The Truman Show and the Air Loom
How culture shapes psychopathology
Have you ever felt that you’re being watched? Or that people around you are actors? Perhaps the ceiling light feels unnaturally bright, like a film studio? Has the world felt odd or unreal lately? Or maybe you just can’t quite put your finger on it…but something is definitely up.
The slow realisation of being the unwitting subject of a reality TV show is the subject of The Truman Show, a 1998 film starring Jim Carrey, in which the titular character’s life is constantly and secretly recorded for the viewing public’s entertainment. Everyone he interacts with - his wife, neighbours, best friend - are actors, while his whole world is a massive studio containing thousands of hidden cameras. Every element of his life, right down to the weather, is under the control of a group of sinister TV executives.
Truman starts noticing strange occurrences: a studio light falling from the sky or a radio frequency that comments on his movements. There is a disturbing scene when he grabs his wife around the neck after hearing her talk to the audience and producers. Eventually he sails to the edge of the studio and iconically leaves the filmset through an exit door.
The feeling of being in a TV show, if fleeting and open to reason, doesn’t necessarily indicate a mental illness. I hope so anyway, as I have experienced it myself. In the context of a hospital environment, with bright artificial light and in the midst of sleep-deprivation, I interviewed a patient who had just been admitted to the ward. During our conversation, I began to suspect the patient was actually an actor, like the ones I had previously met in practical examinations. His answers to my questions seemed just too textbook. I wondered whether I was being watched or filmed. I felt like I should speak carefully and not make any mistakes.
Thankfully this feeling passed but it did make me think how unusual beliefs might form. At the more extreme end, when these beliefs become unshakeable, preoccupying, and impairing, we might classify them as delusions. Culture influences our interpretation of internal experiences and thus the expression of psychopathology.
The Air Loom
How were delusions interpreted before the age of surveillance? Explanations may have come from religious experiences, magic or witchcraft. A common delusional experience is that of being influenced by an external agent. This might involve the feeling that someone is controlling your body or your thoughts. Often the explanation is attributed to a new mysterious technology.
The case of James Tilly Matthews is an excellent, well-documented example. Matthews was a London tea-broker, admitted to Bethlem hospital in 1797 after disrupting a debate in the House of Commons, shouting ‘treason’ at the Home Secretary from the public gallery.
Friends of Matthews argued that he was sane and should be released from hospital. The resident apothecary at Bethlem, John Haslam, opposed this, compiling a detailed case report of Matthews’ symptoms. This report, Illustrations of Madness, contained verbatim descriptions of his symptoms and is considered one of the earliest accounts of paranoid schizophrenia. (Sadly, Haslam was also accused of mistreating Matthews due to personal animosity).
A notable part of the report is the description and illustration by Matthews of the Air Loom. This was a device, employed by a gang of spies and criminals skilled in pneumatic chemistry. It was used to influence the thoughts of both Matthews and influential politicians. The operator appears to send rays from the machine which infiltrate the mind and body of the victim. The instrument was hidden close to Bethlem hospital where it could exert control over Matthews.
The device described by Matthews bore resemblance to the power loom, which was invented in 1786 and was a key development in the industrialisation of weaving. The loom likely represented Matthews’ idea of the most cutting edge technology of his day, and the best explanation of how his thoughts were being influenced. The device itself appears archaic to modern psychiatrists but the idea behind it, that shadowy operants might be using a machine to exert influence over people’s thoughts, is commonplace.
The latest technology has always served as an explanation for feelings of being watched or influenced. Could single pieces of art, such as a film, similarly provide a patient with an explanation of their unusual beliefs? To my knowledge, The Truman Show, might be the most notable example.
Truman signs
The first case report relating to The Truman Show came ten years after the film, published in the British Journal of Psychiatry by Paolo Fusar-Poli and colleagues:
Mr M.A., a 26-year-old postman, presented with the feeling there was something subtle going on around him that others knew about but he didn’t. He had a vague sense that people around him were ‘acting’, he was the focus of their interest and they knew a secret that was being kept from him. Furthermore he felt ‘detached from the environment’ and had a sense the world was slightly unreal, as if he was the eponymous hero in the film The Truman Show. He was preoccupied with the belief that he was the focus of something that he couldn’t quite understand. At no point did his conviction reach delusional intensity. There was no evidence of hallucinations, thought disorder, odd behaviour or other features of psychosis.
