I am being watched

Updated: Aug 31 2008, 05:38am hrs
Psychosis in the 21st century looks something like this: You think your every move is being filmed for a reality television show starring you, and that everyone in your life is an actor. Or you think you are under intense surveillance by an army of spies, whom you refer to as the www people, as in the World Wide Web, and they wiretap your furniture and appliances.

Or else you refuse to drink water because you fear that another cup drawn from your faucet will, once and for all, deplete the worlds water supply.

Those thoughts are from three case studies of what psychiatrists interested in the intersection of mental illness, culture and society are calling, respectively, Truman Show delusion, Internet delusion and climate change delusion; all of them a window, through madness, into the modern world.

If you have delusions of grandeur in this century, you are probably not Napoleon, but you may be Bill Gates.

The Truman Show delusion, or Truman Syndrome, has drawn attention in recent months, in the United States and Britain, as psychiatrists in both countries describe a small but growing number of psychotic patients who describe their lives as mirroring that of the main character in the 1998 film The Truman Show. Played by Jim Carrey, Truman Burbank leads a mundane existence in the suburbs, starting from the time he was in the womb, while being filmed for a documentary television show that he cannot escape. Everyone is in on it, including his wife, and no one will believe Truman when he discovers clues that his life is being chronicled all the time by cameras.

With Internet delusion, patients typically incorporate the Internet into paranoid thoughts, including a fear that the Web is somehow monitoring or controlling their lives, or being used to transmit photographs or other personal information.

The delusions are fuelling a chicken-and-egg debate in psychiatry: Are these merely modern examples of classic paranoia fed by the current cultural landscape, or is there something about media like reality television and the Internet that can push people over the sanity line

Dr Joel Gold, a psychiatrist at Bellevue Hospital Center in New York, said he saw five patients at the hospital from 2002 to 2004 with Truman Show delusion. Dr Gold and his brother, Dr Ian Gold, the Canada research chair in philosophy and psychiatry at McGill University in Montreal, came up with the term Truman Show delusion.

But the more radical view is that this pushes some people over the threshold; the environment tips them over the edge, said Dr Joel Gold, who is a clinical assistant professor of psychiatry at New York University. And if culture can make people crazy, then we need to look at it.

One way of looking at the delusions and hallucinations of the mentally ill is that they represent extreme cases of what the general population, or the merely neurotic, are worried about. Schizophrenics and other paranoid patients can take common fears like identity theft because of information transmitted on the Internet, or the loss of privacy because of the prevalence of security cameras to fight crime and magnify them, psychiatrists say.

During World War II, for example, psychotics might have believed a neighbour was a Nazi. During the cold war, they might have thought the KGB or CIA was following them. In a post-Sept. 11 world, the persecutor might be Al Qaeda or the Department of Homeland Security.

A study found a delusion occurring only in rural West Bengal in which women and men bitten by dogs believe they have become pregnant with puppies.

One of Dr Golds patients reported that he also came to New York to see if the Twin Towers were still standing, because he believed that seeing their destruction on Sept. 11 on television was part of his reality show. If they were still standing, he said, then he would know that the terrorist attack was all part of the script. Psychiatrists say that other movies whose characters are living in a unreal world or being watched by malevolent forces, including The Matrix, Edtv and even the film based on George Orwells 1984, have come up in conversations with psychotic patients.

NYT / Sarah Kershaw