Unreality Star

By Andrew Marantz

Nick Lotz believed that he was being tracked by TV cameras all day and all night.Photograph by AJ Frackattack

Soon after Nick Lotz enrolled at Ohio University, in the fall of 2007, he grew deeply anxious. He was overweight, and self-conscious around women; worse, he thought that everyone sensed his unease. People who once seemed like new friends gradually stopped returning his texts. He went out four or five nights a week, and drank to mask his discomfort, occasionally to the point of blacking out. After such episodes, he worried that he’d said, or typed, something that he should have kept private. He suspected that people were posting embarrassing videos of him online, though he couldn’t find any on Facebook.

Lotz, who wanted to be a filmmaker, largely ignored his classwork. Often, he’d draw the blinds of his dorm room and take Suboxone, an opiate that he bought from an older student, and sleep for days. Then he’d snort Adderall or Focalin and stay up all night, watching YouTube videos and working on screenplays. His laptop became his primary connection to the world. Online interactions were less taxing than face-to-face conversations, but they introduced new concerns: just as he monitored his friends’ Internet activity, he assumed that, whenever he clicked links on BuzzFeed or posted comments on Reddit, people were tracking him, too. When he surfed the Web, in a sleepless blur, every site seemed to contain a coded message about him.

In the spring, he returned home to Hudson, an affluent town between Akron and Cleveland. One evening, his mother, Ann, found him taking apart the thermostat in the front hallway. He was looking for cameras.

On another occasion, he told her that he was at the center of a network of covert operatives.

"Have you seen that movie ‘A Beautiful Mind’?" she asked.

"Mom, I’m not like that," he said.

The next morning, he seemed more lucid, and he assured her that he was fine. School was stressful, and Adderall had aggravated the problem, but it wouldn’t happen again.

Lotz and his sister, Cecelia, had long-standing plans to attend a jam-band festival in western Michigan; their father, Jay, an event promoter, was travelling to the festival separately. Cecelia was concerned about Lotz’s state of mind, and told their parents that he should stay home, but he protested. His parents knew about his drinking and drug habits and were worried about him. They told him that he could attend the concert if he agreed to enter a rehab program, in Montana, immediately afterward.

Cecelia drove to the festival in their parents’ Volvo, with Lotz asleep in the passenger seat and three friends in the back. After the group pitched a tent, Lotz found a drug dealer and said, "Give me whatever I can get for a hundred dollars." The next night, he took acid and Ecstasy. He and his friends hung out for a while, but eventually Lotz drifted, alone, toward the main stage. The headliner was the Dave Matthews Band, and, though Lotz did not love their music, he felt that he was there for a reason. He wedged his body closer to the stage. Matthews’s lyrics seemed eerily appropriate: "One year of crying and the words creep up inside."

Suddenly, Lotz solved the puzzle of his life. Since starting college, he had been the star of a reality-TV show. The network had kept the cameras hidden, as in "Candid Camera" and "Punk’d." That night was supposed to be the finale. All he had to do was call his father, who’d find him in the crowd, lead him onstage, and present him with a check for a million dollars. Lotz took out his cell phone, but he was too strung out to place the call. It was too late—he’d missed his chance to make the cameras turn off.

He returned to the tent and paced outside it until daybreak. When Cecelia woke up, she asked him what was wrong. He responded, "Smile, you’re on camera!"

The next day, he flew to Montana and began rehab. A counsellor, explaining the rules of the program, said, "We’re all going to be watching you." To Lotz, this was an explicit acknowledgment that he was the star of a show that was being broadcast live, all day and all night. At the treatment center, he ducked into empty rooms, searching for editing equipment. He didn’t find any, but that proved nothing: cameras could be hidden behind mirrors or inside shirt buttons.

Lotz was discharged from rehab before he completed the program—his problems, the counsellors said, went beyond drug abuse. Back at home, he remained agitated, but he decided to keep quiet about the show. He completed a local rehab program, and declared himself ready for school. His parents, unsure what to do, allowed him to return to college for his sophomore year.

