“Maybe I’m going out of my mind,” said Truman Burbank, played by Jim Carrey in 1998’s “The Truman Show,” “but I get the feeling that the world revolves around me somehow.”
How Culture Shapes Madness
by Joel Gold and Ian Gold
Slight variations of this sentiment came from my own mouth in 2009. I believed I was constantly surrounded by an army of undercover reporters; I thought that photographers were secretly camped out waiting to take my picture; I was top-of-the-hour news, and millions of people were tuning in to watch me.
This delusion of being monitored is not unique to me, a person who suffered from a curable neurological disease that caused the delusion. It’s not unique to Truman Burbank. It’s not unique to those with diagnosable delusional disorders, caused by psychiatric conditions like schizophrenia and bipolar disorder, or by brain diseases like dementia, or by alcohol and drug abuse.
With “tweets” and “likes,” and ads geared directly toward our specific Google search histories, it’s hard not to, at least at times, feel as if the “world revolves around me somehow.”
It’s not surprising then that this phenomenon has earned a place in the scientific literature. The Truman Show Delusion, first described in 2006, written up in academic journals in 2012, and now the subject of a fascinating new book called “Suspicious Minds” by NYU psychiatrist Joel Gold and his brother Ian Gold, a professor philosophy and psychology at McGill University, reveals how intimately culture interacts with madness and mental health.
Dr. Joel Gold met Albert, his first “Truman patient” in 2003 while working as an attending psychiatrist at Bellevue Hospital. Admitted to the psychiatric unit, he complained that his family members were mere actors on his unscripted television show. Brian, a visual artist, who was admitted soon after, believed that he was living a secretly taped life. There was a computer engineer, an MIT professor, a lawyer — all of whom believed the same thing: They were on camera.
“I thought I was being followed, like ‘The Truman Show’, and I was a hit. People were following me all over the world,” said David, one of Gold’s patients who, incidentally, worked as a producer on a real reality TV show at the time.
Gold has now collected over 100 cases. “I started to think: There’s something really going on here,” he said. “What struck me was how all-encompassing the Truman Show Delusion is.
What does it say about our society? With cameras on every corner, Snowden, P.R.I.S.M., drones, YouTube, overnight fame, those of us with genetic predispositions might be pushed over the edge.”What struck me was how all-encompassing the Truman Show Delusion is.
Gold likens mental illness to lung cancer. Some people can smoke three packs a day and never get it. Others will get it if they smoke or not. Many more, though, have genetic inclinations but need a trigger for the cancer to occur. Culture, Gold argues, is mental illness’ equivalent to lung cancer’s cigarettes.
How many of us, then, are teetering on a razor’s edge between sanity and insanity?
In the book, he points out that child sexual abuse increases the odds of developing psychosis later in life by 2.78% and that living in an urban area increases the rate by nearly 2.5%. Other studies have shown that immigrating or living as a minority in a city further increases these odds.
The content and type of our delusions are also culturally specific. Delusions of persecution are the most common form, but highest in Africa. English-speaking people have the most referential delusions (the belief that the TV is talking to you), while Far Easterners exhibit the greatest number of sexual delusions.
Delusions of jealousy are more common in Germany than in Japan; preoccupations with poisonings are popular in Turkey. The West Bengali delusion called “puppy pregnancy,” a belief that when a woman is bitten by a dog she becomes pregnant with puppies, is only seen in that area.
A study out of Stanford published in the British Journal of Psychiatry last week revealed that auditory hallucinations differ between Western and Eastern cultures. While Africa and India tend to have a more “benign and playful” relationship with voice-hearing, the US had an overwhelmingly dark and negative one. This relationship might have “clinical implications” on treatment outcomes, with a more positive relationship with voices producing a more favorable outcome, the study suggested.
As we invest a greater awareness about reducing the stigma of mental illness with research projects like the B.R.A.I.N. Initiative to identify the neurobiological and genetic markers for mental illnesses, Gold cautions psychiatrists not ignore how environment influences how we treat mental illness.
“This is an art not a science. We know a little more than we did 100 years ago, but we still don’t know much,” Gold says. “It would be wise for psychiatry to be a broad church at least until the science catches up with our hopes.”
As a person who suffered from a neurological brain disease that appeared like mental illness and could easily have been mistaken for it, my survival depended on this new focus on neurobiology in psychiatry. It’s not easy for me to see a focus on society and culture in mental illness as anything but a step backward, a return to Freudian schizophrenegenic mothers and egos and ids.
But Gold has changed my perspective — at least a little. There’s just too much we don’t know about the brain to be certain about anything. Reading “Suspicious Minds” offers lessons to anyone interested in the complexity of the mental health field’s future.
Susannah Cahalan chronicled her illness in “Brain on Fire: My Month of Madness.”