suspicious Minds – how Culture Shapes Madness
by Joel Gold and Ian Gold
Free Press, Toronto, 2014
PART I – the Sleep of Reason
1 a short history of madness
2 one hundred years of delusion
PART II – The Social Life of Madness
3 the Madding Crowd
…the health of a population isn’t correlated with the average income in that group but with the size of the gap between richest and poorest. The bigger the gap, the worse the overall health of the population. …longevity doesn’t depend on absolute wealth. more egalitarian countries, all things equal, are going to be healthier than those with large social inequalities.
[Robert] Sapolsky’s research shows that the stress of being subordinate has devastating effects on the brain and, in turn, on the body: low social rank leads to heart disease, reproductive problems, and suppression of the immune system.
Marmot argues that low status in humans produces similar stress. Low social position is accompanied by the severe stress of restricted autonomy. … Human social life more broadly shows…the lower one’s social position, the fewer options one has in many areas of life, and, over time, this constraint is poisonous.
We have a long way to go before we understand the percise biological mechanism through which stress works its way intot he brain in psychosis. The new field of “epigenetics,” however, may prove important in the effort. Epigenetics investigates the ways in which molecules associated with DNA can turn gene expression on and off, including in the brain. There is now evidence that epigenetic changes can occur as a result of experience, so epigenetic processes may constitute a family of mechanisms through which the social world alters brain function.
4 Hell Is Other People
We are all too familiar with the direct methods of exploiting others: take compromising pictures and squeeze them for money; hold their passports and make them work for nothing; hit them with a brick and take their wallet’ kill them and steal their wives. Gaining advantage at others expense in these direct ways can be effective but is risky. Overt exploitation invites violence from the exploited, or their community, whenever the tables are turned or the exploitation becomes widely known. If you can exploit someone covertly, therefore, without it becoming known to others, or even to them, you may get the advantages of exploitation without incurring the risks…. Human existence is nicomparably less bloody and dangerous today than it has been for much of our history. … Exploitation can thrive, however, even as violence declines. For this reason, deception is at the heart of covert exploitation and makes full use of [Theory of Mind (ToM)] no less than cooperation does. If ToM greases the social wheels, it also provides the wolves among us with a behavioral strategy that (with a scattering of exceptions) no other animals have. The vast majority of exploitation in nature is overt. With a brain evolved for complex social life, clandestine exploitation comes into existence.
What sort of cognitive system is required to enable one to be sensitive to social threats? We face all sorts of dangers and obstacles to well-being every day: sleeping in and missing a job interview; writing bad checks; slipping on an icy patch of sidewalk. Most of these threats are either sufficiently minor, or sufficiently predictable, that we can learn, or be taught, to avoid them. Parents look after infants, but nature helps, too. Babies are born with a suite of reflexes because the cost of learning some behaviors through trial and error is too high.
Let’s take predation (that is, a strategic physical attack by an animal or human) as the paradigmatic threat. If you come face-to-face with a chainsaw-wielding man wearing a hockey mask, the signs of danger are unambiguous. But if youa re walking through a dark forest–or a bad neighborhood late at night–you have to be sensitive to signs of danger that are deeply ambiguous. A slight rustle behind you is most likely dry leaves pushed around by the wind–but could also be the careful steps of someone preparing to spring on you. A successful cognitive system for threat detection must be able to draw your attention automaticallyl, motivate you to start thinking hard (if unconsciously) about what the sound might mean, and move you to act if action seems warranted. In addition, the motivation that is produced by a threat system like this should suppress competing impulses temporarily, until the threat has passed. Responding to a sound that might signify danger requires full attention even if it turns out to be a flase alarm. Being vigilant in this way means that you will have to act on the basis of uncertain information; but when it comes to wolves in forests or assilants in alleys, it’s better to err on the side of cuation. What we call “fear” is one such cognitive system: an automatic, unpleasant, highly effective mechanism that commandeers our full attention for the purpose of self-preservation.
the Suspicion System is, we hypotehsize, 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 detectino and defense. For the reasons we’ve just rehearsed, at least some parts of this system are likely to be innate in human beings–present at birth or arising through normal development. The system produces “suspicion”–the term we’ll use to refer to a family of psychological states, both conscious and unconscious, that arise in response to evidence that someone may intend you harm. By creating suspicion directed at other people the Suspicion System makes social life safer because people who make you suspicious are by deinition unsuitable for cooperative endeavors.
The Suspicion System is likely to be very sensitive and will err on the side of signaling danger rather than cuatiously waiting for solid evidence. As in the case of detecting the danger of predation, it is better to generate fals alarms than to risk missing a real threat. The Suspicion System is also likely to target other people’s intentions to harm you.