Lotz decided to embrace being watched by millions of strangers. He left his laptop open, allowing the cameras to zoom in on the screen, broadcasting his words to the world. When he spoke in class, he grinned clownishly, letting the audience know that he was in on the joke. He enrolled in acting and public-speaking courses, determined to become a better performer. Once, in acting class, he read an article about "the doubt or fatigue" that can wear down an actor. That night, Lotz wrote in his journal, "Anything that humiliates me or pisses me off is actually . . . a hazard of being famous."

Psychotic disorders typically emerge between the ages of eighteen and thirty. One such condition, schizophrenia, affects approximately one per cent of the population, a figure that appears to have remained stable across epochs and continents. Hippocrates wrote of patients who exhibited paraphrosune, which translates roughly as "paranoia."

Hypothetically, any false belief might turn into a delusion. You could become convinced that a Cézanne still-life contained real apples and pears. But in practice nobody suffers from Edible-Painting Delusion. Mental illness has rules. Just as all spoken languages share a universal grammar, clinically recognized delusions conform to a familiar set of themes, including persecution, grandiosity, and erotomania.

If form is fixed, content is not. Between 1995 and 2004, the International Study on Psychotic Symptoms, a survey of eleven hundred patients from seven countries, found that the mind supplies the contours of delusions, and culture fills in the details. Grandiose schizophrenics from largely Christian countries often claim to be prophets or gods, but sufferers in Pakistan, a Muslim country, rarely do. In Shanghai, paranoid people report being pricked by poisoned needles; in Taipei, they are possessed by spirits. Shifts in technology have caused the content of delusions to change over the years: in the nineteen-forties, the Japanese controlled American minds with radio waves; in the fifties, the Soviets accomplished this with satellites; in the seventies, the C.I.A. implanted computer chips into people’s brains.

For nine years, Joel Gold was the attending psychiatrist at Bellevue Hospital. "New York is a magnet for psychosis," he says. "If someone loses it at J.F.K. or Grand Central, they’re brought right to Bellevue." The delusions of Gold’s patients fell within standard categories, but the details often varied from those he’d read about in textbooks. "After 9/11, many Southern African-American women came to New York to raise the dead at Ground Zero," he says. "You see that once and it’s, like, ‘Oh, interesting.’ Then, a week later, another one comes in."

The doctors at Bellevue discussed such trends, but did not report them to journals. Psychiatry, as a discipline, has largely lost interest in the content of delusions. Freud based his theories on his patients’ dreams and fears, and other early clinicians—Joseph Capgras, Jules Cotard—rose to prominence by documenting a single rare delusion. But in the nineteen-fifties antipsychotic drugs came into wide clinical use. To many doctors, the subject of a patient’s rantings no longer mattered; the goal was to administer medication that stopped the ranting. In 1984, Nancy Andreasen, an American neuroscientist and psychiatrist, summed up the consensus: "The biological revolution in psychiatry has already occurred."

Gold, who was trained in both neuroscience and psychoanalysis, worries that doctors of psychotic patients have limited themselves to psychopharmacology. "All productions of the mind have meaning," he says. "To disregard any content, no matter how psychotic it is, seems to me to be a miscarriage of what the discipline was founded on." When his patients describe odd beliefs, he pays close attention.

In 2002, Gold treated several young, educated men who shared a peculiar set of symptoms. One patient, who suspected that the September 11th attacks had been a plot twist on his TV show, had travelled across the country to Manhattan to see if the Twin Towers were still standing. Another man reported that all his friends and relatives were actors following a script; another had worked on the production team of a reality show until he concluded that the show was actually about him. Some of these patients compared their experiences to the 1998 movie "The Truman Show," in which Jim Carrey plays a man for whom all the world’s a soundstage.

Other doctors began referring such cases to Gold, and within two years he had interviewed nearly fifty patients. In 2012, he and his brother, Ian, a philosopher at McGill University, published a paper in Cognitive Neuropsychiatry describing a form of psychosis in which "the patient believes that he is being filmed, and that the films are being broadcast for the entertainment of others." They named this disorder the "Truman Show" delusion.

Several newspapers and blogs covered the story, and Gold soon received e-mails from dozens of Truman patients. He could not treat them all, but he spoke to many of them on the phone. "I wish I had more to tell them," he says. "There’s no Truman Show pill. As with any psychosis, you just do the best you can."

