Suspicious Minds: How Culture Shapes Madness

by Joel Gold, Ian Gold

What if you woke up with the alarming suspicion that you were being watched?

One day in 2003, a patient unlike any other that Dr. Joel Gold had seen before was admitted to his unit at Bellevue Hospital. This man claimed he was being filmed constantly and that his life was being broadcast around the world like The Truman Show—the 1998 film depicting a man who is unknowingly living out his life as the star of a popular soap opera. Over the next few years, Dr. Gold saw a number of patients suffering from what he and his brother, Dr. Ian Gold, began calling the “Truman Show delusion,” launching them on a quest to understand the nature of this particular phenomenon, of delusions more generally, and of madness itself.

The current view of delusions is that they are the result of biology gone awry, of neurons in the brain misfiring. In contrast, the Golds argue that delusions are the result of the interaction between the brain and the social world. By exploring the major categories of delusion through fascinating case studies and marshaling the latest research in schizophrenia, the brothers reveal the role of culture and the social world in the development of psychosis—delusions in particular. Suspicious Minds presents a groundbreaking new vision of just how dramatically our surroundings can influence our brains.

Genres: Psychology, Nonfiction, Science, Mental Health, Sociology, Mental Illness, Cultural

352 pages, Hardcover

First published September 4, 2012

About the author

I am Clinical Associate Professor of Psychiatry at New York University School of Medicine. I evaluate and treat adults in my private practice in Manhattan. I practice both psychotherapy and medication management.
I went to school at Brown, then McGill Med before training in psychiatry at Bellevue/NYU.

I worked at Bellevue for almost 15 years where I held a few jobs including running the psychiatric ER and the outpatient clinic. My experiences at Bellevue brought me to write Suspicious Minds: How Culture Shapes Madness, my first book, with my brother, Ian.

I'm a regular contributor to Edge.org and my work has been profiled in The New Yorker, The New York Times, on This American Life, and elsewhere. I've published articles in peer-reviewed journals like The New England Journal of Medicine, Psychiatry and Science.

Reviews

[BlackOxford · Rating 3 out of 5]

The Enduring Mystery of Psychosis

As the old advert promoting advanced education used to say, “A mind is a terrible thing to waste.” It is frightening to consider how close we all are to the epitome of the wasted mind that is psychosis. If we are lucky enough to avoid psychosis in early life, we are still likely to have friends or family members who seem to just leave the domain of sanity and mentally inhabit some other region. And there is always that longer term threat of dementia to contend with. Whatever place those with advanced Alzheimer’s emigrate to, it represents a sort of hell to those left behind.

The central concept underlying a diagnosis of psychosis is ‘delusion.’ The psychotic, it is said, lives in a world of delusion. Psychiatry and psychology have come up with various classifications of these delusions, usually keyed on human desires and fears - power/impotence, sex/violation, reputation/disgrace, etc. The content of these delusions, researchers claim, vary by culture and epoch, but their form (a somewhat malleable term) remains constant. The most influential current theories about these delusions, according to the Golds, all centre on the social desire to belong, to be a valued member of society. Part of the rationale for such theories is that social cohesion is an evolutionary necessity. We can be driven mad by our intense personal drive to be part of a psychically as well as physically supportive community.

The authors suggest at several points that there are many more psychotics, and people on the verge of psychosis, than medical science has yet identified. One can hardly avoid referring to QAnon conspiracists, anti-vaxxers, and supporters of the Big Trump Lie of a stolen election as confirmation of the suggestion. A poll out this week shows that approximately half of all Americans believe in at least one of the various fantasies circulating on the internet - from Hillary Clinton’s sex-trade in children, to the toxicity of vapour trails and 5G, to Mike Lindell’s rants about Chinese vote-flipping. Delusion is obviously rampant. Or to put it another way, many Americans have found the home they’ve always dreamed of.

Or delusion might be rampant if only we could be sure about what psychosis (or more broadly, mental illness) signified. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is a 500 page Bible for the profession. The DSM lists the detailed symptoms of almost 300 named mental disorders along with helpful hints about what ‘therapies’ (mostly drugs) might be indicated. The rub is that psychiatrists have almost no idea how and why these therapies affect brain chemistry. The DSM taxonomy has no basis in biology. It is purely a lexicon of symptoms. As the authors note, “… we still don’t have anything like a theory of mental illness that is good enough even to be wrong.”

Even more worrisome is that the idea of ‘delusion’ is fundamentally undefined. According to the DSM, “a delusion is a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary.” The editors of the DSM have clearly had a defective training in philosophy to put such a statement in print without embarrassment. What constitutes proof? Who determines this? When does stubbornness become delusion? And what is this vague criterion of ‘almost everyone?’

So I can understand the Golds’s central question: “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.” I agree. But then I hit an intellectual dead end with their claim: “Our answer, in brief, is that delusions are symptoms of a disorder in a mental capacity whose function is to navigate the threats of social living. What distinguishes them from other bizarre thoughts is their origin in this mental capacity.” Come on guys. Disorder of a mental capacity? Isn’t that where we started? The term moves the quest on not an iota.

