The “Truman Show” delusion

English: Maybe visual delusions exist to remin...

This is the abstract of a recent journal article by psychiatrist brothers Joel Gold (NYU) and Ian Gold (McGill).

Introduction. We report a novel delusion, primarily persecutory in form, in which the patient believes that he is being filmed, and that the films are being broadcast for the entertainment of others.

Methods. We describe a series of patients who presented with a delusional system according to which they were the subjects of something akin to a reality television show that was broadcasting their daily life for the entertainment of others. We then address three questions, the first concerning how to characterise the delusion, the second concerning the role of culture in delusion, and the third concerning the implications of cultural studies of delusion for the cognitive theory of delusion.

Results. Delusions are both variable and stable: Particular delusional ideas are sensitive to culture, but the broad categories of delusion are stable both across time and culture. This stability has implications for the form a cognitive theory of delusion can take.

Conclusions. Cultural studies of delusion have important contributions to make to the cognitive theory of delusion.” (Cognitive Neuropsychiatry).

However, as a psychiatrist specializing in the treatment of delusional conditions, I just don’t buy it. There is nothing so unique or novel about this delusion. I wrote about it here three years ago. As a matter of fact, there was an episode of the television show The Twilight Zone, oh probably in the ’50’s, depicting similar themes. Then there’s the related trope of The Adjustment Bureau, in which life is orchestrated behind the scenes for obscure purposes. Being controlled or manipulated, being observed or monitored — these have always been the essence of paranoid delusions. All that changes is the technology the affected individual fears, according to what they know: the written or printed word, radio surveillance, implanted bugs, computer chips, television cameras, spy satellites. As sophisticated as one is about technology, that is how sophisticated and modern one’s delusions will be.

It is also worth noting that, to a careful and discerning clinician, some patients’ presentations of the ‘Truman Show’ sensation about reality may not really represent a delusion, in other words the patient may not warrant a psychotic diagnosis. It may arise from the terribly disquieting and often unrecognized, thus underdiagnosed, condition called derealization, in which a person feels distanced from their experience, as if they are watching a movie or a cartoon of the world instead of being engaged in life. This is a dissociative, rather than a psychotic, condition. For those who are interested in learning more, here is a Wikipedia article on the phenomenon, and another one on the related condition of depersonalization, which may be the flip side of the same coin phenomenologically.