The Truman Show is a 1998 movie starring Jim Carey. The plot follows Truman Burbank, a married man living a seemingly idyllic life on an island named Seahaven. He has a good job, a loving wife, and everybody is his buddy. What Truman doesn’t know, however, is that every single person – other than himself – living in Seahaven is an actor and that the island has been constructed underneath a massive dome, and that several thousand cameras have watched his every single move since birth and documented it on a television show out in the real world. When he discovers the truth, he fights to find an escape from this phoney life.

In 2008, brothers Dr. Joel Gold, a psychiatrist, and Dr. Ian Gold, a neurophilosopher, coined the term “The Truman Show Delusion.” The delusion afflicts people who are convinced that every waking moment of their life is being filmed for a secret reality show. Dr. Joel Gold encountered his first “Truman” patient in 2003 while working as an attending psychiatrist in the psychiatrist ward of the Bellevue Hospital. A 26-year-old assembly plant worker named Albert had been admitted to the hospital after complaining that his family members were just actors on an unscripted television show where he was the unwitting lead character. Early on in their research into the perplexing delusion, the two brothers encountered five patients suffering from “The Truman Show Delusion.” Several of them even specifically mentioned The Truman Show to explain their delusions. A visual artist named Brian was admitted to the hospital shortly afterwards and had similar delusions to the prior patient. Then there was a computer engineer, an MIT professor and a lawyer – all of whom believed the exact same thing: That they were all being secretly filmed for some kind of reality show. “I thought I was being followed, like “The Truman Show” and I was a hit. People were following me all over the world,” said another patient. One patient – an army veteran – stated: “I realized that I was and am the centre, the focus of attention by millions and millions of people.”

The brothers started to present their observations at medical schools. After word of their research spread, the brothers collected over 100 similar cases. “I started to think: There’s something really going on here,” said Dr. Joel Gold. “What struck me was how all-encompassing the Truman Show Delusion is. What does it say about our society? With cameras on every corner, Snowden, P.R.I.S.M., drones, YouTube, overnight fame, those of us with genetic predispositions might be pushed over the edge.” One patient flew to New York City following 9/11 to make sure that the terrorist attacks were not a plot twist in his reality show. Another patient wanted to climb the Statue of Liberty where his true love would be waiting for him and the puppeteer strings would be cut. If she wasn’t there, he would jump to his death. There was also another patient who was convinced that everything – the news, his psychiatrists, the drugs the prescribed – was part of a show. Vaughan Bell, a psychologist who has researched Internet-related delusions, described one of his own patients who believed he was in the virtual-reality universe in the 1999 film, The Matrix.

While the movie, The Truman Show, is a heart-warming watch in the end, the delusion is often horrifying for the patients. Typically, the delusion is a combination of paranoia, grandiosity, and the ideas of reference, which means that patients believe that they are receiving signals that are specifically meant for them. “The wish for fame is a form of grandiosity, and the fear of threats such as surveillance can bring about paranoia,” said Dr. Ian Gold.

British psychiatrists described the disorder in the British Journal of Psychiatry as:

“A preoccupying belief they the world has changed in some way that other people were aware of, which he interpreted as indicating he was the subject of a film and living in a film set (a ‘fabricated world’). The cluster of symptoms… is a common presenting complaint in individuals… who may be in the prodromal phase of schizophrenia.”

The Truman Show Delusion is a new twist on an old mental illness – persecutory or grandiose delusion disorders, both of which are manifestations of psychosis. Scientists have said that the disorder underscores the influence pop culture can have on mental conditions. “The question is really: Is this just a new twist on an old paranoid or grandiose delusion … or is there sort of a perfect storm of the culture we’re in, in which fame holds such high value?” said Dr. Joel Gold. Dr. Joel Gold has likened mental illness to lung cancer in the past. He said that some people can smoke several packets of cigarettes a day but not get lung cancer while others can get lung cancer even though they don’t smoke. Many more, though, have genetic inclinations but need a trigger for the cancer to occur. Culture, Gold argues, is mental illness’ equivalent to lung cancer’s cigarettes.

While the chemical causes of psychosis remain constant, it is true that delusions themselves tend to vary depending on culture and era. For example:

In desert regions, people can suffer from a delusion known as Turabosis, which is the belief that they are covered in sand.

In Shanghai, deluded people often believe they are being pricked with poisonous needles.

In 1940s America, people suffering from delusions often thought their minds were being controlled by Japanese via radio waves. In the 1950s, these mind controllers became Soviet spies with satellites and in the 1970s, people began to report that the CIA was implanting their dental fillings with thought control chips.

The Truman Show Delusion is not officially recognized nor listed in the Diagnostic and Statistical Manual of the American Psychiatric Association.