That one man’s delusion is another’s cause is obvious. The distinction is one of politics not science. This is obvious from the history of the psychiatric discipline itself. Delusion, it seems, might be the fundamental principle not only of psychosis but of the psychiatric profession as well.

[♑︎♑︎♑︎ ♑︎♑︎♑︎ · Rating 2 out of 5]

What a disappointment. For some crazy reason I thought, given the title, that this was a book about "how culture shapes madness." I took the authors at their word and expected a reasoned discussion of how "madness" is defined from the culture surrounding a person and what is 'mad' in one culture is 'sane' in another. I've been thinking about this ever since I read "The Confessions of St. Patrick," in which Patrick reports the devil came and sat on his chest, something he apparently believed really happened to him--and why not, if the devil is real?

But no. The book doesn't actually have a thing to say about how culture shapes madness, beyond the most superficial observation that delusional people pick up cues from their culture and misinterpret them. Beyond this common sense observation the book is primarily a quick survey of how mental illness has been treated in the past, interspersed with case studies of Gold's patients. Reading this book did make me appreciate Oliver Sachs more, for the way he treats each person he writes about with compassion. I felt a little bit as if Gold was trivializing the suffering of these people or using them for shock value or entertainment of the reader, rather than presenting their stories with dignity and human kindness.

[Ann · Rating 3 out of 5]

An accessible, easy-to-read book about one of the most fascinating aspects of mental disorders - delusions.

The authors start by describing a couple of cases of what they name "The Truman Show Delusion" , a feeling expressed by psychotic patients that their lives are a show, scripted by a not necessarily benevolent mastermind, and peopled by actors/impostors.

They then take the reader on a quick and rather superficial history of the field of psychiatry, with all the usual names (Kraepelin, Freud). Then they switch to biological psychiatry, with the success of neuroleptics as a turning point in the practice of psychiatry. That brings the book to their thesis : that there is a strong connection between delusions and the culture in which these delusions take place. Much of the research was familiar to me (the higher risk of schizophrenia in urban environments, or in people born in winter), and so perhaps I am not well positioned to judge how interesting this would be to people who come to this for the first time.

Finally, they propose their own hypothesis : humans are equipped with a social Suspicion System, a vaguely-defined cognitive process that allows us to pick up small clues that something might be going wrong in our (social) environment. That significant glance that your spouse just exchanged with your best friend could mean that they are having an affair. The fact that your coworker won't meet your eyes might mean that he is planning to stab you in the back professionally. The authors hypothesis is that in delusions, especially in delusions of persecution, the Suspicion System's alarm is triggered, and that somehow the normal cognitive processes that sort the junk from the real signals aren't working -and so the psychotic person becomes convinced, despite all evidence to the contrary, that he is the victim of a conspiracy.

I had two main critiques of this book.

The first is that the attribution of figures and tables was sloppy. It was not clear whether they had created these figures and schematics themselves, or copied from the scientific literature. The very first table, which was about the prevalence and frequency of various types of delusions in various countries and regions, was confusing: it consisted of a set of unit-less numbers without much explanation. Were these percentages? Absolute numbers? incidence numbers normalized per 100,000 inhabitants? And who had compiled this table?

My second point is that it wasn't clear to me what the authors were really trying to do with this book. I had the impression that they had first tried to write a book to claim "The Truman Show Delusion" as an important new psychopathology, but were dissuaded from it when they realized how this is probably just one of the older types of delusions (Capgras? Persecution?) with a new pop-culture name. So then they seemed to have decided to turn it into a general popular-science book, throwing in some history, some recent research, some case histories. The case histories were interesting and sometimes painful, but it wasn't clear what purpose they served in the context of the main narrative. Yet the authors must have gone to some trouble to obtain them, recontacting and re-interviewing these patients years after the initial contact.

In summary : an accessible book about delusions, with some interesting case histories and some historical perspective, but without a strong, cohesive central purpose.

[Al Bità · Rating 3 out of 5]

It is, perhaps, an inconvenient truth that we are fascinated and intrigued by stories (as opposed to personal experiences) of the maladies of others, particularly those of the mental kind. From this perspective, this book provides over a dozen case files scattered throughout, which are inherently interesting. They are presented as some examples of stories which might help elucidate the authors’ thesis that psychiatry should consider the possibility that culture shapes madness, and to include this awareness in their therapy. This is to counterbalance the idea that a theory of mental illness must be a theory of genetic and brain disorders alone.

In order to understand this distinction, there are at least three aspects detailed in this book: first, the identification of a particular type of delusion which they reference to the excellent 1998 Peter Weir film The Truman Show (written by Andrew Niccol) and which they call The Truman Show Delusion; second, the need to position their theory of culture shaping madness within a traditional history of madness; and third, discussion on the concept of Suspicious Minds (which, of course, is where the title of this book comes from) as some kind of common link between these aspects.

