Capgras delusion

Capgras delusion
Other names	Capgras syndrome
Pronunciation	/kæpˈɡrɑː/ kap-GRAH
Specialty	Psychiatry

Capgras delusion is a psychiatric disorder in which a person holds a delusion that a friend, spouse, parent, or other close family member (or pet) has been replaced by an identical impostor. It is named after Joseph Capgras (1873–1950), a French psychiatrist.

The Capgras delusion is classified as a delusional misidentification syndrome, a class of delusional beliefs that involves the misidentification of people, places, or objects. It can occur in acute, transient, or chronic forms. Cases in which patients hold the belief that time has been "warped" or "substituted" have also been reported.

The delusion most commonly occurs in individuals diagnosed with paranoid schizophrenia but has also been seen in brain injury, dementia with Lewy bodies, and other dementia. It presents often in individuals with a neurodegenerative disease, particularly at an older age. It has also been reported as occurring in association with diabetes, hypothyroidism, and migraine attacks. In one isolated case, the Capgras delusion was temporarily induced in a healthy subject by the drug ketamine. It occurs more frequently in females, with a female to male ratio of approximately 3 to 2.

Signs and symptoms

The following two case reports are examples of the Capgras delusion in a psychiatric setting:

Mrs. D, a 74-year-old married housewife, recently discharged from a local hospital after her first psychiatric admission, presented to our facility for a second opinion. At the time of her admission earlier in the year, she had received the diagnosis of atypical psychosis because of her belief that her husband had been replaced by another unrelated man. She refused to sleep with the impostor, locked her bedroom and door at night, asked her son for a gun, and finally fought with the police when attempts were made to hospitalise her. At times she believed her husband was her long deceased father. She easily recognised other family members and would misidentify her husband only.

— Passer and Warnock, 1991

Diane was a 28-year-old single woman who was seen for an evaluation at a day hospital program in preparation for discharge from a psychiatric hospital. This was her third psychiatric admission in the past five years. Always shy and reclusive, Diane first became psychotic at age 23. Following an examination by her physician, she began to worry that the doctor had damaged her internally and that she might never be able to become pregnant. The patient's condition improved with neuroleptic treatment but deteriorated after discharge because she refused medication. When she was admitted eight months later, she presented with delusions that a man was making exact copies of people—"screens"—and that there were two screens of her, one evil and one good. The diagnosis was schizophrenia with Capgras delusion. She was disheveled and had a bald spot on her scalp from self-mutilation.

— Sinkman, 2008

The following case is an instance of the Capgras delusion resulting from a neurodegenerative disease:

Fred, a 59-year-old man with a high school qualification, was referred for neurological and neuropsychological evaluation because of cognitive and behavioural disturbances. He had worked as the head of a small unit devoted to energy research until a few months before. His past medical and psychiatric history was uneventful. [...] Fred's wife reported that about 15 months from onset he began to see her as a "double" (her words). The first episode occurred one day when, after coming home, Fred asked her where Wilma was. On her surprised answer that she was right there, he firmly denied that she was his wife Wilma, whom he "knew very well as his sons' mother", and went on plainly commenting that Wilma had probably gone out and would come back later. [...] Fred presented progressive cognitive deterioration characterised both by severity and fast decline. Apart from [Capgras disorder], his neuropsychological presentation was hallmarked by language disturbances suggestive of frontal-executive dysfunction. His cognitive impairment ended up in a severe, all-encompassing frontal syndrome.

— Lucchelli and Spinnler, 2007

Causes

It is generally agreed that the Capgras delusion has a complex and organic basis (caused by structural damage to organs) and can be better understood by examining neuroanatomical damage associated with the syndrome.

In one of the first papers to consider the cerebral basis of the Capgras delusion, Alexander, Stuss and Benson pointed out in 1979 that the disorder might be related to a combination of frontal lobe damage causing problems with familiarity and right hemisphere damage causing problems with visual recognition.

Further clues to the possible causes of the Capgras delusion were suggested by the study of brain-injured patients who had developed prosopagnosia. In this condition, patients are unable to recognize faces consciously, despite being able to recognize other types of visual objects. However, a 1984 study by Bauer showed that even though conscious face recognition was impaired, patients with the condition showed autonomic arousal (measured by a galvanic skin response measure) to familiar faces, suggesting that there are two pathways to face recognition—one conscious and one unconscious.

In a 1990 paper published in the British Journal of Psychiatry, psychologists Hadyn Ellis and Andy Young hypothesized that patients with Capgras delusion may have a "mirror image" or double dissociation of prosopagnosia, in that their conscious ability to recognize faces was intact, but they might have damage to the system that produces the automatic emotional arousal to familiar faces. This might lead to the experience of recognizing someone while feeling something was not "quite right" about them. In 1997, Ellis and his colleagues published a study of five patients with Capgras delusion (all diagnosed with schizophrenia) and confirmed that although they could consciously recognize the faces, they did not show the normal automatic emotional arousal response. The same low level of autonomic response was shown in the presence of strangers. Young (2008) has theorized that this means that patients with the disease experience a "loss" of familiarity, not a "lack" of it. Further evidence for this explanation comes from other studies measuring galvanic skin responses (GSR) to faces. A patient with Capgras delusion showed reduced GSRs to faces in spite of normal face recognition. This theory for the causes of Capgras delusion was summarised in Trends in Cognitive Sciences in 2001.

William Hirstein and Vilayanur S. Ramachandran reported similar findings in a paper published on a single case of a patient with Capgras delusion after brain injury. Ramachandran portrayed this case in his book Phantoms in the Brain and gave a talk about it at TED 2007. Since the patient was capable of feeling emotions and recognizing faces but could not feel emotions when recognizing familiar faces, Ramachandran hypothesizes that the origin of Capgras syndrome is a disconnection between the temporal cortex, where faces are usually recognized (see temporal lobe), and the limbic system, involved in emotions. More specifically, he emphasizes the disconnection between the amygdala and the inferotemporal cortex.