Michael Garrett, a professor of clinical psychiatry at SUNY Downstate Medical Center, says, "Joel is clearly right that the way we communicate is spawning new sorts of delusions—not new diseases but new content, which can be equally important." Paolo Fusar-Poli, a psychiatrist who works at a public clinic in London, estimates that, of the approximately ten patients he sees each week, one or two exhibit Truman-like symptoms. He says, "We see many, many young people who have had the sensation of being filmed."

In Nick Lotz’s mind, the show was everything, and everything was the show. The producers had invented a wireless speaker that went into his head, and they used it to feed him lines and critique his performance. They informed him that the audience could hear his thoughts. "Make sure your thoughts are entertaining!" they said, with the forced cheer of a game-show announcer.

Every few hours, the producers issued a new challenge. "No food for three days!" they said. (After several failed attempts, Lotz completed the fast.) Once, they woke him in the middle of the night and ordered him to stand on one leg: "America doesn’t want to watch you sleep—it’s boring." They told him to exercise regularly: "You have to look good on camera!" Lotz lost fifty pounds. If he made it to the end of the show, the producers promised, he’d win a hundred million dollars.

When he went home on breaks, his family kept asking him what was wrong. His responses were usually elusive: "You know all about it"; "Careful, you’re off script." He was tempted to ask for help, but he didn’t want to break the fourth wall.

His mother tried to be supportive without driving him away. Lotz was now nineteen, and she couldn’t force him into an institution. Still, she demanded that he see a psychiatrist. "They don’t want me to," he said, meaning the producers.

"Maybe we shouldn’t listen to them anymore," she said.

One afternoon, at a Chinese restaurant in Hudson, he told his mother to stop asking so many questions. When he won a hundred million dollars, she’d be glad that she hadn’t sabotaged him. "That doesn’t make sense, Nick," she said. But at the end of the meal the message inside his fortune cookie read, "You will win a great reward in the near future."

Lotz’s family couldn’t pinpoint the moment when he had become unstable. As a child, he had been shy around girls, but among boys he had been an extrovert, playing Dungeons & Dragons and quoting his favorite movies and fantasy novels. In tenth grade, Lotz discovered drugs: mainly marijuana, but also Ecstasy and cocaine. He grew his hair long, spent a lot of time on Web sites like Digg and Reddit, and joined a clique of genial stoners. When those friends saw Lotz now, they agreed that he had changed.

Against Lotz’s wishes, his mother scheduled appointments with therapists near Hudson. (Lotz’s parents are married, but his father lives in Los Angeles.) Lotz was terse at the sessions, but he said enough to receive a diagnosis of "delusional disorder, persecutory type." The American Psychiatric Association’s Diagnostic and Statistical Manual, or DSM, has long stated that a delusional disorder is characterized by "one or more nonbizarre delusions that persist for at least one month." In its first edition, in 1952, the DSM divided delusions into two categories: bizarre and nonbizarre. The former are beliefs that can’t possibly be true; the latter are beliefs that aren’t true but could be. "I am dead" is bizarre. "Millions of strangers are obsessed with me" is nonbizarre (and, for Ryan Gosling, nondelusional).

DSM-5, the first major revision in nineteen years, came out in May, and for the first time the chapter on psychosis no longer emphasizes the bizarre/nonbizarre distinction. Dolores Malaspina, one of the chapter’s authors, says, "Rapid expansion of technology raises questions about the reliability between clinicians in determining which delusions are possible and which ones are bizarre." In 2005, the New York Civil Liberties Union canvassed Manhattan and found nearly forty-two hundred security cameras south of Fourteenth Street. And, given the recent revelations about the N.S.A.’s domestic surveillance, it is hardly implausible to think that the government monitors your every move.

Is it bizarre for a college student to think that he is a household name? With rare exceptions, it used to be that only extraordinary people—the most talented, the richest—became famous. Now, Us Weekly regularly covers reality-TV stars who, apart from their narcissism, really are just like us. In "The Image," published in 1962, Daniel Boorstin wrote of people whose "chief claim to fame is their fame itself." He was writing about faded starlets like Brenda Joyce; he could not have predicted Snooki. On the CBS series "Big Brother," contestants live in a house infested with cameras. For a subscription fee, you can watch them twenty-four hours a day.

