The Truman show delusion: a transition from bizarre to mundane in the age of live-streaming

The current trends of the internet have made almost everything accessible with just a few clicks. ‘Content creation’ with posts, stories and live streaming have been trending globally especially among the youth. With such massive and constant influx of information, increasingly the boundary between normal and pathological seems a blur regarding certain aspects of personal life. We present a case of a 24 year male with the complaints of being bothered by being recorded through hidden cameras, which was further being live streamed to the public without his consent. These beliefs were held with a delusional intensity and good response was seen with antipsychotic treatment. In our review of literature, we came across The Truman show delusion based on the movie by Peter Weir ‘The Truman show’ which follows the life of a person named Truman Burbank, who’s entire life right from in-utero has been broadcasted without his knowledge, similar to the complaints voiced by the index case. Psychopathology like this which would be labelled as bizarre is becoming the new normal and thus it mandates clinicians all over to be vigilant and updated with the ever-changing jargon of the social media.

Accessibility is a word that captures the essence of the internet, from service providers to the billion consumers who are ready to dive deeper with every click. In the current frenzy of the social media platforms ‘content creation’ with regular posts, reels and live streams is the new norm. It is easier than ever to stay not just connected, but to know about the precise whereabouts, activities and much more of our loved ones 24 x 7. With this constant barrage of information, it gets difficult to decide as to where to draw a line between normal and the pathological.

Here we present the case of a 24-year-old, unmarried male who presented to us with complaints of being bothered by the fact that he was being live-streamed on the internet. He would voice out that hospital facility including the doctors, staff as well as other patients were fake and along with the family members are just actors. He would claim further that a large nexus of such fake hospital centre’s was going all throughout India. On asking how, he reasoned that there were hidden cameras throughout the hospital premises which are recording his every movement and conversation which was then live streamed, without his consent. He would say that all the mobile phones have been hacked by a software and since no disclaimer was issued before his live-stream, untoward events like collision of trains, religious fights have started to happen in the community. Other than this belief, he was observed smiling and talking to self and reported auditory hallucinations though would not elaborate about its content. A diagnosis of Schizophrenia was made according to ICD-11 and was given consecutive trials with Tb. Risperidone up to 8mg and subsequently with Tb. Olanzapine up to 30mg with no significant response. Tb. Clozapine was started and optimized till 225mg, and improvement was thus seen. Though he continued to express intermittently that he is being live streamed, which further decreased. Subsequently, no hearing of voices or suspiciousness was reported.

Fish defines delusion as ‘false, unshakable belief, that is out of keeping with the patient’s social and cultural background’ ¹. A detailed exploration was thus done for this case whereby, mobile phones were operated in front of our index case to exhibit the normal functioning of internet search engines and apps, however he was not convinced. As per the request by our case, key search words were typed in Google and YouTube which showed no significant results related to the train collisions, riots, software hack as was claimed by him, but he would still be disturbed that his movements are being recorded and would even be reluctant to converse with the treating team on certain topics fearing that it would be heard in the livestream. Keeping in mind the fixed, false nature as well the extreme conviction and extension of his beliefs, possibility of these beliefs being delusional was considered and improvement with Clozapine further solidifies the same. Even though internet services have been there for what seems like a lifetime, but such a presentation even 10 years ago would have been labelled implausible and bizarre, but with the constant and ever evolving, technological advancements, living within the internet is the new normal. As seen in the index case, ‘Cyber Paranoia’ ² could be morbid enough to warrant attention to our current understanding of technology. Similar to presentation of the index case, Joel and Ian Gold³ had described five patients with a novel delusion whereby patient believes to be a star of reality television show who is being filmed secretly and is being broadcasted for the entertainment of others like the main character in the film by Peter Weir’s 1998 film The Truman Show. Three out of five patients even mention the film by its name, and all five responded well to antipsychotic medication. The film follows the daily life of Truman Burbank whose whole life right from in-utero is being broadcast around the world as a soap opera without his knowledge. His parents, wife, friends, co-workers, were actors in fact the entire city he inhabits was a part of an elaborate setup whereby right from the weather to the movement of each person was choreographed. The story focuses on his increasing awareness of the oddities in his environment to his escape from the studio and reuniting with his former girlfriend, banished previously by the creators for maintaining the plot. During his realizations he expresses ideas of paranoia as to how he is being followed and plotted against and referential ideas as to how everything revolves around him. Just to keep the drama running the creators in fact are able to convince him that he might be suffering from a psychiatric illness. Like the cases described by Joel and Ian Gold ³, our case responded well to antipsychotic treatment, however unlike the cases mentioned our case does not happen to mention or know anything about the movie The Truman Show. In our review of literature only a handful of cases are reported with similar psychopathology ⁴ and to the best of our knowledge, except our index case none has been reported in Indian sub context. Given the ever-increasing involvement of artificial intelligence in nearly all domains of our lives now, presentation of cases based on similar or more varied psychopathology would become increasingly common. Clinicians all over the world should be vigilant and be updated with rapid technological advances to understand the jargon of social media and how more systemic research is required to help standardize and navigate the changing landscape of psychopathology.

Conflict of Interest statement

The authors declare no conflict of interest.

Funding

None.

Authors’ contribution

M.A. and A.A. prepared the manuscript. A.S. helped in management of the index case, final editing and approval of the manuscript.

Ethical consideration

Consent for research purposes was taken from the index case as per department protocol and anonymity was ensured.

History

Received: January 24, 2024

Accepted: May 11, 2024