In 2010, Hirstein revised this theory to explain why a person with Capgras syndrome would have the particular reaction of not recognizing a familiar person. Hirstein explained the theory as follows:

my current hypothesis on Capgras, which is a more specific version of the earlier position I took in the 1997 article with V. S. Ramachandran. According to my current approach, we represent the people we know well with hybrid representations containing two parts. One part represents them externally: how they look, sound, etc. The other part represents them internally: their personalities, beliefs, characteristic emotions, preferences, etc. Capgras syndrome occurs when the internal portion of the representation is damaged or inaccessible. This produces the impression of someone who looks right on the outside, but seems different on the inside, i.e., an impostor. This gives a much more specific explanation that fits well with what the patients actually say. It corrects a problem with the earlier hypothesis in that there are many possible responses to the lack of an emotion upon seeing someone.

Furthermore, Ramachandran suggests a relationship between the Capgras syndrome and a more general difficulty in linking successive episodic memories because of the crucial role emotion plays in creating memories. Since the patient could not put together memories and feelings, he believed objects in a photograph were new on every viewing, even though they normally should have evoked feelings (e.g., a person close to him, a familiar object, or even himself). Others like Merrin and Silberfarb (1976) have also proposed links between the Capgras syndrome and deficits in aspects of memory. They suggest that an important and familiar person (the usual subject of the delusion) has many layers of visual, auditory, tactile, and experiential memories associated with them, so the Capgras delusion can be understood as a failure of object constancy at a high perceptual level.

Most likely, more than just an impairment of the automatic emotional arousal response is necessary to form the Capgras delusion, as the same pattern has been reported in patients showing no signs of delusions. Ellis suggested that a second factor explains why this unusual experience is transformed into a delusional belief; this second factor is thought to be an impairment in reasoning, although no definitive impairment has been found to explain all cases. Many have argued for the inclusion of the role of patient phenomenology in explanatory models of the Capgras syndrome in order to better understand the mechanisms that enable the creation and maintenance of delusional beliefs.

Capgras syndrome has also been linked to reduplicative paramnesia, another delusional misidentification syndrome in which a person believes a location has been duplicated or relocated. Since these two syndromes are highly associated, it has been proposed that they affect similar areas of the brain and therefore have similar neurological implications. Reduplicative paramnesia is understood to affect the frontal lobe, and thus it is believed that Capgras syndrome is also associated with the frontal lobe. Even if the damage is not directly to the frontal lobe, an interruption of signals between other lobes and the frontal lobe could result in Capgras syndrome.

Diagnosis

Because it is a rare and poorly understood condition, there is no definitive way to diagnose the Capgras delusion. Diagnosis is primarily made on a psychiatric evaluation of the patient, who is most likely brought to a psychiatrist's attention by a family member or friend believed to be an imposter by the person under the delusion.

Treatment

Treatment has not been well studied and so there is no evidence-based approach. Treatment is generally therapy, often with support of antipsychotic medication.

History

Capgras syndrome is named after Joseph Capgras, a French psychiatrist who first described the disorder in 1923 in his paper co-authored by Jean Reboul-Lachaux, on the case of a French woman, "Madame Macabre," who complained that corresponding "doubles" had taken the places of her husband and other people she knew. Capgras and Reboul-Lachaux first called the syndrome "l'illusion des sosies", which can be translated literally as "the illusion of look-alikes."

The syndrome was initially considered a purely psychiatric disorder, the delusion of a double seen as symptomatic of schizophrenia, and purely a female disorder (though this is now known not to be the case) often noted as a symptom of hysteria. Most of the proposed explanations initially following that of Capgras and Reboul-Lachaux were psychoanalytical in nature. It was not until the 1980s that attention was turned to the usually co-existing organic brain lesions originally thought to be essentially unrelated or accidental. Today, the Capgras syndrome is understood as a neurological disorder, in which the delusion primarily results from organic brain lesions or degeneration.

Cultural references

In the Memoirs Found in a Bathtub novel by the Polish writer Stanisław Lem, first published in 1961 the narrator inhabits a paranoid dystopia where nothing is as it seems, chaos seems to rule all events, and everyone is deeply suspicious of everyone. In the end, it is revealed that the world is filled by phantom body doubles.

A central character in Richard Powers's 2006 novel The Echo Maker suffers from Capgras Delusion subsequent to traumatic brain injury.

The protagonist in the movie Synecdoche, New York, who is named Caden Cotard (played by Philip Seymour Hoffman), goes to see his ex-wife at her apartment, and, as he enters the building, one of the resident call boxes is taped with the name "Capgras". He is then misidentified as his ex-wife's cleaning lady, Ellen Bascomb, as he tries to enter the apartment, and, later in the film, he actually comes to play the role of Ellen Bascomb in his own play. Throughout the film, Cotard enlists actor-doubles to play actors, and, as the film progresses, the actor-doubles are in turn then given actors-doubles.

Delusion

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Delusion 

 

Delusion
Specialty	Psychiatry

A delusion is a fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, or some other misleading effects of perception.

Delusions have been found to occur in the context of many pathological states (both general physical and mental) and are of particular diagnostic importance in psychotic disorders including schizophrenia, paraphrenia, manic episodes of bipolar disorder, and psychotic depression.

Types

Delusions are categorized into four different groups:

• Bizarre delusion: Delusions are deemed bizarre if they are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences. An example named by the DSM-5 is a belief that someone replaced all of one's internal organs with someone else's without leaving a scar, depending on the organ in question.
• Non-bizarre delusion: A delusion that, though false, is at least technically possible, e.g., the affected person mistakenly believes that they are under constant police surveillance.
• Mood-congruent delusion: Any delusion with content consistent with either a depressive or manic state, e.g., a depressed person believes that news anchors on television highly disapprove of them, or a person in a manic state might believe they are a powerful deity.
• Mood-neutral delusion: A delusion that does not relate to the sufferer's emotional state; for example, a belief that an extra limb is growing out of the back of one's head is neutral to either depression or mania.

