Rachel Phillip (name changed) is terrified of a television news anchor. She feels he is watching her and is out to get her. Phillip suffers from schizophrenia and so experiences delusions. She is undergoing treatment for the illness, where the spectre of live television is so debilitating and the sense of being watched by the TV, instead of watching the TV, so overwhelming that it interferes with her everyday life.
As cultural contexts and social landscapes change with the advent of technology and newer forms of popular culture, the contents of delusions have transformed drastically. From themes of black magic, strangers chanting evil mantras and visions of gods that were a common theme until 10 years ago, the delusional palette has exploded with technology.
No academic work has been done on the changing content of delusions in India. The most famous work in the West is on the ‘Truman Show’ delusion, where its authors identified it as a separate syndrome. Here patients feel they are trapped in a reality show, their lives broadcast to a watching audience globally, drawing on the 1998 Jim Carrey film where the protagonist is unwittingly on television 24/7.
Dr Joel Gold, clinical associate professor, department of psychiatry, NYU School of Medicine, with his brother Ian first described and wrote about the “Truman Show” delusion.
“We first described the delusion in 2006. It got some media attention in 2008. Our journal article was published in 2012. I cannot tell you how many patients I have spoken to or corresponded with who have the delusion, but I imagine it is dozens,” Dr Joel Gold told HT in an email interview.
Psychiatrists across the country attest to this shift, with urban populations showing a marked move towards delusions coloured by Google Apps, Wikileaks, CCTVs and website tracking. Doctors in cities as diverse as Mumbai, Chandigarh, Udaipur and Bangalore spoke of this evolution, many saying such technology-driven delusions constituted half their cases. “Patients’ delusions are coloured by the current knowledge that they have,” said Dr BN Gangadhar, professor, National Institute of Mental Health and Neurosciences, Bangalore. “They used to say that God comes and speaks to us or a satellite is watching us; those concepts have definitely changed as modern science has changed… This is more so in the literate and urban population.”
Gangadhar has treated a patient suffering from the “delusion of doubles”, a veritable sci-fi plot, where the person believed his genetic code had been cracked and a clone of himself created using that information.
With the proliferation of cameras and reality show-focussed entertainment, patients are no longer just being ‘followed’ like before. Popular delusions relate to being tracked through Google and Yahoo, having search engines throwing up a person’s name to the world all the time, and being followed through phone apps that reveal one’s location.
“Now more than half the cases are about these things,” said Dr SK Sharma, professor, RNT Medical College, Udaipur. “Five years ago, it would have been less than 10%.”
While mentally fit people might also feel besieged, in some cases, this becomes mental illness. “The sense of being under scrutiny has increased,” said Dr Harish Shetty, a Mumbai-based psychiatrist. “People feel that Obama and Assange are watching them. They think ‘I have to live underground’ and that they are being persecuted by such individuals.”
A delusion is defined in psychiatric terms as a false, unshakeable belief held with deep conviction without a basis in reality and not in keeping with the socio-cultural background of the person. Delusions cut across cultures and could arise out of different underlying conditions such as schizophrenia or depression. “A delusion is a psycho-pathological construct that will vary according to the context,” said Dr R Raguram, a Bangalore-based psychiatrist and senior academician with an interest in cultural psychiatry. “People following you is not a new phenomenon. The variation has occurred because of the changes in media and exposure. The basic feeling is you are being observed. The content will keep varying depending on cultural influences.”
As a result, psychiatrists said, rural populations might not experience this extent of technological delusions, and older forms still do take root.
However, psychiatrists said that although the kinds of delusions have evolved, the disease has not changed, and treatment too, is broadly the same. “There is no real evidence that the nature of schizophrenia has changed appreciably over the course of time,” Dr MS Keshavan, professor at the Harvard Medical School, Boston, told HT in an email conversation. “Medication treatments for schizophrenia have not changed in a substantive way over the last 60-plus years when antipsychotic medications were introduced. They still remain the mainstay of treatment.” However, psychotherapy has found an expanded role. “Medications are needed to address the basic form of delusional nature of thinking, while psychotherapy is needed to help understand and reframe the content of delusions such as the Truman delusions,” he said.