Unwrapping the 'Truman Show Delusion,' Where You Believe You're Being Watched by the World

Picture this: You're being followed. Not by someone, but by something. A camera. It's hidden somewhere, everywhere—perhaps in the shrubbery outside your kitchen window, or stuck behind the bathroom mirror, or pushed into the soil of the plant your work friend insists on keeping on her desk. And beyond that camera lies a nation of dedicated viewers, watching your every move.

This was the paranoia that Dr. Joel Gold first encountered in October 2003, when a 26-year-old man entered the psychiatric hospital where he worked, sharing his strong suspicion that his life was being secretly filmed and broadcast to the world. The man likened it to the 1998 film The Truman Show, in which protagonist Truman Burbank discovers he is the star of his own carefully orchestrated television show. Everyone he knows is an actor, and he is being watched by the entire world.

In years to come, The Truman Show would become a staple reference for many of Joel's patients with delusions, and plenty of these were documented in the book subsequently written by Joel and his brother Ian, Suspicious Minds: How Culture Shapes Madness.

The Truman Show might be the most apt cultural reference point for this type of delusion, but it's just one of many that relate. In 2003, technology was making strides, and it would only be another four years until Facebook really kicked off. Reality television was going strong—Big Brother was already being broadcast in more than 40 countries—and, post-9/11, CCTV cameras were being more widely employed across the Western world.

Now, in 2016, the idea of being watched—knowingly or unknowingly—is a distinct possibility, no matter who you are. Social media allows us to exist in fabricated realities of our own making, and television provides us with the manufactured existence of others. Our lives are moderated by technology; we write tweets, stack up Snapchat stories, upload our heavily edited photos to Instagram. Every month, Twitter has 115 million active users. So is it so far-fetched to think that someone, somewhere, might be watching?

When comedian Tomoaki Hamatsu—nicknamed "Nasubi"—began his stint on 1990s Japanese gameshow Susunu! Denpa Shōnen, he had no idea that people were watching him. In fact, it wasn't until more than a year later—when his time on the show came to an abrupt end in front of a rabid studio audience—that he discovered he had been seen by anyone at all.

Transported from the audition room to a small, one-room apartment, producers demanded all of Nasubi's clothes, and he was left alone in the apartment, naked. The idea, he was told, was that he must win everything he needed to survive through sweepstakes. Once his sweepstakes winnings amounted to 1 million yen [about $9,700], he would be free. Nearly a year later, Nasubi discovered he had "won" the show. Like something out of a Black Mirror episode, the four walls of his apartment fell away to reveal a cheering studio audience. Nasubi screamed. He was still naked.

"My house fell down," he said nervously to the host, and the audience erupted into laughter. The host began to show him his best bits from the past year. "You mean everyone has been watching my naked body all this time?" a shell-shocked Nasubi asked, unaware that the show had been aired. "Is that allowed?"

Nasubi had become a character in his own show without even knowing it. He was Japan's Truman Burbank, without clothes and wild with loneliness, with millions of dedicated fans. Oblivious of his new celebrity status, Nasubi had unwittingly launched his own line of merchandise and several of his diaries had been published, fast becoming best sellers. The producers had transformed Nasubi into a walking, talking gimmick.

Being put in a room by a production team is clearly nothing like suffering delusions brought on by mental illness, but it does serve to highlight a culture in which having your entire life secretly filmed might be somewhat feasible—that there's some kind of real-world precedent outside of Jim Carrey's fictional experience.

While Nasubi had no idea that people were watching him, we're now all too aware that to be watched without our knowledge is a distinct possibility. The Snowden leaks revealed that governments have long been able to monitor our communication—that they can spy on you through your webcam without you ever finding out. Facebook asks us what's on our minds, and we tell it. People forge careers out of recording their thoughts on iPhones—and sometimes the making of prank and "social experiment" videos mean that a career comes at the expense of unwitting strangers. If you're already mentally predisposed to suffering from these "Truman Show delusions" (TSD), there's now a barrage of exterior factors to reinforce what might be going on in your mind.