All these aspects are, in and of themselves, valid enough to give the ordinary reader some insights into the world of madness, especially as experienced by psychiatrists, and will no doubt “enjoy” (if that is the right word) learning about the issues involved. But it tends to stop just about there… Part of the problem lies in the traditional dichotomy between the experiences of an individual and the proposed theory within which that individual experience is “assessed” — and these never quite mesh properly. It is the problem of the specific versus the general. The general seeks to combine and order many specifics, but in so doing, each individual specific tends to disappear from the equation.

The same applies here. Each of the three aspects identified here has its own general types, but they are somehow tied to a specific, personal aspect which does not quite fit the general type.

The “Truman Show Delusion” is generally understood to mean the delusional belief that every aspect of one’s life is being observed and controlled at all times by someone or something other than oneself. In other words it implies that the supposed perpetual and omnipresent observations and interference in one’s life are not real. But within the context of the film they are real. Indeed, Weir’s impeccable filmmaking, and Niccol’s subtly subversive screenplay, work to actually create a different kind of delusion for the viewer of the film. Think about it too much, and the fantasy of the film becomes a “realistic” portrayal of the conviction that such a scenario may in fact be true: everything we see, the world we live and work in, is subtly the result of unseen controlling forces beyond our control. Worse, those unseen forces are deceptive, dishonest, and essentially unavoidable. The viewer comes away “primed”, as it were, to be assessed as suffering from the Truman Show delusion…

Is this what the Gold brothers mean when they say that culture shapes madness? I don’t know. Their brief and necessarily superficial history of madness refers to various other aspects, starting with religion and other superstitious beliefs, and it is true that the latter form a pertinent part in what society determines as “madness”, especially when the madness consists of words and deeds which are considered alien to the accepted interpretations of shamans, priests and rulers. In this sense, various cultures can indeed be understood as “shaping” madness, each, presumably, in its own special way.

This conclusion, however, seems to be contradicted by the authors by their inclusion (at p. 64 of my edition) of a Chart entitled The Sleep of Reason, with its subtitle: Forms of delusion across cultures. The chart combines the results of six separate studies across the world. The Figure Sources section at the back of the book tells us that these studies were done over 26 years (1994, 1998, 2001, 2002, 2008 and 2010). In summary, one study lists 4 delusions over 9 global locations; another lists 16 delusions in 1 location; then others: 21 delusions in 3 locations; 10 delusions in 3 locations; 9 delusions in 3 locations; and 22 delusions in 3 locations. Lots of numbers are supplied for each category — the lowest is 0, the highest 83.7 — but apart from size, I am not sure what, if anything these numbers represent (they can’t be absolute numbers, as the decimal bits suggest; they are certainly not percentages (the totals in some columns add up to well over 100%); and what is left is that they are averages, but of what, exactly, is hard to say). When put together in this way, it is tempting to use the numbers comparatively across the studies; but again, just what this might mean is unclear.

The authors of the book acknowledge this problem; their explanation reads as follows: “The number of delusional forms identified differ across studies, but there is a lot of overlap. Given the variability in the styles of classification, this overlap suggests that delusions don’t change much from culture to culture. All of the lists identify persecutory delusions as the most common type of delusion, often by a substantial margin. Grandiose delusions appear everywhere, and many of the other motifs appear on a few of the lists, if not on all. Studies also confirm that the categories of delusions haven’t evolved over time.”

So by “culture” they do not mean “ethnic culture”. It must be something else. The Golds examine other aspects of culture such as Stress, Economic, Technological, Theory of Mind concepts (ToM), the Suspicious Mind concept, etc., most of which seem to me to be related to “cultures” within “cultures” more than anything else. As usual when impasses such as these arrive, one of the “solutions” used is to add to the number of categories and subcategories (a technique which risks even more obfuscation).

Ultimately, of course, there remains the question of just what we consider as “madness”. Along the way, concerns about what is “acceptable” behaviour and beliefs inevitably suggests that, for the most part, everyone we know (including ourselves) have beliefs which can be called delusional, and it is only occasionally, and in comparatively very small numbers, things go “wrong” (however we may define that) — and this is where societal “norms” come into play. For those unfortunates whose delusional beliefs result in “real” or “unreal” pain, discomfort, unhappiness, etc. which then potentially become dangerous to their own welfare, and more alarmingly, to others in society, that demand for some action be taken. It is in these areas of intense personal and social pain that we tend to turn to psychiatrists, and they have the unenviable task of trying to help those afflicted.

