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Suspicious Minds:

How Culture Shapes Madness

Joel and Ian Gold

Mental illness is just a frayed version of mental health. It doesn't take much to become mad.

Medieval treatment mainly bloodletting or purgatives. But if they failed try diet, exercise, travel, music or marriage.

Parents of adopted children: If the kid does something to be proud of, they say "See, that's the effect of a good environment." If they do bad, it's "See, that's the effect of genes."

The success of drugs to calm the psychotic proved beyond doubt that schizophrenia is a biological disorder.

But contrast with other medical areas: Diabetes results from a biological disorder of the pancreas; it is diagnosed by testing, and treated with insulin to correct it. But psychiatric disorders aren't like that - there are no biological markers that can confirm a diagnosis of schizophrenia. The clinician has to depend on symptoms reported by the patient.

Our uncertainty about the underlying biology is one of reasons why mental illness is such a controversial area.

Humans hold a lot of beliefs that qualify as nonsense. If you believe that you personally have been abducted and probed by aliens, you will certainly get a psychiatric diagnosis that you are having sdelusions. But if you merely believe that that happens to other people, that's not enough to be classed as delusional.

Delusions defined (by the DSM-5) as "fixed beliefs that are not amenable to change in the light of conflicting evidence", in tl/dr version "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."

Two hundred years ago, James Tilly Matthews, the subject of the first detailed case study of schizophrenia, had beliefs about fluid locking, kiting, thought making, voice saying, foot curving, knee nailing and eye screwing. He believed that all this mischief was caused by an invisible machine he called an Air Loom. None of which features in modern schizophrenia stories.

In other words, delusions are shaped by the culture of the sufferer. Today people believe its microchips or computers, not the Air Loom, that is responsible.

Why do people hold onto delusional thoughts so tenaciously despite them being so extremely implausible? One suggestion is that they are the result of the brain trying to make sense of abnormal experiences. Example of Capgras delusion where recognize a friend or relative but don't get expected emotional recognition as well.

But that only applies to some. In many others, the thought processes themselves are chaotic. Suggestion that something has disrupted the mental circuits that check the validity of beliefs, and so the person accepts the first explanation he thinks of, no matter how outlandish.

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