Have you ever believed that you are already dead or the star of a Reality-TV series? Psychiatrist Joel Gold has seen his fair share of delusions and believes that our culture has more impact on it, than we might think. A conversation about Donald Trump copycats and our vulnerability to insanity.
In your book Suspicious Minds, you describe how culture shapes madness. How does it?
Throughout the history of mankind, our culture has influenced the content of our delusions. There are many forms of delusions such as paranoid or religious delusions. The forms stay largely the same but the content of the delusions changes over time. In post-revolutionary France, many people that suffered from the grandiose delusions that they were Napoleon. Today a person with a grandiose delusion might believe he is a TV celebrity. Thirty years ago, some paranoid people might have believed that they were being targeted by the CIA or KGB, today it might be ISIS or the NSA.
Madness is always updated?
Yes, but the more controversial question is: can the environment actually induce madness when it would not have otherwise manifested itself in a different environment? Are there circumstances or environments that are likely to cause psychosis? These are fundamental questions.
Distressing situations are obviously fostering mental illness but can they induce it then?
There is actually evidence that shows that the opposite can be true, that in very stressful or painful situations like war, some people with mental illnesses actually do better. They pull themselves together. There are a lot of theories about this but I think that if somebody’s external and internal world match, things make more sense to them. In situations like these, your suspicion or your fears are legitimate, not irrational. But of course in many people war can induce anxiety or depression. In our book, my brother and I argue that environments like the surveillance state and our culture in which seemingly anybody can become a star without any special talents, might be prone to induce delusions. I think the Truman Show delusion could be such a manifestation.
You coined the term the Truman Show delusion which is the belief that one is the star in a reality-TV series and that the world surrounding you is completely fake – just like in the famous movie The Truman Show.
It might be an old delusion in a new guise but the content is new. That specific belief did not exist 200 years ago. But I don’t think that the movie caused the delusion. Some people with this delusion had it before they had ever seen the movie – if they had seen it at all. But many people who have this experience feel it confirmed when they see the movie. It perfectly encapsulates their feelings. The movie is a scaffolding around which the delusion is built.
“Delusions are social in nature”
Delusional people often share the same stories or beliefs. What is it about a certain narrative that makes it so credible for delusional people?
My brother and I believe that delusions are social in nature; our minds are wired to negotiate the social world. There is a part of our brain that we have labelled for descriptive purposes the suspicion system. The suspicion system is meant to monitor the environment for social threats. When the suspicious system is disconnected from the reflective system of our brain, the part that analyses a situation and counterbalances the suspicion system, then delusions can form. Another factor is social interaction. We are not suspicious of furniture but of other people and today there is a huge variety of ways in which we are connected to others. At the core of most delusions is the belief in the malignity of other people. Police, co-workers and family can be the perfect cast for such scenarios. That’s why certain themes recur in delusions.
Is the form of delusion a decisive factor in choosing the adequate narrative?
I think so but as I pointed out, most of them are linked to our social surroundings. That is the common denominator. Take the Napoleon delusion: It is not necessarily a paranoid delusion but more a delusion of grandeur. But it is also social in a way: if you think you are superior, you are less likely to be in danger. You put yourself in a position of power to escape social threats. Today we are surrounded by some people who are famous for no particular reason. That can give the impression that power and fame are easy to acquire.
I hope there won’t be too many cases of Donald Trump copycats.
It would not be surprising if more people with grandiose delusions report that they are Donald Trump. In fact, a colleague of mine told me that he has had some patients of late that believed just that or that he is spying on them. He is the most famous person in the world right now and he is ubiquitous.
“Madness is an experience we are all capable of having”
Delusions are a different perception of reality. Usually that reality is an isolated and unique perception but if a delusional reality spreads and enough people believe it, it can quickly become an alternative reality all together.
That is a valid point. We have criteria to diagnose certain mental illnesses. The problem however is that if a large enough number of people believe something, it is not necessarily recognized as a delusion. Conspiracy theories are good examples. Some of these theories are completely fact-free but we don’t categorize them as delusions but as conspiracy theories because many people hold the same beliefs. The line between the two is very thin.
Myths are another thing that could qualify as delusions but are considered important narratives for our existence.
It’s often said that if you can prove something, it is not a delusional idea. But you can “prove” a lot to back your claims. People can be led to believe a lot, so myths and conspiracy theories are extremely hard to debunk.
Myths not only influence the delusional mind. There are also a lot of myths when it comes to how to cure madness. People used to believe that the “stone of madness” caused insanity or that “black bile” – a humor of medieval physiology believed to be secreted by the kidneys or spleen – caused melancholy and depression.
This is not just true for mental illnesses. There were a lot of medical myths at the time because people didn’t know about viruses or bacteria and so came up with other explanations. Instead doctors used things like leeches to cure patients. Today that would be considered malpractice. When knowledge is absent, people come up with ideas that might seem strange later on. But if many people believed it, it was considered science. Consider the example of vaccinations: A British researcher published an article in the renowned medical journal The Lancet that stated that vaccines could cause or at least increase the risk of autism. People still hold on to that idea well after it has been debunked. Now there is a highly charged controversy surrounding vaccines and his theory is still gaining traction.
Society has a very strange view on mental illnesses, it seems to me. On the one hand, people don’t want to interact with mentally ill people but on the other hand, we cherish the myth of the manic genius or the tormented writer. It could be concluded that we only accept mental illness if it enables you to produce something good from it, if it propels you to another level of creativity.
That’s true. Madness is something we are very afraid of because it is an experience that we are all capable of having. Nobody is safe from psychosis. On some level, possibly unconsciously, we realize that. The right conditions can drive almost every sane brain into madness. If we see a person with mental illness on the street, we find it uncomfortable because we know on some level that it could happen to us. On the other hand, we almost envy some people with mental illness because we believe that their illness has enabled them to do something we are not capable of. Think about somebody like the brilliant mathematician John Nash who suffered from schizophrenia. We tend to think that because of his alternative view of reality, this geniuses realized things that are beyond our imagination. And sometimes that is true, but there is a price you have to pay for that. People with bipolar disorder can show great creativity and productivity during their manic phases but that is by no means guaranteed. In most cases, you pay the price without getting the benefit.
Over the years, you have seen and heard about so many delusions. Is there one in particular that still fascinates you?
Two actually: The Truman Show delusion of course because it was such an important influence on my work. But I also find the Cotard delusion fascinating. It is the nihilistic belief that one is dead but still walking the earth. It is amazing to me because it is such a wild contradiction. Somebody is telling you that he is dead. “But Sir, you are talking to me. How can you be dead?” The belief sticks regardless. New delusional contents might be added to the list but the old forms remain. Still, the list grows.