To assist them psychiatrists have the Diagnostic and Statistical Manual of Mental Disorders, aka DSM, which is the American Psychiatric Association’s classification and diagnostic tool. It was first compiled in 1952 (aka DSM-I) and has had various updates: (DSM-II in 1968; DSM-III in 1980; DSM-IV in 1994; DSM-IV-TR (Text Revision) in 2000; and the current DSM-V published in 2013). Of course, the tool is not considered absolute, and new discoveries and studies have changed many of those things past ages considered dangerous and which are now no longer considered disorders at all — so views of what is mad or even criminal are not, and possibly cannot ever be, hard and fast rules.

The Gold’s attempt to let “cultural” matters be included in their diagnostic bag of tricks seems obvious and sensible to me, as part of the difficult task they have in reality; their slight (?) aversion to modern gene study and analysis (such as in epigenetics) seems to be their main reason for suggesting the “cultural” preference, but this strikes me as a preference for what others might call “spiritual” factors as opposed to a “materialistic” understanding, and I am not so sure about that (especially considering the often sorry history of spiritual and superstitious approaches, particularly in religions, which ultimately rely on evil spirits to “explain” things) — or is that just my natural Suspicious Mind (that which we have biologically developed over the centuries as a survival technique, and which has served us more or less well in the past) concerned about the cultural shaping by psychiatrists, based on another cultural shaping which itself might be delusional?

[Christine · Rating 3 out of 5]

This was originally an academic paper and it shows. Some parts were very interesting and others were very tedious. It could do with an update too.

[Sophy H · Rating 2 out of 5]

This was a semi-enjoyable read for me, but like many other reviewers, I think that the book is somewhat improperly titled. The book doesn't really explore how culture shapes madness at all. It briefly touches upon the increase in surveillance and monitoring via CCTV, internet usage, mobile phones etc, and makes slight reference to reality TV but under the guise of the Truman delusions.

Basically this is Gold's chance to shine as having been one of the first to document his findings of patients with the Truman delusion, and the book is basically an exploration of just that. There isn't much in the wider scope of culture "shaping madness" or even influencing mental illness. There are heavy sections on the history of psychiatry, psychology, psychoanalysis etc and there are frequent descriptions and lists of types of delusions.

The case studies of delusional patients are presented in a rather disjointed manner, often tacked on at the end of a chapter almost as "something to read before you go". There is no real discussion of the case study relating to wider culture or society.

This book isn't great, neither is it terrible. It is pretty average and I enjoyed it to a point but it didn't really teach me anything new. Not a keeper.

[Nicole · Rating 2 out of 5]

A work intending to delve into the etiologies and history of delusions, this novel comes across more like a book for academics and would not be out of place for psychiatry residents or those studying psychology instead of as a work intended for the lay public. The authors spend a fair amount of time discussing the various types of delusions and the main premise behind the book revolves around the concept of "the Truman Show" delusion whereby a patient believes they are trapped within a reality show of sorts, with all the individuals they interact with in life are merely actors being paid to play a role, modeled after the film of the same name. There are wonderful case studies which intersperse the work, detailing their various patients throughout the years who have suffered delusions of one type or another. The remainder of the novel presents various research studies from over the years which attempts to dismantle what is known about delusions, the risk factors for their development, and how this pathological trait could have initially arose out of a survival mechanism (i.e. the 'suspicious mind' of the book's title). It is fairly dry reading but presented in a way that is a notch above the mind-numbing words which other books of this genre suffer from but I still found myself challenged to read this straight through. Intellectually it did give me food for thought as to how something as detrimental as paranoid delusions could have morphed from advantageous survival behavior to manifestations of detrimental mental health disorders. I think those who work with those afflicted with such disorders or who otherwise have an interest in clinical psychology would most benefit from reading - I was just expecting a very different work from the descriptions, hence my own low rating.

[Robert Miller · Rating 4 out of 5]

The author essentially argues that social stress is an important aspect of mental disorders and that the current trend towards using neuroscience to the point of exclusivity from the social world is misplaced. The Gold brothers (mostly Joel, it appears) set forth a number of delusions and explain how various social interactions impact or cause certain disorders. The authors sprinkle in some actual case studies to further reinforce or explain how one's interaction (or lack of) in our increasingly social (internet, Facebook, Twitter, etc), world impact our psyche. The theory is that our suspicious minds, fueled by social contacts can trigger a number of delusions especially when the cognitive part of our brain can't keep up with the automated part (simply stated). The authors zeros in on the "Truman Show Delusion" to augment some of their contentions. The book is informing and topical given our regular reliance on technology and the rapidity of our communications. A classic line from the book is "What do you tell a paranoid patient when a persecutory [concern about being harmed by others] delusion happens to be true? (Referencing the Edward Snowden matter).I recommend this book.

