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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.”

Guest

Transcript

ROBIN YOUNG, HOST:

We've been hearing more about what might have been on the mind of the Navy Yard shooter, including voices. Before his rampage, Aaron Alexis told many people he was hearing them. Now, hearing voices has long been a sign of mental illness, but more recently delusions have taken a form beyond hearing voices to believing that those voices are part of a reality show.

In fact it's being called "The Truman Show" delusion, or TSD, after the movie in which Jim Carey plays a man whose every move is broadcast around the world, his life a TV show, before reality shows were even created. And now with surveillance cameras blanketing some cities and people clamoring to have their lives broadcast, psychiatrists are seeing more and more young people in particular who believe they're starring in a show of their own.

In a moment we're going to speak with Dr. Joel Gold, a psychologist and professor at New York University who coined the phrase "The Truman Show" delusion. But first someone who experienced it. Nick Lotz joins us by Skype from California, where he lives and is in remission. Nick, welcome.

NICK LOTZ: Hi, how's it going?

YOUNG: Well, it's going fine for me. How about for you? How does it work? Do you still have it?

LOTZ: You know, so in periods of high anxiety, I'll still experience delusions now and then. But primarily it's pretty much passed at this point. I'm on medication. I do therapy. And so I'm pretty stabilized at this point.

YOUNG: Well, tell us what it was like. This was primarily in college. Can you describe for us what you thought was happening, how you felt?

LOTZ: Well, it's sort of all-encompassing. Like you feel like you're on a reality TV show. And it's this belief, this general belief that everything in your life is scripted out and that it's all been, you know, organized ahead of time and that it's sort of all-encompassing in the sense that everything in your life around you is part of the television show.

YOUNG: You'll be sitting in a classroom, you get called on, you think it's all part of the scheme?

LOTZ: Exactly. Like things such as just walking down the street, if someone were to point at a bird or something and be like, oh, look at that silly bird, you'd think that they were saying like, oh, look, it's like some kind of backhanded comment about you being like, oh, look at that silly Nick, he didn't eat food today or something.

It's as though everything that anyone says has something to do with you.

YOUNG: Yeah, you also thought the producers of this reality show had planted a wireless speaker in your head and were feeding you lines. What were some of the things they were telling you?

LOTZ: They would tell me to do a lot of stuff. So they would tell me to do things like go for days without food or work out to the point of exhaustion or things such as smoking cigarettes or drinking alcohol, they would tell me to never do those things.

YOUNG: So you'd look good on the reality show, so you'd look good for the audience.

LOTZ: Yes, exactly, right.

YOUNG: Oh boy. And they wanted you to be a comedian? They told you to be a comedian. So did you actually go do standup comedy?

LOTZ: Well, I mean I think that that was part of - partly just my ambitions also, was that I had always sort of wanted to pursue a career in the entertainment industry, but it was sort of like I believed that I was on this TV show, and I was like, oh, I should take advantage of this opportunity. So I began pursuing a career in standup comedy at that point.

YOUNG: You went to Rockefeller Center because - in New York, the home of "Saturday Night Live" and all this other programming, because you thought I'm supposed to perform here. And your mother is noting your behavior. So other people were noting this. But you're still functioning. You're still in college a lot of this time. What's that like for you to believe there's one reality, and yet you knew some of the people didn't believe you?

LOTZ: For me it was - 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.

YOUNG: Because that's all part of the show.

LOTZ: Right, exactly, because it was all part of the television show.

YOUNG: Boy. Let's bring in Dr. Joel Gold, because Nick Lotz, I know that you were trolling the Internet when you came across him as well, and you guys connected. Dr. Gold, you started seeing young men over the last decade. Is what Nick is saying, is that what - the kind of thing you were hearing from other people?

JOEL GOLD: Absolutely. First, I wanted to thank Nick for sharing his story. I think it's been really gratifying for a lot of patients and family members to hear that they're not alone, and I'm so happy that Nick's doing well. So, you know, good on you, Nick, that's fantastic.

