The Truman Show Delusion

Reality television shows have become a staple of modern life. However, little is known about the effect they have on day-to-day living. Back in 2012, Joel Gold and Ian Gold published a paper in the journal Cognitive Neuropsychiatry about a phenomenon that they dubbed the Truman Show Delusion (TSD), based on Peter Weir’s 1998 film that tells the (fictional) story of Truman Burbank (played by Jim Carrey), whose whole life has been filmed and broadcast as a soap opera without his knowledge. All the people around Truman are paid actors and extras.

The plot of The Truman Show revolves around Truman’s gradual awareness that there is something wrong about his life (i.e., that the world appears to revolve around him) and his desire to escape the town in which he lives. Because of the high audience ratings, the show’s producers attempt to keep the show even when Truman begins to suspect there is something amiss in his life. The actors are then instructed by the show’s producers and writers to tell Truman that he is imagining these things and that he is (to all intents and purposes) mentally ill (i.e., it's a persecutory delusion).

In their paper, Gold and Gold described the condition as:

“…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. 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...”

Gold and Gold highlighted five short case studies of patients who had presented for treatment in their psychiatric practices. The cases ‘diagnosed’ as having the TSD are the reverse of what occurred in the film as their reported symptoms recall that of Truman, without the knowledge and awareness that their attempts to understand their situation will lead to a [Hollywood] happy ending. Interestingly, three of the cases highlighted by the authors referred to The Truman Show by name. Here is a brief summary of the five reported cases.

Case 1 (‘Mr. A.’): Mr. A. claimed his life was like The Truman Show, a belief that he had held for five years without his family’s knowledge. He believed the 9/11 attacks were fabricated and travelled to New York to see if the Twin Towers were still standing (and if they were, it would prove that he was the star of his own show). He believed that everyone in his life was part of the conspiracy and that he had cameras implanted in his eyes (and when he was admitted to the psychiatry department he asked to speak to the ‘director’). He was diagnosed as having schizophrenia (and more specifically a chronic paranoid type, versus substance-induced psychotic disorder).

Case 2 (‘Mr. B.’): Mr. B. believed he was being continuously recorded for national broadcast. He formulated a “plan to come to NYC and meet an unknown woman at the top of the Statue of Liberty. He expected [her] to release him from the control of an extended network of individuals who [were]...taping him continually…and broadcasting the tapes nationally for viewers’ enjoyment as part of a scenario similar to…The Truman Show.” He believed he “was and am the centre, the focus of attention by millions and millions of people…my [family] and everyone I knew were and are actors in a script, a charade whose entire purpose is to make me the focus of the world’s attention.” He had attempted suicide three times due to dysphoria, hopelessness, and persecutory delusions. He was diagnosed with schizoaffective disorder (bipolar type) along with both crack cocaine and marijuana dependence.

Case 3 (‘Mr. C.’): Mr. C. – a journalist – had a history of depression, and was manic and psychotic. He believed that stories – in newspapers, online, and on television – were created by his colleagues in the media for his personal amusement. He believed that those around him were paid actors, that everything around him was fake, and that “all [his] associates are involved.” During his hospitalization, Mr. C. attempted to escape to confirm that there were disparities between the news given on the ward and what was happening outside. He was diagnosed as having bipolar disorder with psychotic features.

Case 4 (‘Mr. D.’): Mr. D. actually worked on a reality television show and came to believe that he was the person whose life was actually being broadcast. He also believed all his thoughts were being controlled by a film crew paid for by his family. He was diagnosed with bipolar disorder, had manic episodes, and was a marijuana abuser.

Case 5 (‘Mr. E.’): Mr. E. believed that the Secret Service was following him. He had attention deficit hyperactivity disorder and had bouts of depression. He described a “scheme” that he claimed was similar to The Truman Show. Gold and Gold reported that Mr. E. “believed that he was the master of the scheme, that it involved everyone in his life including the hospital staff, and that all these people were actors. He thought that he might be recorded while in hospital. He believed that the news was fabricated and that the radio was recorded for him…He believed that the scheme would end on Christmas Day and that he would be released then.” He was diagnosed with schizophreniform disorder versus methylphenidate-induced psychotic disorder.

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Gold and Gold searched the academic and clinical literature for other similar scientific reports of patients with delusions of The Truman Show type but said there were none. However, they did cite a 2008 study by Fusar-Poli and colleagues in the British Journal of Psychiatry. They reported the case of a person who ‘‘had a sense the world was slightly unreal, as if he was the eponymous hero in the film The Truman Show [but] at no point did his conviction reach delusional intensity.” They also made reference to two news reports (one in 2007 and the other in 2009) of men who appear to have suffered from the TSD.

“In 2007, William Johns III, a psychiatrist from Florida, attempted to abscond with a child, Thorin Novenski, and subsequently attacked the child’s mother. A news report on the incident claims that ‘a friend of the psychiatrist reportedly told a judge that Johns said he had to go to New York to ‘get out of The Truman Show.' In 2009, Antony Waterlow, a Sydney man, murdered his father and sister while in a psychotic state. A news report stated that Mr. Waterlow believed his family was behind a ‘world wide game’ to murder him or force him to commit suicide. A doctor who interviewed the man is reported to have said that Mr. Waterlow told her in a consultation in February that he believed computers were accessing his brain through brainwaves and satellites. He said his family was screening his life on the Internet for the world to watch, akin to the film The Truman Show.”

Gold and Gold noted that their case studies gave rise to three general questions of interest: (1) How precisely should these peoples’ delusions be characterized? (2) What does the delusion contribute to the understanding of the role of culture in psychosis? (3) What does the influence of culture on delusion suggest about the cognitive processes underlying delusional belief?

Obviously, watching reality television shows does not cause psychotic or delusional episodes. However, these cases appear to highlight that those with underlying illnesses (e.g., schizophrenia) who watch reality television shows may develop delusions that seem somewhat familiar. Gold and Gold concluded that cultural insights into delusions are an essential part of understanding how these phenomena operate.