[Bert · Rating 5 out of 5]

This is a remarkable book, something that you don't need to be a mental health professional to read and appreciate. There is a nice succinct history of psychiatry, refreshing the reader's recollection of how we got where we are today. Then the authors do a comprehensive analysis of how delusional thinking morphs into psychosis, including a healthy and objective debate on whether everything can be explained by neurons and genetics, or whether society & environment play an important role as well. Aspirational psychiatry & psychology students would be well-advised to pay careful attention to this book, and not just because of "The Truman Show Syndrome." Even patients who don't think that their entire lives are being filmed and shown to others are the subject of delusions, which are subdivided into a dozen common categories. Lots of specific clinical examples if you like actual experiential stories, and much statistical and reference analysis if you want to look to the "why" of how patients got that way. 5 stars.

[Annika Katherine · Rating 3 out of 5]

A surprisingly accessible and well-written book providing an overview of how and why delusions take shape and discussing different theories regarding delusions and how to treat them. The personal stories interspersed are greatly timed pivots to give some relief from the academic writing, and they provide a vital human perspective on mental illnesses involving delusions. This book didn't knock my socks off, but it was a good read, and I would especially recommend it for anyone who wants a starting place learning about psychosis, schizophrenia, and delusions.

[Jeff Russo · Rating 3 out of 5]

Based on the subtitle of the book (and, if I recall, the blurbs on the dust jacket, though I always throw that away and thus don't have it handy), I was expecting a book more in line with my broad thought on the whole mental health thing (mainly, that the Mental Health Industries are largely just making shit up and unduly pathologizing every little deviation from "the norm") - something along the lines of "well, this is Madness in the West but not in Japan, so, it's not really Mad in some concrete sense" - but that's not what we have at all.

The authors are in the camp of not only all this stuff being real, and all of it having some biological basis, but that the biology is very sensitive to the environment - that all sorts of stimuli, over time, are generating the biological changes that result in "mental illness". E.g. not only is white people discriminating against non-white immigrants shabby behavior, but, it's also generating "mental illness", literally, in a biological way. Big city life, discrimination, you name it... I think even dirty looks. Someone shoots you a dirty look, boom, brain change, mental illness. But thankfully, the Mental Health Industries are there to help, they take Visa, Mastercard, and if your insurer doesn't cover it they should be browbeaten into it.

Do they present evidence for that? Sure. But, there's certainly other facets to that debate.

All of which is not really as central to the thesis of the book (which takes a good half the book to get to, the first half is largely history and tutorial, and not a horrible one at that) - but, it's just not really what I was expecting.

Certainly nothing I read has budged me from the fact that I'd never, ever, voluntarily toss myself into the arms of the Mental Health Industries - I'm sure they'd get their hands on me and hit me with Asperger's and a half-dozen other diagnoses that I collectively refer to as "my personality". In fact, I saw something mentioned in the book that I'm sure they'd slap on me if they could, that I've never heard of before - schizotypal personality disorder, "avoiding forming close relationships with people". Oh if they could get their claws on me!

[Olga · Rating 4 out of 5]

This book was fascinating. It covers a large body of theories concerning delusions and psychosis, suggesting that the emphasized neuro-biological approach to psychiatry largely ignores social factors that predispose individuals to delusional thinking. The Gold brothers suggest a very interesting theory to explain delusions - a faulty "Suspicion system": our brain's automatic, "knee-jerk" reaction to threats, and a ruptured connection between this and our "Reflective system": the more calculated approach to analyzing a threat and determining its validity. Though this theory is still just that - a theory - I am curious to see whether new research emerges in the coming years to support it. It makes sense! And, answers many questions about delusions that other theories are unable to.

I think my favorite part of this book, though, was Joel Gold's case studies. The cases of patients he has personally worked with are diverse, engaging, and wild! He portrays these real people as people, and not just patients. So often, case studies are first and foremost, portrayals of a psychiatric problem, and totally fail to paint a complete picture of an individual. So much so, that we forget about the good parts! Gold highlights the patients' strengths, interests, hobbies, loving relationships, etc. - things that make them complete humans, not just psychiatric statistics, in conjunction with their delusional symptoms. This alone made me a forever fan!

[Jake · Rating 4 out of 5]

I got a copy of this from a goodreads giveaway. The authors (brothers: a psychiatrist and a philosopher) begin by describing The Truman Show Delusion. This is where someone believes that they are the subject of a TV show and everyone else is in on it. They then outline the history of delusions, including possible evolutionary reasons that they exist. There are super-interesting case studies throughout. Wherever there are delusions, they are influenced by the culture of the deluded. The point of the book is that psychiatrists should not ignore the macro world of madness (the culture involved) while only focusing on the micro (dopamine levels, meds, etc...). The Gold Bros wrote a very interesting book that flowed like good fiction, and made me want to learn more. I wish they discussed religious delusions a bit more (there was a tiny footnote on a common delusion among pilgrims to Jerusalem), but all in all it was a really good read.

[Mark · Rating 3 out of 5]

So this book is more for one who knows a little bit about psychology that is geared towards psychosis. I pretty well versed in the arena due to personal interest and at times I had to reread a section of the book to better understand it. But I still enjoyed the book. Clunky at times, yes but the case studies in the chapters were just plain pleasant to read. I would recommend this book to those that want a look into delusion and how while there is a biological component there at the same time shows cultural and environmental factors that intertwine how delusions manifest.

