Reviewed by Sophia Chiu

Suspicious Minds: How Culture Shapes Madness is an ambitious and fascinating work on the nature of delusions, states of mind defined by DSM-5 (the latest version of the Diagnostic and Statistical Manual, the standard reference for classifying mental disorders) as “fixed beliefs that are not amenable to change in the light of conflicting evidence.” Brothers Joel and Ian Gold, a psychiatrist and a psychologist, respectively, introduce this topic through an interesting series of patients suffering from the Truman Show delusion. Like Jim Carrey’s character in the 1998 film, these patients believe they are the stars of a constructed reality television show and that everyone around them are actors perpetuating this hoax.

However, Gold and Gold go on to discuss other types of delusions as well as the theoretical histories of how delusions arise. Delusions tend to take a circumscribed set of forms throughout various cultures, although the exact details might differ. For example, during the early 90s one patient with the Truman Show delusion believed he was producing a “world party” starring Michael Jackson and Madonna; he also stated his belief that he was in touch with their agents. Today this patient claims he would have picked Lady Gaga and Bono as his chosen celebrities. Further along in the book the Gold brothers present a new theory of delusion that better explains how delusions arise and how individuals hold on to them despite their extreme implausibility. The authors argue that delusions are a result of dysfunction in the “Suspicion System” of our brain, a quick-acting system designed to detect threats in our social environment. Delusions persist because this system does not receive information from other cognitive processes that “know” the belief is implausible.

I found Suspicious Minds to be an enjoyable and thought-provoking read. The authors give good analogies to expound their ideas, but I think some background in psychology, psychiatry, or neuroscience is necessary to understand the scientific studies they describe. However, short vignettes about Joel’s patients are interspersed throughout, providing a more humanistic dimension. Indeed, one of the broader themes of this book is the doctors’ vision of the psychiatry of the future as encompassing more than just clinical neuroscience. Instead of mental illnesses being reduced to brain dysfunction, the direction of current research efforts, they argue that psychiatry would be richer for considering the social and cultural aspects of mental illness. In other words, they hope to see the future of psychiatry include ideas of how culture shapes madness—an inspiring, humanistic idea.

Rating: ★★★★☆ 

Review copy was provided free of any obligation by Free Press. No monetary or any other form of compensation was received.