"If they don’t quit complaining you could threaten them with democracy."

Link copied

In 2003, Matt Kennedy Gould, a law-school dropout from Pittsburgh, signed a contract to appear on "The Lap of Luxury," a show in which contestants would live in a Los Angeles mansion and compete to win a hundred thousand dollars. In fact, Gould was the only competitor. His housemates were actors on the series—a Spike TV production whose real title was "The Joe Schmo Show." In the final episode, the hoax was revealed and Gould was presented with an oversized check. He pumped his fist in the air, then collapsed in tears. Afterward, he told Entertainment Weekly, he "holed up in an apartment in Santa Monica and spent a lot of the money on marijuana and alcohol. . . . The next day, I flushed a half-ounce of pot down the toilet, packed my car, came home to Pittsburgh, and I got help."

By the fall semester of Lotz’s junior year, he felt imprisoned by fame. The producers’ chatter over the tiny speaker had grown incessant; to drown out their voices, he sat at his computer and wrote stream-of-consciousness journal entries for twelve hours at a stretch. One night, he wrote, "I don’t know if its basic cable or just cable and I can’t really understand jokes I just kind of laugh I guess it’s what being an idiot feels like." The words ran on for fifty-two pages.

Desperate for help, Lotz wrote to two hundred actors and directors, including Judd Apatow and Tina Fey: "I’m currently stuck in a mind control loop. My career and life are in ruins." He considered hiring a lawyer so that he could dissolve his contract, even if it meant forgoing prize money. While taking notes in Spanish class, he scribbled, "There is no amount large enough to make me do this anymore."

In December, the premise of his show shifted. The goal was no longer to win a hundred million dollars; it was to join the cast of "Saturday Night Live." A voice on the speaker commanded, "Get out there and do standup." Lotz began performing at open-mike nights around town, telling jokes about marijuana and Internet porn. His delivery was unsettlingly antic, and the crowds were small and aloof, but he persisted; millions were watching at home, including casting agents for "S.N.L." When he could not get onstage, he performed without an audience—in a parking lot, on a bus, in his dorm room while his roommate tried to sleep.

One Thursday night, a producer’s voice told Lotz, "It’ll end if you go to New York." Using savings from summer jobs, he booked a flight for the next morning. He planned to track down Lorne Michaels, the producer of "S.N.L.," and demand to be hired. Whatever the response, it would be a memorable final scene.

He made it to New York and headed for Rockefeller Center, feeling exultant. The plot was moving, finally, toward the climax. It was Saturday. If all went well, Lotz’s show would end at 11:29 P.M.; at eleven-thirty, he would appear on "S.N.L." Then he would sleep peacefully for the first time in years.

Outside Rockefeller Center, people were ice-skating, just like in the movies. He pushed through a revolving door and entered the lobby of NBC headquarters.

"I need to see Lorne Michaels," he told a security guard.

"You can’t go inside," the guard said.

"Please," Lotz said. "Tell him I’m here."

"I can’t," the guard said.

Lotz waited in the lobby for a while. People passed by without looking in his direction. The trip was a mistake, he realized. He walked out into the cold city air.

"The Truman Show" did not single-handedly cause Truman delusions, any more than "The Manchurian Candidate" caused Cold War paranoia. In the fifteen years since "The Truman Show" was released, its premise has increasingly come to seem nonbizarre. Reviewing the film in 1998, Jonathan Rosenbaum expressed skepticism about its conceit: "Given the number of undramatic moments that fill Truman’s daily life . . . are we supposed to believe that millions of spectators . . . are taking all this in?" The millions of people who watch Honey Boo Boo, or scroll through endless tweets, have answered that question.

In 1941, Robert Heinlein published a story, "They—," in which a mental patient insists that his surroundings are a "stage" and the patients and staff "swarms of actors." Philip K. Dick adopted a similar premise in his 1959 novel, "Time Out of Joint." Both stories invoke a fear of solipsism that goes back to the Sophists; but, because they were written before television became ubiquitous, the scenarios were vague or outlandish. In the recent film "Reality," a Neapolitan fishmonger comes unravelled after auditioning for Italy’s version of "Big Brother." The filmmakers didn’t have to invent a shadowy conspiracy—"Grande Fratello" has been on the air since 2000.