Reading about the Trueman show was interesting as I have heard of both the show and this delusion. It is quite impressive what the mind can do to itself to protect itself. Delusions are apart of that and it goes from little to extreme.

[Tom Boates · Rating 3 out of 5]

I have been curious about the mentality of conspiracy theorists, and thought this book would help me better understand how average people get there, but for me it never quite got there. There was a lot of discussion about clinical schizophrenia and psychosis, with plenty of case studies that showed some signs of how "normal" people share traits with psychiatric patients, but I found the discussion of every day people's behavior lacking. Maybe this was not the author's intent in the first place, but the description made it seem like that was more of a focus than I felt it was.

[Dave Schoettinger · Rating 3 out of 5]

Drs. Gold have used fascinating examples of delusional patients to explain their position on psychoanalytical treatments of mental disorders and cast doubt as to whether such treatments are fated to be strictly tied to biological manipulation of the brain. I'll leave that dispute to the doctors themselves. I just enjoyed the insight provided on the nature of delusions and the authors' speculation on their causes.

[Rose · Rating 1 out of 5]

I was disappointed to find that it was not a study of delusions that are found only in various cultures.

[1.1 · Rating 3 out of 5]

The authors begin this book by taking the reader on a whirlwind journey through the history of ‘madness’ and delusions, from the dawn of recorded history through psychoanalysis towards modern treatment. Their argument concludes with the objection that there probably won't be a breakthrough unified theory of mind that will make clinical neuroscience end delusional thought forever and transform psychiatry into a medical field capable of curing all that which ails our minds. All of which is quite a jump from what I had expected to read.

Types of delusions are covered, as is the perennial question ‘if madness is madness, then why do all delusions follow one of 12 themes?’. It’s a question I didn’t even know existed. I thought the flavours of madness were infinite, but due to biology and society, and our own limitations, they’re almost invariably following certain patterns and professionals can quickly identify them. Oh well.

The Truman Show frames the whole book, by way of the titular delusion that people have. This I think is where the title and blurb mislead us. Instead of stating how cultural touchstones frame madness and inspire how it’s perceived and experienced, this book follows a different approach of how human culture, by virtue of existing, has framed madness since time immemorial. There's a bit of discussion of how mass media has influenced the contents of madness, but it isn't a central theme or explored too deeply. Different goals.

The authors take a moment to acknowledge that the kind of paranoid suspicions that would've made one a conspiracy theorist 20-30 years ago are now confirmed by the continued revelation of all the surveillance systems built into society and technology. It's uncomfortable, they say, but it doesn't change what delusional psychosis is or how it's caught by professionals. It just means, I guess, that being suspsicious doesn't automatically make you paranoid—this book discusses how paranoia evolved in society and how its malfunction may prompt psychotic delusions.

There’s some evo-psych stuff, analysis of conditions that may exacerbate psychosis, and in each section of the book there are stories from the authors’ patients. Plenty of food for thought, references and allusions to studies, even some pictures for those who like their text broken.

Not exactly what I had expected to read, but still very interesting. If you’ve ever had even a passing interest in the content and patterns of delusions, this book is a very worthwhile choice whether your interest is professional or merely uninformed curiosity. You’ll come away with some new knowledge and maybe an insight or two.

[Craig · Rating 2 out of 5]

I'll start by saying this wasn't a book I instantly saw and coveted. Rather, it was a book suggested on the back of others I had combed through on Amazon. Regardless, I was quite looking forward to what I'd learn only to be left with a bad taste in my mouth for a reason I can't really put a finger on.

First of all, the positives - like with other similar works, the best part of this book was the borderline clinical analysis of case studies. However, much like Oliver Sachs (whom I also directed a less than positive review towards) these studies are used more anecdotal than they are by means of empathy. The way that these people are presented, they feel more like spectacles and oddities than actual individuals. I didn't think Ian Gold is a bad writer or analyst, far from it, as another positive of the book I can gleam is how well it's written. I enjoyed the flow and pace, and even with some disrupting days surrounding me reading this I didn't struggle picking it up back and continuing from where I had left.

My main qualm is the title itself, and something I've noticed other reviewers pondering over. Yes, the book does explore madness in other cultures but not to any great depth, certainly not at the level you'd expect from the book's namesake. I don't know if it's a fault of my own expectation, but I was looking forward to some direct and not-so-direct comparisons between cultures and how our own ideas are corrupted by who we are. As it happens, this seemingly got lost somewhere along the way.

Ultimately, not a terrible book by any stretch, but it isn't something that I'll be recommending.

[Sophia · Rating 3 out of 5]

The best thing about this book was the collection of case histories. They were really interesting, as most delusions are.

