The delusions are fueling 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?

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“Most likely these people would be delusional anyway,” said Dr. Joel Gold, a psychiatrist at Bellevue Hospital Center in New York, who 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.

“There is the old saying that just because you’re paranoid doesn’t mean there’s not somebody after you,” said Dr. Jeffrey A. Lieberman, chairman of the Department of Psychiatry at Columbia University.

The prevailing view in psychiatry is that a delusion is just a delusion, psychosis is psychosis, and the scenery is incidental. Fear, a sense of persecution and grandiosity are static features of delusional thinking, many psychiatrists say.