Todorov’s studies show that people make judgments of trustworthiness remarkably quickly. This suggests that the Suspicion System is a special-purpose mechanism. What does “special purpose” mean? There are many domains of cognition in which it appears that human beings have two distinct systems for handling a single cognitive task. One type of system (often given the generic name “System 1”) operates quickly, effortlessly, automatically, and unconsciously; these are the special-purpose mechanisms in our sense. In contrast, a parallel system (“System 2”) is slow, requires attention and mental effort, and has to be consciously engaged in problem-solving.
|System 1||System 2|
|Low effort||High effort|
|High capacity||Low capacity|
|Holistic, perceptual||Analytic, reflective|
|Evolutionarily old||Evolutionarily recent|
|Evolutionary rationality||Individual rationality|
|Shared with animals||Uniquely human|
|Nonverbal||Linked to language|
|Modular cognition||Fluid intelligence|
|Domain specific||Domain general|
|Independent of general intelligence||Linked to general intelligence|
|Independent of working memory||Limited by working memory capacity|
A comparison of some characteristic features of System 1 and System 2
5 Belief Unhinged
…what large cities have in common with childhood abuse, and the experience of being an immigrant, is fear. Weve argued that the price of social life is eternal vigilance, watchfulnessa gainst potential dangers; but being vigilant is inherently stressful. We suspect that the social determinants of psychosis bring about an internal state of heigtened vigilance, and this, rather than social defeat, is what enhances vulnerability to psychosis. Being victimized or subordianted produces a fear of future repetitions, and although large cities are not necessarily more dangerous than small ones, they may feel that way. When people feel this way about the environment they live in, they become more vigilant. … People living in cities felt more threatened than those living in rural areas, and the greater the sense of threat, the greater the severity of tehir delusions or hallucinations. Neighborhoods that are more ethnically homogenous and more socially cohesive may protect people against schizophrenia precisely because they feel safe.
…Recall…[the] idea that as the geographic area one lives in gets larger, the risk of free-riding goes up. This is because larger territories increase the possibility of encountering strangers whose dispositions are unknown. The size of cities may be significant because cities are filled with strangers, and the Suspicion System focuses on their possible malign intentions rather than on absolute levels of danger. Suppose that the cognitive limit of human social gropu size is around 150. There is soem evidence that group size is contrained in part by the limits of ToM, so let’s suppose that ToM can deal with the optimal group size of 150 but no more. Someone who lives in a small town, therefore, has a capacity to keep track in an ongoing way of the mental states of everyone around. in a town of 1,500, however, one can keep track of the mental states of only 10 percent of the locals, and in a city of 1.5 million, only .01 percent. If the Suspicion System is affected by how many potentially dnageroous others it can’t track, ti might indeed be more stressed by a bigger number. The larger the number of unknown others, the greatehr the vigilance required and the greater the stress.
The social determinants of psychosis, therefore, may be stressors that increase our need for vigilance and in the long run “overload” the Suspicion System. childhood abuse and immigrant adversity render malign intentions more tangible, and urban living multiplies them. As the amperage being sent through the Suspicion System increases, it overheats; and when social life puts too much current across these already heated circuits, delusions are kindled.
There is a second theme that runs through the delusion. In the film, Truman is seen by billions around the world by means of mass media; the “Truman Show” of the film is, after all, a television show. The sociologist Thomas Mathiesen has argued that Foucault’s panopticism is only half the story of contemporary culture. At the very moment when the modern prison was being born, the mass media were also coming into existence, starting with mass-circulation newspapers and followed by film, radio, television, and the internet. The birth of the prison marks the beginning of panopticism, in which one person surveys many; the mass media, in contrast, initiate what Mathiesen calls “synopticism,” in which the many observe the few. Surveillance technology combined with mass media thus express the fear not only of being watched, but of being watched by an indefinitely large number of unknown others.
Writing about James Tilly Matthews, the historian of medicine Roy Porters says that “[e]very age gets the lunatics it deserves.” It is not suprising that in the current culture of reality television, celebrity as power, and overnight fame, amny Truman Show patients speak of the “entertainment” they are providing to their viewers. Still the element of performance built into the delusion doesn’t change the fact that it is a delusion of control.
the afflicted may believe their lives have sky-high Nielsen ratings, but the watching goes on without their consent.
6 Beyond Belief
The proven effectiveness of [Cognitive Behavioural Therapy (CBT)], especially in concert with medication, shows that people who hear voices and have delusions can get better by talking to another person. CBT research has also shown tha tpatients’ thoughts about their illness play a role in recovery. The conclusion seems undeniably: if other people can damage your brain, they can also minister to it.