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Friday, September 27, 2013

The ‘Truman Show’ Delusion: When Patients Think They’re On TV

Psychiatrists are reporting more cases of the "Truman Show" Delusion or T.S.D., after the movie in which Jim Carrey plays a man who unknowingly stars in a reality TV show. (Paramount Pictures)

Psychiatrists are reporting more cases of the “Truman Show” Delusion or T.S.D., after the movie in which Jim Carrey plays a man who unknowingly stars in a reality TV show. (Paramount Pictures)

Delusions, paranoia and hearing voices have long been signs of mental illness. But psychiatrists are reporting a new variation.

While patients in years past may have feared the CIA, some patients now believe they’re being watched and tracked, reality show-style.

It’s being called the “Truman Show” delusion or T.S.D., after the movie in which Jim Carrey plays a man who unknowingly stars in a reality TV show.

With surveillance cameras blanketing some cities and people clamoring to have their lives broadcast on reality shows, psychiatrists are seeing more and more people — young people in particular — who believe they are starring in a show of their own.

Here & Now speaks with Dr. Joel Gold, the psychiatrist who coined the phrase “Truman Show delusion,” and to Nick Lotz, a patient who was featured in the New Yorker article “Unreality Star.”

Interview Highlights

What the “Truman Show” delusion feels like

Nick Lotz: “It’s this belief that everything in your life is scripted out, and that it’s all been organized ahead of time. And it’s all-encompassing in the sense that everything in your life around you is part of the television show.”

“I never believed that no one believed me. I believed that they knew what was going on and they just weren’t telling me what was going on … because that was all part of the television show.”

Dr. Joel Gold: “I did start seeing these guys about ten years ago, and essentially they all described very similar themes to what Nick just described: feeling as though their family perhaps were reading from a script, there were cameras everywhere at all time, they had no privacy. And this was obviously — for most — very, very disturbing. For a small minority there was an excitement about it, that they were the most famous person on Earth. But eventually, even for those people, it became unbearable.”

How cultural context affects the content of delusions

Gold: “We think there are about a dozen kinds of delusions: persecutory, grandiose, guilt, nihilistic, one might think that they are dead. Those are fixed over time, but the details get filled in. So as an example, in the nineteenth century there were far more religious delusions, when society was more religious than it is today.”

“The ‘Truman Show’ delusion is not a new illness. We think it is a new kind of persecutory, grandiose, referential, controlled delusion. In this ‘Truman Show’ delusion we see things that could not have been observed 20 and 30 years ago because the technology just wasn’t there. Now we have closed-circuit televisions, we have reality television, YouTube. We have revelations that the NSA is listening … to all of our phone calls, reading our emails. And what impact does that have on the brain and mind of someone who is at risk for delusion?

How the content of delusions could affect treatment

Gold: “Psychiatrists today tend to overlook the content of delusion and just say again: ‘Whether you think you’re Jesus or whether you think your neighbor is trying to poison you, I don’t really care. Just take this anti-psychotic medication and come back to see me in a month, and we’ll see if you’re doing better.’”

“The simple fact that the delusional content is important to our patients, like Nick, should be reason enough for us to take that content seriously. If we take what they take seriously, aside from learning about their minds, we develop a link with them that helps us in treating them.”

Lotz: “For the initial treatment of it, I think psychiatry is absolutely essential, to get on the medication and to sort of quell the voices, and that’s the only thing that helped stop the voices for me. Psychology just simply wouldn’t work, given the fact that you think that any interaction with the doctor is scripted out.”

“In the time since I’ve gotten on medication, psychology has done wonders in helping me to deal with my delusions and deal with my paranoid thoughts and manage my overall anxiety.”

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