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‘Truman’ signs and vulnerability to psychosis

  • Paolo Fusar-Poli (a1), Oliver Howes (a2), Lucia Valmaggia (a2) and Philip McGuire (a2)
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1 Rossler, W, Riecher-Rossler, A, Angst, J, Murray, R, Gamma, A, Eich, D, van Os, J, Gross, VA. Psychotic experiences in the general population: a twenty-year prospective community study. Schizophr Res 2007; 92: 114.
2 Kapur, S, Mizrahi, R, Li, M. From dopamine to salience to psychosis-linking biology, pharmacology and phenomenology of psychosis. Schizophr Res 2005; 79: 5968.
3 Sass, L, Parnas, J. Self, consciousness, and schizophrenia. Schizophr Bull 2003; 29: 427–44.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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‘Truman’ signs and vulnerability to psychosis

  • Paolo Fusar-Poli (a1), Oliver Howes (a2), Lucia Valmaggia (a2) and Philip McGuire (a2)
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eLetters

The �Truman Show� delusion

Joel Gold, Psychiatrist
08 June 2009

In a recent volume of this journal, Fusar-Poli, Howes, Valmaggia, andMcGuire (1) describe a patient, Mr. M.A., who, in the prodromal phase of schizophrenia, “had a vague sense that people around him were ‘acting’, he

was the focus of their interest and they knew a secret that was being kept

from him. Furthermore he felt ‘detached from the environment’ and had a sense the world was slightly unreal, as if he was the eponymous hero in the film The Truman Show.” The delusion that one’s life is like The Truman Show is not only a symptom of prodromal psychosis. Between 2002 and 2004, we treated five patients at Bellevue Hospital Center who had a variety of delusions of this type: that they were being filmed and the films were being broadcast; that the doctors and patients in the hospital were actors and the environment was fake; or that they were on a reality television show. Three of the patients referred to The Truman Show by name. In all cases, the Truman

Show delusion presented as part of a persecutory delusional system which also included grandiose thoughts and ideas of reference. Diagnoses for these patients ranged from schizophreniform disorder, to schizophrenia, schizoaffective disorder, bipolar disorder, and substance-induced psychotic disorder. In recent months we have heard of similar cases from colleagues and have had correspondence from some dozens of individuals who claim to have suffered from a similar delusion; almost all refer to The Truman Showin describing their experience.

It is well known that while the forms of delusion appear to be constant across cultures (2), the content of delusional beliefs are sensitive to local culture, including technology (3). Delusions about electronic chips (4), and the internet (5), among others, have already been reported. It is perhaps not surprising, therefore, that persecutory and grandiose delusions should incorporate references to the scenario represented in The Truman Show, especially in a political climate in which concerns about privacy are salient and in places where cameras are in fact recording everyday life for security purposes.

(1)Fusar-Poli P, Howes O, Valmaggia L, McGuire P. ‘Truman’ signs and

vulnerability to psychosis. Br J Psychiatry 2008; 193: 168.

(2)Stompe T, Ortwein-Swoboda G, Ritter K, Schanda H. Old wine in new

bottles? Stability and plasticity of the contents of schizophrenic delusions. Psychopathology 2003; 36: 6-12.

(3)Suhail K, Cochrane R. Effect of culture and environment on the phenomenology of delusions and hallucinations. Int J Soc Psychiatry 2002;

48: 126-38.

(4)Eytan A, Liberek C, Graf I, Golaz J. Electronic chips implant: a new culture-bound syndrome? Psychiatry 2002; 65: 72-4.

(5)Bell V, Grech E, Maiden C, Halligan P, Ellis H. ‘Internet delusions’: a case series and theoretical integration. Psychopathology 2005; 38: 144-50.
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