Themes

In addition to these categories, delusions often manifest according to a consistent theme. Although delusions can have any theme, certain themes are more common. Some of the more common delusion themes are:

• Delusion of control: False belief that another person, group of people, or external force controls one's general thoughts, feelings, impulses, or behavior.
• Cotard delusion: False belief that one does not exist or that one has died.
• Delusional jealousy: False belief that a spouse or lover is having an affair, with no proof to back up their claim.
• Delusion of guilt or sin (or delusion of self-accusation): Ungrounded feeling of remorse or guilt of delusional intensity.
• Delusion of mind being read: False belief that other people can know one's thoughts.
• Delusion of thought insertion: Belief that another thinks through the mind of the person.
• Delusion of reference: False belief that insignificant remarks, events, or objects in one's environment have personal meaning or significance. "Usually the meaning assigned to these events is negative, but the 'messages' can also have a grandiose quality."
• Erotomania: False belief that another person is in love with them.
• Religious delusion: Belief that the affected person is a god or chosen to act as a god.
• Somatic delusion: Delusion whose content pertains to bodily functioning, bodily sensations or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal or changed. A specific example of this delusion is delusional parasitosis: Delusion in which one feels infested with insects, bacteria, mites, spiders, lice, fleas, worms, or other organisms.
• Delusion of poverty: Person strongly believes they are financially incapacitated. Although this type of delusion is less common now, it was particularly widespread in the days preceding state support.

Grandiose delusions or delusions of grandeur are principally a subtype of delusional disorder but could possibly feature as a symptom of schizophrenia and manic episodes of bipolar disorder. Grandiose delusions are characterized by fantastical beliefs that one is famous, omnipotent or otherwise very powerful. The delusions are generally fantastic, often with a supernatural, science-fictional, or religious bent. In colloquial usage, one who overestimates one's own abilities, talents, stature or situation is sometimes said to have "delusions of grandeur". This is generally due to excessive pride, rather than any actual delusions. Grandiose delusions or delusions of grandeur can also be associated with megalomania.

Persecutory delusions

Persecutory delusions are the most common type of delusions and involve the theme of being followed, harassed, cheated, poisoned or drugged, conspired against, spied on, attacked, or otherwise obstructed in the pursuit of goals. Persecutory delusions are a condition in which the affected person wrongly believes that they are being persecuted. Specifically, they have been defined as containing two central elements: The individual thinks that:

1. harm is occurring, or is going to occur.
2. the persecutor(s) has (have) the intention to cause harm.

According to the DSM-IV-TR, persecutory delusions are the most common form of delusions in schizophrenia, where the person believes they are "being tormented, followed, sabotaged, tricked, spied on, or ridiculed." In the DSM-IV-TR, persecutory delusions are the main feature of the persecutory type of delusional disorder. When the focus is to remedy some injustice by legal action, they are sometimes called "querulous paranoia".

Causes

Explaining the causes of delusions continues to be challenging and several theories have been developed. One is the genetic or biological theory, which states that close relatives of people with delusional disorder are at increased risk of delusional traits. Another theory is the dysfunctional cognitive processing, which states that delusions may arise from distorted ways people have of explaining life to themselves. A third theory is called motivated or defensive delusions. This one states that some of those persons who are predisposed might suffer the onset of delusional disorder in those moments when coping with life and maintaining high self-esteem becomes a significant challenge. In this case, the person views others as the cause of their personal difficulties in order to preserve a positive self-view.

This condition is more common among people who have poor hearing or sight. Also, ongoing stressors have been associated with a higher possibility of developing delusions. Examples of such stressors are immigration, low socioeconomic status, and even possibly the accumulation of smaller daily hassles.

Specific delusions

The top two factors mainly concerned in the germination of delusions are: 1. Disorder of brain functioning; and 2. background influences of temperament and personality.

Higher levels of dopamine qualify as a symptom of disorders of brain function. That they are needed to sustain certain delusions was examined by a preliminary study on delusional disorder (a psychotic syndrome) instigated to clarify if schizophrenia had a dopamine psychosis. There were positive results - delusions of jealousy and persecution had different levels of dopamine metabolite HVA and homovanillyl alcohol (which may have been genetic). These can be only regarded as tentative results; the study called for future research with a larger population.

It is too simplistic to say that a certain measure of dopamine will bring about a specific delusion. Studies show age and gender to be influential and it is most likely that HVA levels change during the life course of some syndromes.

On the influence of personality, it has been said: "Jaspers considered there is a subtle change in personality due to the illness itself; and this creates the condition for the development of the delusional atmosphere in which the delusional intuition arises."

Cultural factors have "a decisive influence in shaping delusions". For example, delusions of guilt and punishment are frequent in a Western, Christian country like Austria, but not in Pakistan, where it is more likely persecution. Similarly, in a series of case studies, delusions of guilt and punishment were found in Austrian patients with Parkinson's being treated with l-dopa, a dopamine agonist.

Pathophysiology

The two-factor model of delusions posits that dysfunction in both belief formation systems and belief evaluation systems are necessary for delusions. Dysfunction in evaluations systems localized to the right lateral prefrontal cortex, regardless of delusion content, is supported by neuroimaging studies and is congruent with its role in conflict monitoring in healthy persons. Abnormal activation and reduced volume is seen in people with delusions, as well as in disorders associated with delusions such as frontotemporal dementia, psychosis and Lewy body dementia. Furthermore, lesions to this region are associated with "jumping to conclusions", damage to this region is associated with post-stroke delusions, and hypometabolism this region associated with caudate strokes presenting with delusions.

The aberrant salience model suggests that delusions are a result of people assigning excessive importance to irrelevant stimuli. In support of this hypothesis, regions normally associated with the salience network demonstrate reduced grey matter in people with delusions, and the neurotransmitter dopamine, which is widely implicated in salience processing, is also widely implicated in psychotic disorders.