Fusar-Poli describes this individual later going on to develop grandiose and persecutory delusions, which are diagnosed as schizophrenia. In this case, the Truman sign of being the subject of a film in a fabricated world was a prodromal symptom of psychosis. The authors report that this sign is common in people presenting to their clinic for people ‘at risk’ for psychosis. In a small follow-up study, they found that half of people attending such clinics reported Truman signs, while it was absent in all healthy controls. However, they did not report how many of the sample went on to develop frank psychosis.
Although the interpretation of being filmed for a reality show is quintessentially modern, having the sense that something is ‘in the air’, is a well documented concept, delusional mood. It is thought to represent a prodromal state, as described by the psychiatrists (and later Nazi party member) Klaus Conrad.
His conceptualisation of delusional mood is described in a paper by Aaron Mishara:
In his interview with Conrad, the patient reports that ‘‘everything begins’’ one morning as his unit breaks to leave camp. When the sergeant asks him for the key to his quarters, it is suddenly clear to him that it is a ploy to ‘‘test’’ him. While departing in the bus, he notices that his comrades are behaving strangely: They know something that he is not supposed to know. One of his comrades asks ‘‘conspicuously’’ if he has any bread. In the pub that evening, the music, the woman selling cigarettes, and the conversations have been prearranged to test whether he notices. Everyone has been instructed and knows exactly what to do.
Conrad calls this initial phase as Trema or stage-fright. The patient has the expectation that something important is about to happen. The perceptual background, previously unnoticed, takes on a character of its own as the sense of threat spreads. The delusions, when they appear, represent an aha! moment, resolving the sense of perplexity. The delusions themselves co-incidentally hark back to the Air Loom, updated to the technology of the day:
When he reaches Conrad’s military hospital, the delusions have progressed from external space to the inner space of his body. The patient reports that a “wave apparatus” controls his movements from some distance through electric current. Adjusted by a dial, the current changes from having negligible control over his movements, preserving his “free will,” to having complete control, at which point, the machine “inputs” commands.
The Truman Show delusion
Truman signs may be a harbinger of impending psychosis, but The Truman Show has also formed part of patients’ complex delusional belief systems. A case series of five patients with Truman Show delusions was published in 2012 by two sibling professors, Joel and Ian Gold.
These five patients presented at various times to the same hospital in New York City, each believing they were being filmed, with three of them referring to The Truman Show by name.
The one which mirrors the film most closely is Patient 1:
Mr A. was admitted after he scuffled with security at a federal building. He said that his life was like The Truman Show and that he had come to ask for asylum. He had held this belief for five years, and although he lived with family, they were not aware of his delusions until several days prior to admission; he had only told a friend about it two weeks prior to admission. He believed that the attacks of 9/11 were fabricated as part of his narrative. He had travelled from out-of-state in order to see if the World Trade Centre had in fact been destroyed; if the towers were standing, he would have proof that he was on the show. On first presentation, he demanded to speak to ‘‘the director’’. He said that since he had seen The Truman Show, he believed that all the individuals in his life were part of the conspiracy. He also believed he had cameras in his eyes.
Imagine how frightening it must be to be utterly convinced that everyone was filming you using cameras hidden in their eyes. To be so convinced that you believe the World Trade Centre is still standing in New York. Much like this patient, many people admitted to hospital with acute psychotic episodes believe the nurses and doctors are imposters - out to harm rather than care for them.
Conclusion
Of course ideas of Air Looms and Truman Shows don’t cause delusional thoughts, rather they offer explanations for unusual emotional states or sensations associated with a developing psychosis. They provide the aha! moment as to why a person’s thoughts do not feel like their own or why the world seems unreal or why other people seem fake - it is because they are under the influence of invisible rays or being filmed for a reality show.
The Golds conclude that delusions are both variable and stable: specific delusional ideas (the content) are influenced by culture, but broad categories (the form) are stable both across time and culture. The content of delusions, change across time and cultures. They may follow consistent themes - for example persecutory, grandiose or nihilistic - but how a person interprets them is dependent on their own cultural milieu. This demonstrates a maxim about psychosis - there may be common underlying biological mechanisms, but each patient must be seen in the context of their own personal cultural background.
Thank you for this. It helped me to understand my friend's experience a little better.