While there was nothing really bad, I found the author to be only a mediocre "thinker". He provided a fairly good outline about what delusions are, and what theories have been made to try and explain them. He did a really good job in pointing out the flaws in these theories, but he did only an ok job piecing together clues from other fields to try and understand for himself what delusions might be. He fell for the same pitfalls he critisized in others, and a few more. His weakest point is his theory that all delusions have some kind of social aspect, and to prove this point he goes on to say how various social maladies are linked with higher risks of psychosis, and yet he himself points out how these social factors also impact bodily health, and therefore he cannot use it as proof of a social component. It's not that he's necessarily wrong, it's just that his proof is not good enough.
In the end, it seems like his explanation is just another "just so" story, but the questions he beings up are interesting.

[Heidi · Rating 3 out of 5]

I received this book as a part of the Goodreads Giveaway.

I was excited to read this book as it presents an fascinating premise, but it didn't quite stick the landing for me. While presenting an interesting look at how we have viewed and treated mental illness in the past, the book struggles with condensing competing theories and drawing firm conclusions into why these illnesses occur. This is highlighted by structural and pacing issues that either leave the reader searching for closure on a topic, or trying to find an exit from a train of thought that has gone on for much too long. Some substantial editing could really make this into a much stronger book.

Despite these shortcomings, I found the book informative and accessible for the average reader. I enjoyed the case studies presented, and the insight into how the mental illnesses described have affected real patients. If nothing else, perhaps stories like these will breed more empathy and understanding toward those who find themselves suffering from these types of mental illness.

[Paula · Rating 5 out of 5]

This is a wonderful book. I am impressed with the good Doctors' knowledge, experience and humanity in discussing and explaining delusions and schizophrenia, a very difficult mental disorder to treat. I'm getting the book to read in print because it's worth reading again, in print, because it is so good.

The book also does a great service in enlightening ordinary, everyday people about the tragedy of mental illness and how pervasive it can be. Mental illness affects many, whether the patient is a co-worker, relative or close friend. This is demonstrated in the book by the numerous case studies found throughout the book. They are enlightening and really show the human, caring side of the doctors. This is a very kind and educational book.

I would recommend it to anyone wanting to know more about delusions and schizophrenia, since it is very approachable and easy to read.

[Natalie · Rating 3 out of 5]

This book is a mix of theories in psychology and patient vignettes. The theories get a little confusing. According to the authors, we don't have a definitive way to treat psychosis and delusional thinking. While it gives a clear definition of delusions and schizophrenia, it hypothesizes ways the conditions arise, what worsens them, and how to treat them. By the end of the book, I felt unsure about a conclusion to what I read. The only thing I'm sure of, is that a good therapist and medication are helpful. The vignettes, while interesting, seemed similar to each other: person has delusions, they get worse, they live, mostly unhappily with their condition. While somewhat interesting, this isn't a clear book on mental illness.

[Emily · Rating 3 out of 5]

This is a strange book in that the authors have a particular thesis they are trying to prove - it reads like an academic paper which they tweaked to be able to sell to the general public. Still, it is fascinating, if a little repetitive. Their thesis is that delusions are a result of a problem in the part of the mind which allows us to live in society and are just "mistakes" in otherwise useful adaptations. I found the descriptions of actual patients' particular delusions the most compelling part of the book although there are other sections which were fascinating if you are a brain enthusiast. I think the book needed a better editor, but it was still worth reading.

[Brown Robin · Rating 2 out of 5]

Another psychology book I could not finish. Maybe I expect too much, or the wrong book, or the writers are just too snooty for my tastebuds, but I am almost invariably disappointed with pop-psy, or at least clinical psy books. This one has some interesting things to say, so I do recommend it if you want case studies of self-afflicted people shared publicly, but the larger themes are not in the text, at least not the first half. Maybe Gold wrote a stem-winder, and he gets to the gist before he's through.

I didn't stand and wait to find out.

[Uwe Hook · Rating 4 out of 5]

Incredible insight into how modern culture influences mental health and paranoid delusions. Must read for amateurs and academics alike. The writing style is very accessible and the case histories are fascinating. It also doesn't take itself too seriously. If you're a fan of Oliver Sacks you'll definitely find this book interesting as well, and in many ways more satisfying as it digs deeper and reveals brand new insights into how the outer world can influence psychosis.

