Psychotic delusions change with the times and a new study looking back over almost 120 years of hospital records has found that it’s possible to track how cultural upheavals are reflected in the themes of madness. Changes in politics, technology and psychiatry all seem to colour the preoccupations of the deluded as reported in the patient records.
A Slovenian research team, led by psychiatrist Borut Skodlar, discovered that the Ljubljana psychiatric hospital had patient records going as far back as 1881. They randomly selected 10 records from every 10 year period to see how delusions matched up to the society of the time.
One key finding was that paranoid and persecutory delusions seem much more common now, with a big jump after the 1960s, in line with other studies that have found that paranoia is much more common in the modern age.
Another interesting finding concerned the widespread availability of radio and television:
A very interesting finding was a significant increase in outside influence and control delusions with technical themes following the spread of radio and television in Slovenia. To the best of our knowledge, no such studies exist with which to compare our results.
Both of these new technical devices, which served as a means to powerfully and quickly disseminate information, apparently became appropriate for ‘serving’ as a means of influence and control in the eyes of schizophrenia patients.
We found this change much more expressed in the case of television, where the increase of delusions of outside influence and control was dramatic. Perhaps an accumulation of both television together stimulated the increase. Or perhaps the two-dimensional auditory and visual nature of television opened up more opportunities to perceive it as a possible source of influence.
One aspect of the study looked not at how wider cultural changes altered the theme of delusions, but how changes in the culture of psychiatry did the same.
Psychiatrist Kurt Schneider listed a number of symptoms which he argued were characteristic of schizophrenia and still form the basis of modern schizophrenia diagnoses.
They include audible thoughts, hearing voices arguing, voices commenting on your actions, feeling that your body, mind or emotions are being controlled by outside forces, thought insertion and withdrawal, thought broadcasting, or delusional interpretations of everyday perceptions.
Interestingly, these ‘first rank symptoms’ were reported much more commonly after they had become widely known in the psychiatric community.
This is one of the key issues in the epidemiology of psychiatry: when the rate of reported symptoms changes over time, is it because they’re just being noticed more, because psychiatrists have moved the goalposts, because patients are learning to report symptoms in the language that doctors use, or that the experiences are more common in the population with all things being equal.
Of course, it can be a mixture of all or some of the above, as culture is one of the key influences on how we experience and express our distress – both physical and psychological.