IEEE Technology and Society Magazine - June 2015 - 19

there is a major psychiatric facility, claiming to be at the center of
a reality TV show, just like The Truman Show. They were the stars,
which meant that everything around
them was artificial, and the people
in their lives were actors. Joel Gold,
a professor of psychiatry at New
York University, attended some of
these patients at Bellevue and was
intrigued by their strange delusion.
He was familiar with delusions
caused by mental illness. Some
individuals believe they are Jesus
Christ. Some believe that someone
is manipulating their behavior by
inserting thoughts into their minds.
The emergence of Truman Show
delusions was one of a number of
factors that led Joel Gold and his
brother Ian Gold, a professor of philosophy and psychiatry at McGill
University, to begin rethinking their
ideas about mental illness, especially about schizophrenia, in which
delusions are common. In their
book Suspicious Minds, they lay
out a hypothesis about the origin
of delusions, along the way offering
an alternative to today's dominant
approach to psychosis, namely that
it is neurological [3].

them into 12 categories. Examples
is the slow, careful, rational part
are delusional jealousy, in which a
of the mind [4]. An autonomous
cheating partner is seen as threatsuspicion system would be an aid
ening, and grandiosity, in which a
for survival: without conscious properson believes they are Napoleon,
cessing, it would constantly be on
have the key to cancer, or can fly.
the alert for subtle signs of danHowever, by far the most common
ger. The sound of a leaf crunchdelusion is of being persecuted.
ing might indicate a predator, and
At this point, I reflected on my
people would be safer responding
contacts with whistleblowers and
to lots of false positives - taking
dissidents. Unlike those with deluaction, although there is really no
sions of inescapable surveillance,
danger - than being complacent
dissidents tell much more plauwhen actually there is danger.
sible stories, and in many cases
Gold and Gold say delusions
there is good evidence to back up
can be understood as products of a
their claims. One academic dissident named John,
whose case I investigated
in some detail, told me a
One caller said he had
revealing anecdote. One
of his supporters had sat
written an unpublished
in on a discussion by colpolitical novel - and therefore
leagues. They said "John
is paranoid" and then prothe government was monitoring
ceeded to plot how to get
rid of him. Although much
his calls and following his
delusion is paranoid, not
every movement.
all paranoia is delusional.
Gold and Gold comment that, in principle,
there could be an infinite
number of types of delusions. For
disordered suspicion system. Their
example, a person could believe
hypothesis has an attractive feathey are a tree or a clock or a galture: it explains why people with
axy. But delusions in practice fall
delusions can't see how irrational
into just 12 categories, and every
they are. Systems 1 and 2 do not
one of them involves people. This
communicate directly, so there is
is obvious in the case of delusions
no way the rational mind can interof persecution. Gold and Gold comvene and switch off the delusion,
ment, "Paranoia is nothing more
which continues to seem completethan an overly sensitive form of susly real. Eventually system 2, the
picion that cannot shut itself down"
rational part of the mind, offers a
[3, p. 192].
seemingly plausible explanation for
To make sense of the observed
the delusion.
types of delusions and research
In large, complex societies, the
on patterns of psychosis, Gold and
primary dangers are from other
Gold postulate the existence of a
people. The larger the population,
suspicion system. This, they prothe greater the risk of a disordered
pose, is one of several modules in
suspicion system and the higher the
the part of the mind that is fast,
rate of psychosis. Gold and Gold's
intuitive, and automatic, sometimes
idea allows a prediction that psycalled system 1, whereas system 2
chosis will become more prevalent

Psychiatry and Delusions
To accomplish this ambitious agenda, Gold and Gold review the history of psychiatry. They then examine
some recent research about psychosis, in particular how it varies according to the surrounding environment.
One striking finding is that when population centers are larger, psychosis
occurs at higher rates: it is lowest in
rural regions and small towns, higher
in medium-sized cities, and highest
in large cities. Other factors increasing the risk of psychosis are being
abused as a child, having parents
who separated, being an immigrant,
and being discriminated against.
Gold and Gold then examine various types of delusions. They classify
june 2015

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IEEE Technology and Society Magazine

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