Medical historian Roy Porter once said that "every age gets the lunatic it deserves," and so as culture continues to interact with us in a progressively intrusive manner, it also has the ability to interact with psychoses. As technology changes, the TSD can begin to manifest in new ways. "There is good reason to think that if the environment is more 'toxic,' there will be more illness," says Ian Gold over the phone. "If the social world gets more 'toxic,' psychosis is likely to increase."

Which is why the reference to the Truman Show works for the Gold brothers: It allows patients to easily explain their delusions to their psychiatrist. "People who have it resonate with it," says Ian. "They often say it's a relief to know that this is a real phenomenon, and they're not alone."

But the fabric of our minds is made from delicate cloth, and if mental illness is—as Joel puts it in the book—"just a frayed, weakened version of mental health," then we must be careful not to pull at that thread. So I ask Ian if there was any trepidation in naming a delusion after such a well-known film, for fear of glossing over the serious nature of the illness with a pop-culture reference. It was certainly something that crossed their minds: "We don't want to do anything to trivialize psychotic illness," he says. "Joel knows firsthand how much suffering is associated with it. The worry is that associating the delusion with the movie might make the illness worse. So far, we haven't had any interactions with the movie that made us think this is the case."

As there are risks that parts of the illness can overlap with real life, the brothers are often reluctant to let journalists speak to a patient for fear that the experience of "fame" may make their condition worse. However, this is just precautionary: Joel says that it's not exactly fame that exacerbates the symptoms of TSD but more social stressors.

Kevin Hall, a patient of the Gold brothers, was the only person happy to have his real name put in their book. Kevin is bipolar, and his TSD is brought on by stressful periods in his life. His delusion involved thinking the world was watching what he called the "TrumanKev Show" during his manic episodes. His first outburst came at college as he studied mercilessly for his mid-terms while simultaneously trying to shake a bout of shingles. He had given up on sleeping and instead was replacing rest with energy drinks. He started to think that all songs on the radio were related to his life.

This episode ended with Hall approaching strangers in Boston and asking them uncomfortable questions, before coming to the attention of police after climbing a tree. His next episode occurred after graduation, in Japan during a sailing regatta where he and his teammates were stuck in a vicious cycle of partying and competing. His delusions deal with the idea that there was a "director" controlling aspects of his life, which led him to think he could drive around Tokyo in a stolen truck because he found the keys hidden in the vehicle's sun visor. The next was after he discovered he had testicular cancer for the second time (he'd had a testicle removed due to the disease in his last year of college but refused radiation to return to his studies). Another came after the breakdown of his marriage. Most recently, the death of a close friend brought on a brief episode of TSD—after 14 years without one.

Hall is an anomaly. He is very open about his TSD. He has received media attention in the past; his fight with cancer while competing in Olympic sailing was documented by the New York Times and the Washington Post. While he still takes part in a few professional sailing gigs, Hall is now a writer. I contacted him on Twitter to talk about whether his relationship with technology was strained due to his condition.

As a writer, Hall is aware that part of his job is to raise his own profile, and so an online presence became necessary, meaning he had to "fold in the dangerous elements of my psychotic trips with my everyday life." Hall tried a plethora of different meds when writing his book Black Sails White Rabbits: Cancer Was the Easy Part, which chronicles his struggles with mental and physical illness, and while the new medication worked for a while, he eventually found himself falling into a new psychotic episode.

"Before the fall," he tells me, "the feedback loop of social media became very compelling—I post more, search more, interact more. At some point, the script flips from that prolific posting to believing everyone is really watching." This switch goes from "broadcasting to share," to "being directed to give a show," and this is the point where things get scary for Hall, who has spent a while trying to figure out what exactly it is that triggers his eventual turn—something he is yet to fully understand.

The Truman Show delusion might seem novel to outsiders—no doubt because of the link with the Hollywood film—but really, it's a common paranoid psychosis, attached to a modern point of reference. It's hard to say for sure if the proliferation of technology is impacting the amount of diagnoses, but if the opinion of Ian Gold—an expert on the topic—is anything to go by, it would seem that it might be.

If you are concerned about the mental health of you or someone you know, here's how to get help.

Follow Pascale Day on Twitter.