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Just when you thought those annoying Kardashians couldn’t mess with your head any more than they already do, consider “Mr. A.” When he first saw the psychiatrist, he demanded to speak to “the director” of the reality show in which he was starring.

When “Mr. B.” met psychiatric workers, he informed them that he was being continuously taped for national broadcast. “Mr. D.” really was working on a reality show -- until he came to believe that he was the actual star.

All these people, and others, suffered from the delusion that they were serving as entertainment for others. All of them specifically cited the 1998 movie “The Truman Show,” written by Andrew Niccol, directed by Peter Weir, and starring Jim Carrey. In the movie, Carrey plays an insurance man living in a town that’s actually a TV set and populated by actors he thinks are his friends, family and neighbors.

Psychiatrist Joel Gold, in private practice and a professor of psychiatry at New York University, and his brother Ian Gold, a philosopher of psychiatry at McGill University, writing in the most recent issue of the journal Cognitive Neuropsychiatry, dub this the "Truman Show" delusion. They ask “Can a case be made that the phenomenon of reality television might interact with the expression of psychotic symptoms?”

The answer, they argue, is most definitely yes.

They suggest that “reality television resonates with a common anxiety about one’s position in the social hierarchy…. Someone who is particularly anxious about their social status, therefore, might experience reality television as presenting a significant social threat, or a tantalizing possibility of success, or both. In the life of such a person, reality television might act as a significant stress, the effects of which might include a persecutory or grandiose delusion of the Truman Show type.”

It’s not that watching lots of reality TV causes a mental illness (believe it or not). Rather, an existing or nascent illness, like schizophrenia, interacts with the cultural pervasiveness of reality TV to give form to the delusion. It’s a little like those unstable people who go to Jerusalem and experience “Jerusalem Syndrome,” the belief that they’re characters from the Bible.

The Golds wrote the paper because they think the environmental associations with psychosis don’t get enough attention. “We think in North America that it’s overlooked,” he said in an interview.

“We are interested in the way society as a whole has changed,” he said, “With the advent of reality TV and closed circuit TVs in cities such as London where people are truly observed, and the Internet with YouTube, what impact might that have on people otherwise predisposed to grandiosity and paranoia?”

As the Golds point out, delusions fall into a limited number of standard types no matter where the sufferer lives. People from Saudi Arabia tend to have delusions about being covered in sand. People in the U.S. tend to have delusions about being followed by the CIA. The specific content of the delusion can be culturally based.

For example, in this month’s issue of the International Journal of Social Psychiatry, researchers from Maywood University studied records from a state psychiatric institution across the last century and found that while the categories of delusions were the same as today -- such as persecutory, religious or grandiose -- the content of the delusion depended on whatever was happening in the culture at the time.

At the moment, we’re steeped in “reality” television, so it’s no wonder, the Golds suggest, that people with a mental illness might get the idea they’re the next Bethenny Frankel.

Science has not yet pinned down the root biological causes of delusions. A leading theory involves the way the chemical dopamine activates motivational brain circuitry. A person suffering from a delusion may not just notice that there’s an anchorman on TV is wearing a yellow tie, he might attach enormous importance to that fact, and come to believe that the yellow tie is communicating some vital message. The social brain may also be impaired. What scientists call “Theory of Mind” -- the ability to figure out what others are thinking and feeling -- may be misfiring. The brains of the delusional may also be too quick to jump to conclusions about common experience.

“If a car is bearing down on you, you see it as a threat,” Gold explained. “You better get out of the way. Well, there are two blue cars parked outside my home, and two days ago, there was also a blue car. Is there something to that? Is it a threat? You could build a delusion around that.”

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young PhD., of "The Chemistry Between Us: Love Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com)  to be published Sept. 13.

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