Hektoen International

A Journal of Medical Humanities

The Truman delusion: All the world’s a stage

Howard Fischer
Uppsala, Sweden

“All the world’s a stage / And all the men and women merely players”
– William Shakespeare, As You Like It, Act 2, Scene 7
“You know you’ve made it when you have a disease named after you.”
– Andrew Niccol, writer of The Truman Show

Three surveillance cameras on the corner of a building. Photo by Hustvedt on Wikimedia. CC BY-SA 3.0

Movies may influence people in unexpected ways. An example of this phenomenon is the effect of the film The Truman Show (1998). In this movie, Truman Burbank is the unwitting star of a television program about his life. The program started at his birth and is still running when the movie starts, when he is thirty years old. He does not know that he is being filmed twenty-four hours a day, seven days a week. The people in his small town are all actors, including his “family” and “friends.” The small town is enclosed in a gigantic dome, and the TV show’s director controls the rising and setting of the sun, as well as the town’s weather. The show is watched by over one billion people in more than 200 countries. During the two weeks that the movie covers, Truman starts noticing clues that he is the victim of a massive fraud. He is also prevented from leaving the island on which his small town is located—by his fear of water, a result of seeing his “father” “drown” in a boating accident. When he overcomes his fear, a series of improbable events are staged (forest fires, nuclear reactor leaks) to keep him from driving over a bridge. He steals a sailboat, reaches the outer wall of the dome, finds an exit, and escapes.1

The film has been called, variously, a critique of the omnipresent surveillance in our lives, of reality television, of the power of the media, and of voyeurism. It has also been called an allegory of an adolescent reaching adulthood.2

Psychiatrist Joel Gold saw, starting in 2002, patients who believed that their life was a scripted reality show, or that they were being constantly observed by cameras. Gold and his brother, neuroscientist and philosopher Ian Gold, noticed that three of the first five patients with schizophrenia who presented with such beliefs specifically mentioned The Truman Show film.3 Such delusions (that is, fixed fallacious beliefs) are not new. In the 1940s, psychotic patients believed that their brains were being controlled by radio waves, and currently they may say that a computer chip has been implanted in their brain. A 1959 science fiction story by Philip K. Dick, “Time out of Joint,” has a protagonist who believes that he lives in a “created world” and that his family and friends (as in The Truman Show) are paid actors.4

In our society, with so much technology and surveillance, Ian Gold has said that “cultural realities are always intruding into psychotic experience.”5 Historian of medicine Roy Porter puts it bluntly: “Every age gets the lunatics it deserves.”6 Joel Gold had a patient who traveled to New York City to verify that the World Trade Center towers had really been destroyed on September 11, 2001. He wanted to be sure that the destruction was not a hoax, a part of “his reality show.”7

Patients with a Truman delusion may be in a prodromal phase of schizophrenia. Fusar-Poli, a psychiatrist in the UK, described8 a twenty-six-year-old mailman who felt that “something subtle was going on around him that others knew about, but he didn’t.” People were “acting.” He felt like he was in a television show. At the patient’s first visit, Fusar-Poli thought that he had an “at risk mental state.” After being followed for nine months, the patient worsened and developed delusions of persecution, and was finally diagnosed as having schizophrenia. His symptoms resolved with pharmacologic treatment. Several hundred cases of Truman syndrome have been reported from around the world.9

Psychologist Jill Weber wrote that these patients would have become psychotic with or without The Truman Show film.10 The brothers Gold do not disagree. They consider the Truman syndrome to be simply a variant of grandiose and of persecution delusions.11 The American Psychological Association agrees that the syndrome shows “no distinct features to distinguish it from other types of delusions.”12

Final thoughts about The Truman Show film: “Nothing is ever as it seems.”13

The audience watching The Truman Show on round-the-clock television see “nothing wrong with the fact that Truman’s freedom is the cost of their fun.”14


  1. Patrick Weir, dir, Andrew Niccol, writer. The Truman Show, 1998. Paramount.
  2. “The Truman Show.” Wikipedia.
  3. Joel Gold and Ian Gold. Suspicious Minds: How Culture Shapes Madness. New York: Free Press, 2014.
  4. Gold and Gold, Suspicious Minds.
  5. Emily Maskell. “The Truman Show: Has a film ever predicted the future so accurately?” BBC Culture, June 1, 2003.
  6. Gary Greenberg. “The delusions we deserve,” New York Times, August 28, 2014.
  7. Truman Show delusion.” Wikipedia.
  8. Paolo Fusar-Poli et al. “’Truman’ signs and vulnerability to psychosis,” Brit J Psychiatr, 193(68), January 2, 2018.
  9. Suzanne Wright. “The Truman show delusion: Real or imagined?” WebMD, August 6, 2008. https://www.webmd.com/mental-health/features/truman-show-delusion-real-imagined.
  10. Truman Show delusion,” Wikipedia.
  11. Wright, “Real or imagined?”
  12. American Psychological Association. “Truman show delusion.” APA Dictionary of Psychology. https://dictionary.apa.org/truman-show-delusion.
  13. Gina Wurtz. “The hidden meaning of the Truman show.” The Daily Fandom, October 5, 2020. https://thedailyfandom.org/the-hidden-meaning-in-the-truman-show/.
  14. Megan Garber. “The real lesson of The Truman Show.” The Atlantic, June 10, 2023. https://www.theatlantic.com/culture/archive/2023/06/the-truman-show-25-years-later/674456/.

HOWARD FISCHER, M.D., was a professor of pediatrics at Wayne State University School of Medicine, Detroit, Michigan.

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