Specific regions have been associated with specific types of delusions. The volume of the hippocampus and parahippocampus is related to paranoid delusions in Alzheimer's disease, and has been reported to be abnormal post mortem in one person with delusions. Capgras delusions have been associated with occipito-temporal damage and may be related to failure to elicit normal emotions or memories in response to faces.

Diagnosis

James Tilly Matthews illustrated this picture of a machine called an “air loom”, which he believed was being used to torture him and others for political purposes.

The modern definition and Jaspers' original criteria have been criticised, as counter-examples can be shown for every defining feature.

Studies on psychiatric patients show that delusions vary in intensity and conviction over time, which suggests that certainty and incorrigibility are not necessary components of a delusional belief.

Delusions do not necessarily have to be false or 'incorrect inferences about external reality'. Some religious or spiritual beliefs by their nature may not be falsifiable, and hence cannot be described as false or incorrect, no matter whether the person holding these beliefs was diagnosed as delusional or not. In other situations the delusion may turn out to be true belief. For example, in delusional jealousy, where a person believes that their partner is being unfaithful (and may even follow them into the bathroom believing them to be seeing their lover even during the briefest of partings), it may actually be true that the partner is having sexual relations with another person. In this case, the delusion does not cease to be a delusion because the content later turns out to be verified as true or the partner actually chose to engage in the behavior of which they were being accused.

In other cases, the belief may be mistakenly assumed to be false by a doctor or psychiatrist assessing it, just because it seems to be unlikely, bizarre or held with excessive conviction. Psychiatrists rarely have the time or resources to check the validity of a person’s claims leading to some true beliefs to be erroneously classified as delusional. This is known as the Martha Mitchell effect, after the wife of the attorney general who alleged that illegal activity was taking place in the White House. At the time, her claims were thought to be signs of mental illness, and only after the Watergate scandal broke was she proved right (and hence sane).

Similar factors have led to criticisms of Jaspers' definition of true delusions as being ultimately 'un-understandable'. Critics (such as R. D. Laing) have argued that this leads to the diagnosis of delusions being based on the subjective understanding of a particular psychiatrist, who may not have access to all the information that might make a belief otherwise interpretable. R. D. Laing's hypothesis has been applied to some forms of projective therapy to "fix" a delusional system so that it cannot be altered by the patient. Psychiatric researchers at Yale University, Ohio State University and the Community Mental Health Center of Middle Georgia have used novels and motion picture films as the focus. Texts, plots and cinematography are discussed and the delusions approached tangentially. This use of fiction to decrease the malleability of a delusion was employed in a joint project by science-fiction author Philip Jose Farmer and Yale psychiatrist A. James Giannini. They wrote the novel Red Orc's Rage, which, recursively, deals with delusional adolescents who are treated with a form of projective therapy. In this novel's fictional setting other novels written by Farmer are discussed and the characters are symbolically integrated into the delusions of fictional patients. This particular novel was then applied to real-life clinical settings.

Another difficulty with the diagnosis of delusions is that almost all of these features can be found in "normal" beliefs. Many religious beliefs hold exactly the same features, yet are not universally considered delusional. For instance, if a person was holding a true belief then they will of course persist with it. This can cause the disorder to be misdiagnosed by psychiatrists. These factors have led the psychiatrist Anthony David to note that "there is no acceptable (rather than accepted) definition of a delusion." In practice, psychiatrists tend to diagnose a belief as delusional if it is either patently bizarre, causing significant distress, or excessively pre-occupying the patient, especially if the person is subsequently unswayed in belief by counter-evidence or reasonable arguments.

It is important to distinguish true delusions from other symptoms such as anxiety, fear, or paranoia. To diagnose delusions a mental state examination may be used. This test includes appearance, mood, affect, behavior, rate and continuity of speech, evidence of hallucinations or abnormal beliefs, thought content, orientation to time, place and person, attention and concentration, insight and judgment, as well as short-term memory.

Johnson-Laird suggests that delusions may be viewed as the natural consequence of failure to distinguish conceptual relevance. That is, the person takes irrelevant information and puts it in the form of disconnected experiences, then it is taken to be relevant in a manner that suggests false causal connections. Furthermore, the person takes the relevant information, in the form of counterexamples, and ignores it.

Definition

Although non-specific concepts of madness have been around for several thousand years, the psychiatrist and philosopher Karl Jaspers was the first to define the three main criteria for a belief to be considered delusional in his 1913 book General Psychopathology. These criteria are:

• certainty (held with absolute conviction)
• incorrigibility (not changeable by compelling counterargument or proof to the contrary)
• impossibility or falsity of content (implausible, bizarre, or patently untrue)

Furthermore, when a false belief involves a value judgment, it is only considered a delusion if it is so extreme that it cannot be, or never can be proven true. For example: a man claiming that he flew into the Sun and flew back home. This would be considered a delusion, unless he were speaking figuratively, or if the belief had a cultural or religious source.

Robert Trivers writes that delusion is a discrepancy in relation to objective reality, but with a firm conviction in reality of delusional ideas, which is manifested in the "affective basis of delusion" Trivers, Robert (2002). Natural Selection and Social Theory: Selected Papers of Robert Trivers. Oxford University Press. ISBN 978-0-19-513062-1.

Criticism

Some psychiatrists criticize the practice of defining one and the same belief as normal in one culture and pathological in another culture for cultural essentialism. They argue that since cultural influences are mixed, including not only parents and teachers but also peers, friends, books and the internet, and the same cultural influence can have different effects depending on earlier cultural influences, the assumption that culture can be boiled down to a few traceable, distinguishable and statistically quantifiable factors and that everything that does not fall in those factors must be biological, is not a justified assumption. Other critical psychiatrists argue that just because a person's belief is unshaken by one influence does not prove that it would remain unshaken by another. For example, a person whose beliefs are not changed by verbal correction from a psychiatrist, which is how delusion is usually diagnosed, may still change his or her mind when observing empirical evidence, only that psychiatry rarely if ever present patients with such situations.