[Dmitry · Rating 2 out of 5]

(The English review is placed beneath Russian one)

Название книги не соответствует содержанию. Как правильно заметили два англоязычных комментатора, книга, во-первых, совсем не о том, как общество ведёт отдельных индивидуумов к сумасшествию, как она медленно придаёт форму безумия. Во-вторых, книга довольно тяжёлая в плане чтения и скорее стоит ближе к специализированной литературе по медицине, нежели к более доступной для публике литературе, типа того же Фрейда. Хотя, мутность книги я объясняю скорее не желанием отдифиринцировать её от популярной литературы по психологии, а скорее отсутствием у авторов стоящих идей.
Начнём с того, что авторы практически всю книгу посвящают вопросу Шизофрении и начинают свою книгу с описания того, как Шизофрению «лечили» в 18-19 веках. Честно сказать, скучно и не интересно. Возможно, это обязательная формальная часть, без которой такая книга просто не может обойтись. Тем не менее, читать было скучно. Мне как-то совсем не интересует, как в 18-19 вв. обращались с пациентами. Тем не менее, интерес был полностью убит самой сухостью материала. Как я сказал, авторы старались соблюдать академический слог, из-за чего книга получилось довольно пресной, т.е. скучной.
Далее можно определить книгу, как набор историй. Этот блок был интересен и именно на него я рассчитывал больше всего (и именно это спасло книгу от 1 балла). Да, медицинские кейсы представлены интересно, хоть и недостаточно подробно. В книге «The Incurable Romantic and Other Tales of Madness and Desire» примеры приведены не только интересные, но и написаны они максимально подробно, я бы даже сказал, захватывающе. Тут же, могло быть и лучше.
И последний блок связан с углублением в специализированные направления, такие как нейропсихология и пр. Тут-то я, что называется, поплыл, ибо, когда заходила роль о процессах, происходящих в мозге, я практически ничего не понимал, а то, что понимал, находил абсолютно для себя не интересным.
В конечном итоге мы имеем скорее специализированную книгу по Шизофрении (включая историю вопроса), т.е. книга для тех, кто «в теме». Плюс, книга с абсолютно ложным названием, которое привлекает людей, которые изначально ждут от книги совсем другого и с набором историй людей, которые страдали от того, что считали, что за ними либо следят секретные службы, либо – и чаще всего – считающие, что они либо мертвы, либо участники реалити-шоу находящиеся в каждую секунду под непрестанным наблюдением публики. Повторю, что единственное, что понравилось в книге, это эти самые истории.
Ах да, совсем забыл сказать, что ближе к концу авторы пишут, кто большее всего расположен к шизофрении (иммигранты, сильное социальное расслоение).

The title of the book does not correspond to the content. As two English-speaking commentators have rightly pointed out, the book is not at all about how society leads individuals to madness, how it slowly makes them mad. Second, the book is quite heavy in terms of reading and is closer to specialized medical literature than to more publicly obtainable literature such as Freud's. However, I do not explain the vagueness of the book by the desire to differentiate it from popular psychology literature, but rather by the lack of worthwhile ideas among the authors.
To begin with, the authors devote almost the entire book to the issue of Schizophrenia and begin their book by describing how Schizophrenia was "treated" in the 18th and 19th centuries. To be honest, it's boring and not interesting. Perhaps this is the formal part that such a book simply cannot do without. Nevertheless, reading was boring. I'm not interested at all in how patients were treated in the 18th and 19th centuries. Nevertheless, the interest was completely destroyed by the very dryness of the material. As I said, the authors tried to keep the academic syllable, which made the book quite dull.
Next you can define the book as a set of stories. This block was interesting and was the one I was counting on the most (and that's what saved the book from 1 point). Yes, medical cases are presented in an interesting way, although not in sufficient detail. In the book "The Incurable Romantic and Other Tales of Madness and Desire" examples are not only interesting, but they are written in as much detail as possible, I would even say, exciting.
And the last block is related to the deepening into specialized areas, such as neuropsychology, etc. Here I floated, because when the authors described the processes taking place in the brain, I understood almost nothing, and what I understood was absolutely not interesting for me.
In the end, we have rather a specialized book on Schizophrenia (including the history of the issue), i.e. a book for those who are "in the subject" (i.e. who have been interested in this topic for a long time). Plus, a book with an absolutely false title that attracts people who initially expect a completely different subject. It is also a book with a set of stories of people who thought they were either being watched by secret services, or - and most often - believed that they were either dead, or participants in reality shows who were under constant public scrutiny every second. Again, the only thing I like about the book is these very stories.
Oh, yes, I forgot to say that at the end of the book the authors write who is most inclined to schizophrenia (immigrants, strong social stratification).

[Ashley · Rating 3 out of 5]

The title of this book is slightly misleading. Overall, it's more a history of madness and, specifically, delusions. The authors do talk about how culture can affect madness, but they really don't delve very deep and mostly focus on what delusions are and the various ways they've been treated and categorized over the years.It was still interesting. Just not quite what I thought it would be.

[Ryan Johnson · Rating 2 out of 5]

Hippocrates is supposed to have said that it is much more important to know what sort of a patient has a disease than what sort of a disease a patient has......

Coming back to this back after a year away from it, I must say that while I liked the case vignettes, the continual referencing of studies and some of the deeper stuff, bored me and I struggled to truly read the book...

[Michelle · Rating 4 out of 5]

Having encountered a friend with a similar story to those therein, this book provided a thought provoking frame for what may be happening in his/her reality. Plenty of patient cases and anecdotal evidence. I enjoyed listening to the author read on CD.