• 'Truman show' delusion: Believing your life is a reality TV show

    Paramount Pictures

    By Brian Alexander, NBC News Contributor

    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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  • When one hand develops a mind of its own

    Alien hands are sometimes known as "Dr. Strangelove syndrome," named for the character in Stanley Kubrick's famous 1964 film, in which Dr. Strangelove's right arm repeatedly tries to give a Nazi salute, and he must beat it down again and again with his left arm.

    You know that saying "the left hand doesn't know what the right is doing"? For people with a strange disorder called alien hand syndrome, that's literally true -- the neuropsychiatric condition makes them feel as if one of their hands has taken on a mind of its own.

    "An alien hand is an arm and hand that moves when the person to whom that arm belongs does not intend it to move," says Dr. Ken Heilman, a neurologist at the University of Florida College of Medicine in Gainesville, Fla. Heilman goes on to note that there are many neurological conditions that cause an arm to move unintentionally -- like seizures or tremors, and movement disorders such as chorea, dystonia and athetosis. Here's the difference: In each of those cases, if the arm moves, it's pretty much just flailing about purposelessly, "but with an alien hand, the movement appears to be purposeful." Creepy.

    Heilman recalls one patient whose hands actually fought over fashion: Her right hand took a pair of red shoes out of the closet. Her left hand -- the "alien" hand -- pulled the red shoes out of her right hand, put them back and picked up a pair of blue shoes. When the right hand went again for the red shoes, the left hand slammed the closet door on the right hand.

    A German neurologist and psychiatrist named Kurt Goldstein was the first to report a case of alien hand syndrome in 1908. His patient's left hand seemed to do whatever it pleased, including, at least once, an attempt to throttle its owner. It's most commonly the result of an injury to an area of the brain called the corpus callosum, which is, as Heilman describes it, "the major cable connecting the two hemispheres." (The injury often happens during surgery, such as an attempt to curb seizures, but it can also happen in stroke victims.) That injury prevents the two hemispheres from communicating, and because each side controls different behaviors and different hands, the confusion begins.

    Usually, it's the left hand that is thought to be "alien," because that's the one controlled by the right hemisphere; the left hemisphere has no control over that hand, but it does control language, which gives the person the words to think, What is happening to my left hand?!

    And it's always an alien hand, never an alien leg or foot. The brain has more bilateral control over the legs than it does the arms, Heilman explains. "The hand is this thing that does purposeful movement," he says. "We don't do a lot with our feet."

    In one recorded case of alien hand syndrome, while a 67-year-old man slept, his hand did not; as a 1997 medical journal article reports, his hand "crept and crawled, especially at night, which caused him to awaken by grasping his collar." He solved his problem by wearing an oven mitt as he slept. But that guy had it easy. According to a 2000 journal article, a 73-year-old man's alien hand had a humiliating favorite hobby: masturbation.

    Another more common (but less creepy) version of alien hand syndrome is an uncontrollable grasp reflex, which causes a patient to reach out and grab whatever is set in front of him, just like a baby would. (It's caused by an injury to the frontal lobe, which suppresses that grasping reflex as we mature.)

    Alien hand syndrome is an extremely uncommon phenomenon -- most physicians have never even heard of it, says Heilman, who has only seen two patients exhibiting the more extreme kinds of symptoms. But it's popped up from time to time in pop culture.

    The condition is sometimes known as "Dr. Strangelove syndrome," named for the titular character in Stanley Kubrick's famous 1964 film, in which Dr. Strangelove's right arm repeatedly tries to give a Nazi salute, and he must beat it down again and again with his left arm. More recently, "30 Rock's" live episode on Oct. 14 took on the spirit of the alien hand idea, featuring Jon Hamm in two fake, "Saturday Night Live"-style "commercials" for hand transplants gone totally wrong. (The late-1990s horror flick "Idle Hands" also nodded to the creepiness of the uncontrollable hand concept, but unless you, too, were a 14-year-old 8th grader in 1999 with a giant crush on Devon Sawa, you probably don't remember that one.)

    In the real world, there isn't anything that can "cure" or even treat alien hand syndrome, Heilman says. Patients usually just come up with creative ways to keep their own appendages in check. "I had a patient who sat on his left hand," he says. "Many others treat their alien hand as if it were a disruptive child."

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