Gaslighting

Sometimes a correct belief may be mistaken for a delusion, such as when the belief in question is not demonstrably false but is nevertheless considered beyond the realm of possibility. A specific variant of this is when a person is fed lies in an attempt to convince them that they are delusional, a process called gaslighting, after the 1938 play Gaslight, the plot of which centered around the process. Sometimes, gaslighting can be unintentional, for example if a person, or a group of people aim to lie or cover up an issue, it can lead to the victim being gaslighted as well.

Treatment

Psychotherapies that may be helpful in delusional disorder include individual psychotherapy, cognitive-behavioral therapy (CBT), and family therapy.

The Truman Show delusion

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/The_Truman_Show_delusion 

The Truman Show delusion, informally known as Truman syndrome, is a type of delusion in which the person believes that their lives are staged reality shows, or that they are being watched on cameras. The term was coined in 2008 by brothers Joel Gold and Ian Gold, a psychiatrist and a neurophilosopher, respectively, after the film The Truman Show.

The Truman Show delusion is not officially recognized nor listed in the Diagnostic and Statistical Manual of the American Psychiatric Association.

Background

Rapid expansion of technology raises questions about which delusions are possible and which ones are bizarre.

Dolores Malaspina, DSM-5 editor

The Truman Show is a 1998 comedy drama film directed by Peter Weir and written by Andrew Niccol. Actor Jim Carrey plays Truman Burbank, a man who discovers he is living in a constructed reality televised globally around the clock. Since he was in the womb his entire life has been televised, and all the people in his life have been paid actors. As he discovers the truth about his existence, Burbank fights to find an escape from those who have controlled him his entire life.

The concept predates this particular film, which was inspired by a 1989 episode of The Twilight Zone in its 1980s incarnation, titled "Special Service", which begins with the protagonist discovering a camera in his bathroom mirror. This man soon learns that his life is being broadcast 24/7 to TV watchers worldwide. Author Philip K. Dick wrote a novel, Time Out of Joint (1959), in which the protagonist lives in a created world in which his "family" and "friends" are all paid to maintain the illusion. Later science fiction novels repeat the theme. While these books do not share the reality-show aspects of The Truman Show, they do have in common the concept of a world that has been constructed by others, around one's personal aspects.

Delusions

Delusions – fixed, fallacious beliefs – are symptoms that, in the absence of organic disease, indicate psychiatric disease. The content of delusions varies considerably (limited by the imagination of the delusional person), but certain themes have been identified; for example, persecution. These themes have diagnostic importance in that they point to certain diagnoses. Persecutory delusions are, for instance, classically linked to psychosis.

Cultural impact

The content of delusions are invariably tied to a person's life experience, and contemporary culture seems to play an important role. A retrospective study conducted in 2008 showed how delusional content has evolved over time from religious/magical, to political and eventually to technically themed. The authors concluded that:

sociopolitical changes and scientific and technical developments have a marked influence on the delusional content in schizophrenia.

Psychiatrist Joseph Weiner commented that:

...in the 1940s, psychotic patients would express delusions about their brains being controlled by radio waves; now delusional patients commonly complain about implanted computer chips.

The Truman Show Delusion could represent a further evolution in the content of persecutory delusions in reaction to a changing pop culture.

Because reality shows are so visible, it is an area that a patient can easily incorporate into a delusional system. Such a person would believe they are constantly being videotaped, watched, and commented upon by a large TV audience.

Reported cases

While the prevalence of the disorder is not known, there have been several hundred cases reported. There have been recorded instances of people suffering from the Truman Show Delusion from around the world. Joel Gold, a psychiatrist at Bellevue Hospital Center in New York City, and Clinical Associate Professor of psychiatry at New York University, and his brother Ian, who holds a research chair in Philosophy and Psychiatry at Montreal's McGill University, are the foremost researchers on the subject. They have communicated, since 2002, with over a hundred individuals suffering from the delusion. They have reported that one patient traveled to New York City after 9/11 to make sure that the terrorist attacks were not a plot twist in his personal Truman Show, while another traveled to a Lower Manhattan federal building to seek asylum from his show. Another patient had worked as an intern on a reality TV program, and believed that he was secretly being tracked by cameras, even at the polls on Election Day in 2004. He shouted that then-President George W. Bush was a "Judas" brought him to Bellevue Hospital and Gold's attention.

One of Gold's patients, an upper-middle class Army veteran who wanted to climb the Statue of Liberty in the belief that doing so would release him from the "show", described his condition this way:

I realized that I was and am the center, the focus of attention by millions and millions of people ... My family and everyone I knew were and are actors in a script, a charade whose entire purpose is to make me the focus of the world's attention.

The choice of the name "Truman Show Delusion" by the Golds was influenced by the fact that three of the five patients Joel Gold initially treated for the syndrome explicitly linked their perceived experiences to the film.

Truman Syndrome

In the United Kingdom, psychiatrists Paolo Fusar-Poli, Oliver Howes, Lucia Valmaggia and Philip McGuire of the Institute of Psychiatry in London described in the British Journal of Psychiatry what they referred to as the "Truman Syndrome":

[A] preoccupying belief that the world had changed in some way that other people were aware of, which he interpreted as indicating he was the subject of a film and living in a film set (a ‘fabricated world’). This cluster of symptoms ... is a common presenting complaint in individuals ... who may be in the prodromal phase of schizophrenia.

The authors suggest that the "Truman explanation" is a result of the patients' search for meaning in their perception that the ordinary world has changed in some significant but inexplicable way.

Medical relevance

The Truman Show delusion is not officially recognized and is not a part of the Diagnostic and Statistical Manual of the American Psychiatric Association. The Golds do not say that it is a new diagnosis but refer to it as "a variance on known persecutory and grandiose delusions."

