SUSPICIOUS MINDS

Brothers Joel Gold (Psychiatry/NYU School of Medicine) and Ian Gold (Philosophy and Psychiatry/McGill Univ.) suggest that to treat delusions simply as manifestations of psychosis, without regard to their cognitive function, is insufficient.

The authors examine the possibility that delusions are symptomatic of a malfunctioning cognitive system whose positive evolutionary function has been protection against social threats. This leads them to conclude that it is necessary to view delusions as a malfunctioning response to “social environment on its own terms and not as an illusion waiting to be reduced to biology.” Their content can be traced to a need to deal with environmental stresses and are, in part, a reflection of the culture. Turning to the field of evolutionary psychology, the Golds suggest the existence of a hypothesized brain system, the “Suspicion System,” whose purpose is to protect the individual from threats; this would have served a useful purpose in alerting our ancestors to danger. It is when these threats are misperceived without corrective cognitive input that delusion follows. Joel Gold cites case histories from his practice as an attending psychiatrist at Bellevue Hospital Center; the cases show how such malfunctioning might occur when “[d]elusional thoughts and their linguistic expression are…cognitively isolated and not integrated with other thinking.” These delusions may be due to neurological malfunction, but biological theories of mental illness need not exclude their social component. “In taking account of the role of the social world in mental illness,” write the authors, “it may be necessary to hang on to notions like threat, discrimination, exploitation and status, and there may be no way to understand these concepts other than by theories far removed from neurons….Reductionism in psychiatry constrains theory to operate within the skull or the skin. Our bet is that the outside world is going to matter as well.”

A provocative new perspective on the diagnosis, and therefore treatment, of mental illness.