The human brain has evolved to have a vigilant threat-detection system. If that system becomes oversensitive, however, the result is paranoia. A delusion of grandeur might represent a paranoid person’s attempt to feel less vulnerable. It’s long been said that in the early nineteenth century madhouses in France were full of people who claimed to be Napoleon—presumably, the least vulnerable person they could imagine. In a sense, Truman disorder is an unusually modest form of grandiose delusion: rather than becoming Napoleon, you become a famous version of yourself.

Joel Gold, the psychiatrist, left Bellevue in 2009. He now has a private practice in Manhattan. He prescribes drugs to psychotic patients and also engages in weekly psychotherapy with most of them. Another man Gold has interviewed, who is bipolar, develops Truman symptoms when he is in a manic phase. During such periods, he might see anonymous strangers and "recognize" them as celebrities making cameos on his show. "He’ll ask his wife, ‘Does that guy look like Bruce Willis?’ " Gold says. His wife will tell him that he’s mistaken; his doctor may then focus on the delusion in a therapy session and adjust his medication. Fusar-Poli, the psychiatrist in London, has developed techniques that he believes to be particularly effective with Truman patients. He notes, "If someone says, ‘I get the impression that I’m being filmed when I walk down the street,’ we might have a psychologist take a walk with him and say, ‘Show me the cameras.’ "

Benjamin Sadock, a professor at N.Y.U. and the author of a best-selling psychiatry textbook, says that many psychiatrists now treat patients with the understanding that "pharmacotherapy combined with psychotherapy gives better results than either one alone." Nancy Andreasen, the psychiatrist who once heralded the "biological revolution," feels that the revolution went too far. "You can’t treat a person as a purely biological creature," she says. Antipsychotic drugs are blunt instruments, and are often administered on a trial-and-error basis; prolonged exposure at high doses can cause brain damage. "When you have a therapeutic relationship, you can manage the dosage better," Andreasen says. "You can talk to the patient about their side effects. Compliance goes up. The patient gets better more quickly."

Gold and his brother are writing a book, for Simon & Schuster, arguing that both biological and social factors contribute to psychosis. Studies show that residents of cities have a higher risk for schizophrenia, as do immigrants. Psychotic people are several times more likely than nonpsychotics to have been sexually abused. Mental illness, the Golds believe, is rarely reducible to brain chemistry.

"Think back a few hundred years," Joel Gold says. "The idea of walking into Times Square would have been crazy-making to absolutely anyone. For most of human history, there weren’t strangers bumping into you. You lived in a place where there were fifty people, and you knew all of them intimately." Now such collisions are constant: a smartphone is a Times Square that we carry around in our pocket.

"If living in New York City is a risk factor of psychosis, then why not the Internet?" Gold continues. "We’re not saying, ‘Don’t let your children surf the Web—they will be psychotic.’ We are saying, ‘This is something we should think about.’ " Just as Times Square is a diversion for some people and a stressful place for others, the cyclopic camera above a laptop’s screen might, for a certain type of person, become a source of corrosive unease.

Lotz decided not to return to college for his senior year. He didn’t want to stay at home in Hudson, though—that would make for a tedious show. He asked his father if he could live with him in L.A. His father said that he could, if he saw a psychiatrist. He refused.

One day, while Lotz was out running, his mother found copies of the desperate letters that he had mailed to celebrities. When she confronted him, he said, "You shouldn’t have opened my mail."

In tears, she said, "You’re asking all these people you don’t know for help. Would you please let me help you?"

She Googled psychiatrists in L.A. while Lotz watched her, silently. The producers wouldn’t like it if he accepted his mother’s help, but he couldn’t figure out a way to refuse it. "Let me go up to my room and think about it," he said. After a few minutes, he bounded downstairs. For the first time in years, his mother saw an unclouded look on his face. "They say I should do it!" he said. "If I go to a doctor in California, I’ll win a million dollars!"

In June, 2010, he moved in with his father and went to see Stephen Marder, a psychiatrist at the U.C.L.A. Psychosis Clinic. Marder gave Lotz a prescription for Geodon, an antipsychotic that usually takes months to work, if it works at all. At first, Lotz only pretended to swallow the medicine; you had to consume five hundred calories of food before taking each pill, in order to prevent nausea, and he didn’t want to anger the producers by gaining weight.

