history alone is worth a read.)

Today, with the prevalence of closed-circuit surveillance cameras and surveillance of online communications and cell phones, people sometimes feel they are at the center of NSA watchers. Not too many go on to believe they are the center of a clandestine television program about their lives, though. What makes the difference?

There is a pattern of circumstances that can make us more vulnerable to delusions and schizophrenia, the authors write. We all have a suspicion system that is always on the lookout for threats to us. When it is functioning properly, we are protected. When it malfunctions, we have problems, such as feeling that we are actors watched and controlled by others.

Of course, Freud is part of the books historical review, but the Golds examine one of his inner circle, too: Paul Federn. Rather than analyze patients, Federn provided more supportive therapy. His work foreshadowed the common factors we look at today for effectiveness, particularly the therapeutic relationship. Later in the book, the authors look at therapy, in particular cognitive behavioral therapy, as a treatment for delusions. Listening with understanding and empathy can be very powerful.

Some other fascinating history in the book: one of the current major treatments for mental illness, psychopharmacology, came into being by accident — from a dye developed for the textile industry in Germany. It began in 1876 with methylene blue, which had the core molecule phenothiazine. That molecule was used for malaria, for shock, and for anesthesia, then evolved into chlorpromazine in the 1950s for use as a neuroleptic.

The book offers stories of people suffering from delusions over the years. The Golds present evidence of how living in cities or being in a group that is suppressed (such as a minority or immigrant group) can increase ones chance of mental illness.

The brothers also present the long term and ongoing research about expressed emotion in mental illness. A few decades ago I was involved in a re-hospitalization study at a state hospital and one of the major factors examined was the expressed emotion of families as a factor differentiating between those former patients who were re-hospitalized and those who were not. Many times in reading this book, particularly the parts about Bellevue, I was taken back to those days. It made the book all the more gripping.

The Golds postulate that mental illness is more like other illnesses than we often believe. You may be predisposed to certain problems, they write, but it is your interaction with your culture and environment that affects whether you develop those problems, as well as how they manifest. “The status of lung cancer and schizophrenia as biological diseases doesn’t mean that the outside world can safely be ignored,” they write. “No self-respecting oncologist would advocate smoking, and no psychiatrist can be indifferent to the toxicity of social life.”

In the end, the authors advocate for a more holistic approach to mental illness, rather than the current biological and reductionist one. They even discuss working with an individual with delusions by using just cognitive behavioral therapy.

The combination of research, history, and individuals’ stories makes for a wonderful read, and helps the Golds advocate for a shift in the way we perceive madness. I highly recommend this book.

Suspicious Minds: How Culture Shapes Madness
Free Press, July 2015
Paperback, 352 pages
$17

Psych Central's Recommendation:
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