Filmmaker's reaction

After hearing about the condition, Andrew Niccol, writer of The Truman Show, said, "You know you've made it when you have a disease named after you."

Solipsism

From Wikipedia, the free encyclopedia

 

Solipsism (/ˈsɒlɪpsɪzəm/ (listen); from Latin solus, meaning 'alone', and ipse, meaning 'self') is the philosophical idea that only one's mind is sure to exist. As an epistemological position, solipsism holds that knowledge of anything outside one's own mind is unsure; the external world and other minds cannot be known and might not exist outside the mind.

Varieties

There are varying degrees of solipsism that parallel the varying degrees of skepticism:

Metaphysical

Metaphysical solipsism is a variety of solipsism. Based on a philosophy of subjective idealism, metaphysical solipsists maintain that the self is the only existing reality and that all other realities, including the external world and other persons, are representations of that self, and have no independent existence. There are several versions of metaphysical solipsism, such as Caspar Hare's egocentric presentism (or perspectival realism), in which other people are conscious, but their experiences are simply not present.

Epistemological

Epistemological solipsism is the variety of idealism according to which only the directly accessible mental contents of the solipsistic philosopher can be known. The existence of an external world is regarded as an unresolvable question rather than actually false. Further, one cannot also be certain as to what extent the external world exists independently of one's mind. For instance, it may be that a God-like being controls the sensations received by one's brain, making it appear as if there is an external world when most of it (excluding the God-like being and oneself) is false. However, the point remains that epistemological solipsists consider this an "unresolvable" question.

Methodological

Methodological solipsism is an agnostic variant of solipsism. It exists in opposition to the strict epistemological requirements for "knowledge" (e.g. the requirement that knowledge must be certain). It still entertains the points that any induction is fallible. Methodological solipsism sometimes goes even further to say that even what we perceive as the brain is actually part of the external world, for it is only through our senses that we can see or feel the mind. Only the existence of thoughts is known for certain.

Methodological solipsists do not intend to conclude that the stronger forms of solipsism are actually true. They simply emphasize that justifications of an external world must be founded on indisputable facts about their own consciousness. The methodological solipsist believes that subjective impressions (empiricism) or innate knowledge (rationalism) are the sole possible or proper starting point for philosophical construction. Often methodological solipsism is not held as a belief system, but rather used as a thought experiment to assist skepticism (e.g. Descartes' Cartesian skepticism).

Main points

Denial of material existence, in itself, does not constitute solipsism.

A feature of the metaphysical solipsistic worldview is the denial of the existence of other minds. Since personal experiences are private and ineffable, another being's experience can be known only by analogy.

Philosophers try to build knowledge on more than an inference or analogy. The failure of Descartes' epistemological enterprise brought to popularity the idea that all certain knowledge may go no further than "I think; therefore I exist" without providing any real details about the nature of the "I" that has been proven to exist.

The theory of solipsism also merits close examination because it relates to three widely held philosophical presuppositions, each itself fundamental and wide-ranging in importance:

• My most certain knowledge is the content of my own mind—my thoughts, experiences, affects, etc.
• There is no conceptual or logically necessary link between mental and physical—between, say, the occurrence of certain conscious experience or mental states and the 'possession' and behavioral dispositions of a 'body' of a particular kind.
• The experience of a given person is necessarily private to that person.

To expand on the second point, the conceptual problem here is that the previous assumes mind or consciousness (which are attributes) can exist independent of some entity having this capability, i.e., that an attribute of an existent can exist apart from the existent itself. If one admits to the existence of an independent entity (e.g., the brain) having that attribute, the door is open. (See Brain in a vat)

Some people hold that, while it cannot be proven that anything independent of one's mind exists, the point that solipsism makes is irrelevant. This is because, whether the world as we perceive it exists independently or not, we cannot escape this perception (except via death), hence it is best to act assuming that the world is independent of our minds.

There is also the issue of plausibility to consider. If one is the only mind in existence, then one is maintaining that one's mind alone created all of which one is apparently aware. This includes the symphonies of Beethoven, the works of Shakespeare, all of mathematics and science (which one can access via one's phantom libraries), etc. Critics of solipsism find this somewhat implausible.

However, being aware simply acknowledges its existence; it does not identify the actual creations until they are observed by the user.

History

Gorgias

Solipsism was first recorded by the Greek presocratic sophist, Gorgias (c. 483–375 BC) who is quoted by the Roman sceptic Sextus Empiricus as having stated:

• Nothing exists.
• Even if something exists, nothing can be known about it.
• Even if something could be known about it, knowledge about it cannot be communicated to others.

Much of the point of the sophists was to show that "objective" knowledge was a literal impossibility.

Descartes

The foundations of solipsism are in turn the foundations of the view that the individual's understanding of any and all psychological concepts (thinking, willing, perceiving, etc.) is accomplished by making an analogy with his or her own mental states; i.e., by abstraction from inner experience. And this view, or some variant of it, has been influential in philosophy since Descartes elevated the search for incontrovertible certainty to the status of the primary goal of epistemology, whilst also elevating epistemology to "first philosophy".

Berkeley

Portrait of George Berkeley by John Smybert, 1727

George Berkeley's arguments against materialism in favour of idealism provide the solipsist with a number of arguments not found in Descartes. While Descartes defends ontological dualism, thus accepting the existence of a material world (res extensa) as well as immaterial minds (res cogitans) and God, Berkeley denies the existence of matter but not minds, of which God is one.

Relation to other ideas

Idealism and materialism

One of the most fundamental debates in philosophy concerns the "true" nature of the world—whether it is some ethereal plane of ideas or a reality of atomic particles and energy. Materialism posits a real 'world out there,' as well as in and through us, that can be sensed—seen, heard, tasted, touched and felt, sometimes with prosthetic technologies corresponding to human sensing organs. (Materialists do not claim that human senses or even their prosthetics can, even when collected, sense the totality of the 'universe'; simply that they collectively cannot sense what cannot in any way be known to us.)