He made frequent visits to the clinic, however, to talk with Marder and the residents. "Psychiatrists who treat serious mental illness don’t spend the time with patients that they used to," Marder says. Yvonne Yang, a resident, recalls Lotz telling her that the clinic "was the first place where he felt listened to, and where people took his feelings and thoughts seriously." Lotz was initially hesitant to describe his symptoms, but he eventually admitted that he heard voices. Soon afterward, he began taking the pills.

On the morning of November 10, 2010, he woke up on the futon in his father’s living room; for the first time in two and a half years, he was alone in his brain. "It felt beautiful," he told me. When his father returned from work, Lotz announced, "It’s all gone." Only weeks later, when he began referring to "my delusions" in a self-deprecating tone—and in the past tense—did his parents feel confident that he was getting better.

Lotz’s irrational thoughts have not disappeared, Marder says, but he "has developed the ability to deal with it." Marder steered him toward cognitive-behavioral therapy, which helps him distinguish fantasy from reality. He does relaxation exercises, repeating words like "peace." Such rituals help push away "interfering thoughts," Lotz says, adding, "If I have an overwhelming fear that I cannot rationalize, I discuss it with my therapist."

In June, 2012, Lotz was surfing the Web when he saw a headline: "CASES OF ‘TRUMAN SHOW’ DELUSION ON THE RISE." The article mentioned Joel Gold. Lotz sent him an e-mail:

I saw an article today in the Daily Mail about the Truman Show disorder and it blew my mind. I subsequently purchased and downloaded your article in the cognitive neuropsychiatry journal. . . . It would really help me to share this with someone, and if there is any ways you can make more effective treatment for this disorder with my help, it would truly help validate my life.

Gold called Lotz, and they spoke for about an hour. Lotz recently told me, "Knowing that other people are afflicted with this, and that there is recognition and treatment for it, has been something that has given me great strength."

In December, I went to Ohio to meet the Lotzes, who live in a planned development called Hudson Hills. As I drove down their block, I noticed tiny, colorful objects scattered across the snow-covered lawns. I stopped the car. Planted in the snow, at ankle height, were dozens of plastic flags. I bent down to read an orange one. "Buried Fiber-Optic Cable," it said.

Lotz was home for the holidays. Although we were meeting for the first time, he told his story in medias res, as though I already knew him. In a way, I did: I had begun following his blog, his Facebook page, his Twitter feed, his LinkedIn profile, and his SoundCloud stream. I had also watched the seventeen videos on his YouTube channel, most of them standup sets that he had recorded while delusional. Some of the videos had been viewed only ten or twenty times, but during the next few months their view counts rose steadily. It was hard to tell if I was the only one clicking on the videos, or if strangers were watching them, too.

The day after Christmas, Lotz and I drove to Ohio University. On High Street, we passed an outdoor wooden staircase that descended a steep hill. "Once, they made me run up and down these stairs all night," he said. We parked the car, and, for a few minutes, we walked without saying much. It was his first visit to the campus since his paranoia had diminished. We passed by Jefferson Hall, his former dormitory, which he had once believed was an elaborate stage set. "I was nervous to come here, like, that I would feel it again," he finally said. "But it’s just a boring college town."

Lotz now lives by himself, in Long Beach, California. He has a part-time job, and he studies Chinese at a local college. On weekends, he goes kayaking or skiing. He still enjoys writing; he is working on three science-fiction screenplays, but has no expectation that they will be produced. He has found a doctor he trusts and a prescription drug that blunts his symptoms without making him dysfunctional. Many people with psychosis are not so lucky. Still, there is no cure—only remission. These days, Lotz finds it helpful to view his brain’s excesses as amusing, not alarming. He recently wrote to me, "Whenever some eerie coincidence happens . . . there’s this part of my brain which jacks itself up all of a sudden and spazzes out, exclaiming ‘This is it! What they were always talking about! It’s happening! They are watching me!’ Except now, it’s kind of reassuring in a way. ‘People care. They are paying attention. I matter.’ I don’t, actually, but it’s nice of my mind to tell me I do." ♦