Essentially I did start seeing these guys about 10 years ago, and they all essentially 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 times, 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.

YOUNG: Because there's - you know, as we were just saying with Nick, they also have a slight grasp on reality. They - you know, it's almost like they are - they know that they're trapped in something.

GOLD: This is true of a lot of people with mental illness. Some have a quality of mental illness that makes it very, very difficult to function. They may have disorganized thoughts, disorganized behaviors. But other people who have delusions or perhaps hallucinations can otherwise function quite well. And in a case where someone thinks they're on a reality show, maybe even more so they feel that they're performing, and therefore they want to perform well.

If you felt as though people were watching you at all times of day and night, you might behave, you know, in ways that you might not otherwise, but you might function just fine or at least to the, you know, observing eye, so to speak. Internally the overwhelming feeling can be just horrific.

YOUNG: Dr. Joel Gold, who came with the diagnosis "The Truman Show" delusion, we're also speaking with Nick Lotz. When he went for treatment, he was so convinced that that was part of his show that he searched the hospital for editing equipment. We're going to have more with both after a break.

JEREMY HOBSON, HOST:

Some of the other stories we're following, the U.N. says at least two million people have left Syria over the last two and a half years seeking refuge in other countries. More than 2,000 have sought safety in the Gaza Strip. Also, polling shows that many Americans aren't quite sure how the Affordable Care Act will affect them, but it may be even more confusing for people who don't speak English as their first language.

So Illinois has been working to resolve language barriers as it prepares to launch its insurance marketplace. That story and other stories coming up later on ALL THINGS CONSIDERED. We're back in a minute, HERE AND NOW.

(SOUNDBITE OF MUSIC)

YOUNG: It's HERE AND NOW, and we've been talking about "The Truman Show" delusion. This is a diagnosis of maybe hundreds of young men, including our guest Nick Lotz, who think their whole life, every second, is a reality TV show, as Jim Carey's character discovered his was in the movie "Truman Show."

(SOUNDBITE OF MOVIE)

(SOUNDBITE OF MUSIC)

UNIDENTIFIED MAN: (As character) I know you better than you know yourself.

JIM CAREY: (As Truman Burbank) I never had a camera in my head.

UNIDENTIFIED MAN: (As character) You're afraid. That's why you can't leave. It's OK, Truman, I understand. I have been watching you your whole life.

YOUNG: We're going to hear more from our guest Nick Lotz, who when he spoke in his college classes would grin clownishly to try to let his audience watching at home know that he was in on the joke. Today all those voices are under control thanks to therapy and drugs, and we've been finding out more about his condition from Dr. Joel Gold, who coined the term "The Truman Show" delusion after treating many other patients.

And Dr. Gold, we're reading all about this in a terrific article in the New Yorker by Andrew Marantz, who says that the form of mental illness is pretty fixed. In other words, there are certain rules. If you think something is happening, and it isn't, you probably are suffering some form of mental illness.

But content is cultural. So for instance in Pakistan a paranoid person might think they're being stuck by a poison needle. In this country there's a tradition of people thinking the CIA is listening in on them. So what does "The Truman Show" diagnosis now tell us about the culture?

GOLD: Well, that's really the $64 question. Different theorists have different ideas, but we think there are about a dozen kinds of delusions, persecutory, grandiose, guilt, nihilistic, one might think that they are dead. And those are, as you say, 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. And the delusions like "The Truman Show" delusion, which I should say parenthetically is not a new illness, we think it is a new kind of persecutory, grandiose, referential, controlled delusion.

In this "The 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 not just to your wonderful show, Robin, but 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?

And that's really what we're looking at. We have more questions than we have answers.

YOUNG: Well, but how has acknowledging it, how has that helped you treat it? Because you and others say that psychiatry in this country has been ignoring content because we have these anti-psychotic drugs, the idea has been less paying attention to the form of the mental illness, the fact that Nick thinks he's on a reality show, and more to just making it stop with drugs.