Materialists do not find this a useful way of thinking about the ontology and ontogeny of ideas, but we might say that from a materialist perspective pushed to a logical extreme communicable to an idealist, ideas are ultimately reducible to a physically communicated, organically, socially and environmentally embedded 'brain state'. While reflexive existence is not considered by materialists to be experienced on the atomic level, the individual's physical and mental experiences are ultimately reducible to the unique tripartite combination of environmentally determined, genetically determined, and randomly determined interactions of firing neurons and atomic collisions.

For materialists, ideas have no primary reality as essences separate from our physical existence. From a materialist perspective, ideas are social (rather than purely biological), and formed and transmitted and modified through the interactions between social organisms and their social and physical environments. This materialist perspective informs scientific methodology, insofar as that methodology assumes that humans have no access to omniscience and that therefore human knowledge is an ongoing, collective enterprise that is best produced via scientific and logical conventions adjusted specifically for material human capacities and limitations.

Modern idealists believe that the mind and its thoughts are the only true things that exist. This is the reverse of what is sometimes called classical idealism or, somewhat confusingly, Platonic idealism due to the influence of Plato's theory of forms (εἶδος eidos or ἰδέα idea) which were not products of our thinking. The material world is ephemeral, but a perfect triangle or "beauty" is eternal. Religious thinking tends to be some form of idealism, as God usually becomes the highest ideal (such as neoplatonism). On this scale, solipsism can be classed as idealism. Thoughts and concepts are all that exist, and furthermore, only the solipsist's own thoughts and consciousness exist. The so-called "reality" is nothing more than an idea that the solipsist has (perhaps unconsciously) created.

Cartesian dualism

There is another option: the belief that both ideals and "reality" exist. Dualists commonly argue that the distinction between the mind (or 'ideas') and matter can be proven by employing Leibniz' principle of the identity of indiscernibles which states that if two things share exactly the same qualities, then they must be identical, as in indistinguishable from each other and therefore one and the same thing. Dualists then attempt to identify attributes of mind that are lacked by matter (such as privacy or intentionality) or vice versa (such as having a certain temperature or electrical charge). One notable application of the identity of indiscernibles was by René Descartes in his Meditations on First Philosophy. Descartes concluded that he could not doubt the existence of himself (the famous cogito ergo sum argument), but that he could doubt the (separate) existence of his body. From this, he inferred that the person Descartes must not be identical to the Descartes body since one possessed a characteristic that the other did not: namely, it could be known to exist. Solipsism agrees with Descartes in this aspect, and goes further: only things that can be known to exist for sure should be considered to exist. The Descartes body could only exist as an idea in the mind of the person Descartes. Descartes and dualism aim to prove the actual existence of reality as opposed to a phantom existence (as well as the existence of God in Descartes' case), using the realm of ideas merely as a starting point, but solipsism usually finds those further arguments unconvincing. The solipsist instead proposes that their own unconscious is the author of all seemingly "external" events from "reality".

Philosophy of Schopenhauer

The World as Will and Representation is the central work of Arthur Schopenhauer. Schopenhauer saw the human will as our one window to the world behind the representation, the Kantian thing-in-itself. He believed, therefore, that we could gain knowledge about the thing-in-itself, something Kant said was impossible, since the rest of the relationship between representation and thing-in-itself could be understood by analogy as the relationship between human will and human body.

Idealism

The idealist philosopher George Berkeley argued that physical objects do not exist independently of the mind that perceives them. An item truly exists only as long as it is observed; otherwise, it is not only meaningless but simply nonexistent. The observer and the observed are one. Berkeley does attempt to show things can and do exist apart from the human mind and our perception, but only because there is an all-encompassing Mind in which all "ideas" are perceived – in other words, God, who observes all. Solipsism agrees that nothing exists outside of perception, but would argue that Berkeley falls prey to the egocentric predicament – he can only make his own observations, and thus cannot be truly sure that this God or other people exist to observe "reality". The solipsist would say it is better to disregard the unreliable observations of alleged other people and rely upon the immediate certainty of one's own perceptions.

Rationalism

Rationalism is the philosophical position that truth is best discovered by the use of reasoning and logic rather than by the use of the senses (see Plato's theory of Forms). Solipsism is also skeptical of sense-data.

Philosophical zombie

The theory of solipsism crosses over with the theory of the philosophical zombie in that all other seemingly conscious beings actually lack true consciousness, instead they only display traits of consciousness to the observer, who is the only conscious being there is.

Falsifiability and testability

Solipsism is not a falsifiable hypothesis as described by Karl Popper: there does not seem to be an imaginable disproof.

One critical test is nevertheless to consider the induction from experience that the externally observable world does not seem, at first approach, to be directly manipulable purely by mental energies alone. One can indirectly manipulate the world through the medium of the physical body, but it seems impossible to do so through pure thought (e.g. via psychokinesis). It might be argued that if the external world were merely a construct of a single consciousness, i.e. the self, it could then follow that the external world should be somehow directly manipulable by that consciousness, and if it is not, then solipsism is false. An argument against this states the notion that such manipulation may be possible but barred from the conscious self via the subconscious self, a 'locked' portion of the mind that is still nevertheless the same mind. Lucid dreaming might be considered an example of when these locked portions of the subconscious become accessible. An argument against this might be brought up in asking why the subconscious mind would be locked. Also, the access to the autonomous ("locked") portions of the mind during the lucid dreaming is obviously much different (for instance: is relatively more transient) than the access to autonomous regions of the perceived nature.

The method of the typical scientist is materialist: they first assume that the external world exists and can be known. But the scientific method, in the sense of a predict-observe-modify loop, does not require the assumption of an external world. A solipsist may perform a psychological test on themselves, to discern the nature of the reality in their mind – however David Deutsch uses this fact to counter-argue: "outer parts" of solipsist, behave independently so they are independent for "narrowly" defined (conscious) self. A solipsist's investigations may not be proper science, however, since it would not include the co-operative and communitarian aspects of scientific inquiry that normally serve to diminish bias.