GOLD: If the average person walked into a psychiatrist's office and said that they were depressed, they wouldn't necessarily immediately reach for their prescription pad and prescribe Prozac. They would say, well tell me how your life has been, if you have a recent breakup, you're having difficulty at work, and they would take that very seriously.

Why, then, do 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.

Even if you're not psychoanalytically oriented, as I am and many others in New York are, and you don't believe in the unconscious, 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. I will say that there are treatments for delusion that particularly in the United Kingdom and now more and more in the United States, things like cognitive behavioral therapy for psychosis or support of psychotherapy for schizophrenia can actually help modulate and moderate delusional thinking, and I think everyone in our field would agree, I would hope most would agree, that psychotherapy and psychopharmacology together are far more likely to yield a good outcome than either one alone.

YOUNG: Well, for instance we're reading about a psychiatrist in London who says if my patient tells me I'm being filmed all the time, I might walk out on the street with him and say, well, show me the cameras, in other words paying attention to the fact that these people think they are in reality shows.

That's Dr. Joel Gold. We're talking about "The Truman Show" delusion. You're listening to HERE AND NOW. And we're also talking to Nick Lotz, who had the delusion. Nick, you had a moment where you woke up, and the voices were gone, and it felt like maybe finally, escape. But was it also a little sad to lose this world that you had lived in for so many years, this reality show?

LOTZ: I would say that it was at first very gratifying to lose this world because it was so all-encompassing and sort of scary. But as time went on, I sort of did develop a deep depression knowing that I was not the center of attention and that I was in fact just a normal person.

And it kind of was almost that I had built my whole life around being on a television show. And I had, you know, gone to school to major in film and started standup comedy and started doing all these things in order to, like, further my career as this super-celebrity figure.

And when it turned out it wasn't real, it was kind of like I was always waiting for the other foot to drop. I was always waiting for someone to sort of show up and be like here, well, here, here's your prize, here's your $100 million, here's your, you know, your acting job on SNL.

And so there was a bit of sadness. As far as the effects of psychiatry versus psychology on these delusions, I would say that 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 really the only thing that helped stop the voices for me because psychology just simply wouldn't work, given the fact that you think that any interactions you have with the doctor are scripted out, and it's really hard to sort of accept therapy when you have that undergoing theme in your therapy that you can't - you obviously can't trust your therapist if that's going on.

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 overall sort of manage my anxiety. And obviously my anxiety leads to more delusions, so managing my anxiety leads to less delusions.

YOUNG: Well, you know, I was just thinking that the funny thing is you are now on "The Nick Lotz Show." I mean, you are really, really talking to me. This is really happening. And so you have achieved a reality that's going to help a lot of other people. So thank you.

LOTZ: Oh, you're welcome.

YOUNG: That's Nick Lotz, diagnosed with "The Truman Show" delusion, which is in remission from. He's profiled in the September issue of the New Yorker, as is the work of Dr. Joel Gold, who coined the phrase. Dr. Gold, I know you and your brother are working on a book about other biological and social factors contributing to psychosis. We look forward to that. Thank you both.

GOLD: Good day.

LOTZ: Have a nice day.

YOUNG: And by the way, a footnote from Andrew Marantz' terrific article in the New Yorker on "The Truman Show" delusion, he points out that the new DSM-V, the American Psychiatric Association's Diagnostic and Statistical Manual, the bible of the field, just came out in May, and for the first time the chapter on psychosis doesn't emphasize a distinction between behavior that's bizarre and behavior that isn't. One of the reasons: the expansion of technology makes it harder for clinicians to tell when someone is crazy just because they think they're on camera.

We'd love to hear your thoughts, especially if you are in the mental health community and have seen "The Truman Show" delusion. Let us know at hereandnow.org. Latest news is next, HERE AND NOW. Transcript provided by NPR, Copyright NPR.


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