Minimalism

Solipsism is a form of logical minimalism. Many people are intuitively unconvinced of the nonexistence of the external world from the basic arguments of solipsism, but a solid proof of its existence is not available at present. The central assertion of solipsism rests on the nonexistence of such a proof, and strong solipsism (as opposed to weak solipsism) asserts that no such proof can be made. In this sense, solipsism is logically related to agnosticism in religion: the distinction between believing you do not know, and believing you could not have known.

However, minimality (or parsimony) is not the only logical virtue. A common misapprehension of Occam's razor has it that the simpler theory is always the best. In fact, the principle is that the simpler of two theories of equal explanatory power is to be preferred. In other words: additional "entities" can pay their way with enhanced explanatory power. So the realist can claim that, while his world view is more complex, it is more satisfying as an explanation.

Solipsism in infants

Some developmental psychologists believe that infants are solipsistic, and that eventually children infer that others have experiences much like theirs and reject solipsism.

Hinduism

The earliest reference to Solipsism may be imputed to a mistaken notion of the ideas in Hindu philosophy in the Brihadaranyaka Upanishad, dated to early 1st millennium BCE. The Upanishad holds the mind to be the only god and all actions in the universe are thought to be a result of the mind assuming infinite forms. After the development of distinct schools of Indian philosophy, Advaita Vedanta and Samkhya schools are thought to have originated concepts similar to solipsism. Actually, Brihadaranyaka (1.3.) mentions 'Prana', which is what the true meaning is of the ancient Greek 'Psyche'. Again, in the 4th chapter of the Brihadaranyaka it is called 'Atma' which is described as the 'jyotih purusha'(4.3.7.). None of these ideas being translatable as Mind, it seems that the Brihadaranyaka itself bears ample testimony to the fact that Hinduism did not preach any form of solipsism.

Advaita Vedanta

Advaita is one of the six most known Hindu philosophical systems and literally means "non-duality". Its first great consolidator was Adi Shankaracharya, who continued the work of some of the Upanishadic teachers, and that of his teacher's teacher Gaudapada. By using various arguments, such as the analysis of the three states of experience—wakefulness, dream, and deep sleep, he established the singular reality of Brahman, in which Brahman, the universe and the Atman or the Self, were one and the same.

One who sees everything as nothing but the Self, and the Self in everything one sees, such a seer withdraws from nothing. For the enlightened, all that exists is nothing but the Self, so how could any suffering or delusion continue for those who know this oneness?

— Ishopanishad: sloka 6, 7

The concept of the Self in the philosophy of Advaita could be interpreted as solipsism. However, the transhuman, theological implications of the Self in Advaita protect it from true solipsism as found in the west. Similarly, the Vedantic text Yogavasistha, escapes charge of solipsism because the real "I" is thought to be nothing but the absolute whole looked at through a particular unique point of interest.

Advaita is also thought to strongly diverge from solipsism in that, the former is a system of exploration of one's mind in order to finally understand the nature of the self and attain complete knowledge. The unity of existence is said to be directly experienced and understood at the end as a part of complete knowledge. On the other hand, solipsism posits the non-existence of the external world right at the beginning, and says that no further inquiry is possible.

Samkhya and Yoga

Samkhya philosophy, which is sometimes seen as the basis of Yogic thought, adopts a view that matter exists independently of individual minds. Representation of an object in an individual mind is held to be a mental approximation of the object in the external world. Therefore, Samkhya chooses representational realism over epistemological solipsism. Having established this distinction between the external world and the mind, Samkhya posits the existence of two metaphysical realities Prakriti (matter) and Purusha (consciousness).

Buddhism

Some interpretations of Buddhism assert that external reality is an illusion, and sometimes this position is [mis]understood as metaphysical solipsism. Buddhist philosophy, though, generally holds that the mind and external phenomena are both equally transient, and that they arise from each other. The mind cannot exist without external phenomena, nor can external phenomena exist without the mind. This relation is known as "dependent arising" (pratityasamutpada).

The Buddha stated, "Within this fathom long body is the world, the origin of the world, the cessation of the world and the path leading to the cessation of the world". Whilst not rejecting the occurrence of external phenomena, the Buddha focused on the illusion created within the mind of the perceiver by the process of ascribing permanence to impermanent phenomena, satisfaction to unsatisfying experiences, and a sense of reality to things that were effectively insubstantial.

Mahayana Buddhism also challenges the illusion of the idea that one can experience an 'objective' reality independent of individual perceiving minds.

From the standpoint of Prasangika (a branch of Madhyamaka thought), external objects do exist, but are devoid of any type of inherent identity: "Just as objects of mind do not exist [inherently], mind also does not exist [inherently]". In other words, even though a chair may physically exist, individuals can only experience it through the medium of their own mind, each with their own literal point of view. Therefore, an independent, purely 'objective' reality could never be experienced.

The Yogacara (sometimes translated as "Mind only") school of Buddhist philosophy contends that all human experience is constructed by mind. Some later representatives of one Yogacara subschool (Prajnakaragupta, Ratnakīrti) propounded a form of idealism that has been interpreted as solipsism. A view of this sort is contained in the 11th-century treatise of Ratnakirti, "Refutation of the existence of other minds" (Santanantara dusana), which provides a philosophical refutation of external mind-streams from the Buddhist standpoint of ultimate truth (as distinct from the perspective of everyday reality).

In addition to this, the Bardo Thodol, Tibet's famous book of the dead, repeatedly states that all of reality is a figment of one's perception, although this occurs within the "Bardo" realm (post-mortem). For instance, within the sixth part of the section titled "The Root Verses of the Six Bardos", there appears the following line: "May I recognize whatever appeareth as being mine own thought-forms"; there are many lines in similar ideal.