Paranoia: contested and contextualised

De-Medicalizing Misery

Bracken and Thomas (2001: 724) note, "[i]t is hard to imagine the emergence of 'antipaediatrics' or 'critical anaesthetics' movements". But why is this so? One of the reasons is that there is often a fundamental disagreement about the meaning attributed to experience and, who has the right to confer that meaning. Experiences like paranoia are often decontextualised and stripped of meaning. For example, psychiatry variously classifies paranoia as a sub-type of schizophrenia, a separate delusional disorder or as a type of personality disorder. Yet arcane discussions of the differences between diagnostic sub-types distract from commonalities in the way paranoia is experienced. In this chapter I investigate the concept of paranoia, paying attention to its contested nature. I take a deliberately broad view, seeing it as an apparently unwarranted fear and belief that others intend to harm one in some way, leading us to respond to others in a fearful, wary and even hostile manner.

The British Journal of Psychiatry, 2013

Paranoid ideation is characteristic of psychotic illness, but, like other psychotic phenomena, may be widespread in non-clinical populations. [1] Wariness of the intentions of others may be adaptive in some situations, and becomes a clinical problem only when it is excessive, exaggerated or distressing, or interferes with functioning. Given that such ideation may precede delusion formation, 6,7 our understanding of delusions should be enhanced by studying paranoid thinking in non-clinical populations. In our cognitive model of persecutory delusions, 8 we hypothesised that even severe paranoia builds on common emotional concerns, particularly themes of interpersonal worry or social anxiety. The interpersonal sensitivities often seen in emotional disorders (e.g. concerns about rejection or about being vulnerable) inform worries about future threat and the intention of others. In some people, these fears lead to ideas that others are watching or talking about them. Ideas of persecution are hypothesised to emerge from these ideas of reference. This process implies a close structured relationship between worry, anxiety and paranoia. It has credence, as all concern the theme of the anticipation of threat, 9 and there is increasing empirical evidence for links between affect and paranoia. The current investigation employs data from a general population survey to examine the distribution and underlying structure of components of paranoid ideation. Our analyses were driven by the hypothesis that the overall distribution of such ideation should be similar in form to that of affective symptoms, with many people having few such thoughts and a few people having many. 3,16,17 Moreover, as with affective symptoms, increasing symptom counts should be characterised by the recruitment of rarer and odder ideas: 18 in other words, a hierarchy of paranoid thoughts underpins an inherent structure within the continuum. In our cognitive model of paranoia, 8 we postulated four subcategories of paranoid experience: interpersonal sensitivities; mistrust; ideas of reference; and ideas of persecution. Moreover, we postulate that this structure arises because the subcategories are linked as part of a hierarchical process. Members of the general population would be classifiable in terms of these factors, and the resulting classification would correspondingly reflect hierarchical relationships between the factors.

Theory and Psychology, 2009

Both psychology and psychiatry are dominated by individualistic accounts of paranoia (and indeed, other forms of distress). As a corrective to these, this paper provides a social account of paranoia grounded in a minimal notion of embodied subjectivity constituted from the interpenetration of feelings, perception and discourse. Paranoia is conceptualised as a mode or tendency within embodied subjectivity, co-constituted in the dialectical associations between subjectivity and relational, social and material influences. Relevant psychiatric and psychological literature is briefly reviewed; relational, social structural and material influences upon paranoia are described; and some implications of this account for research and intervention are highlighted.

Clinical Psychology Forum, 2005

Asian Journal of Humanities and Social Studies, 2014

Paranoid beliefs, though key to the diagnosis of paranoid schizophrenia, are not exclusively seen in patients suffering from this psychopathology and exist in less severe forms across different populations. Evaluating these symptoms as a continuum may be more interesting for the understanding of paranoia rather than the dichotomous approach to this kind of ideation. The main goal of the current research is to assess how paranoid beliefs are present across different populations. Using the Portuguese versions of the General Paranoia Scale and the Paranoia checklist, we compared the endorsement of paranoid beliefs in 187 subjects (64 healthy controls from the general population, 32 relatives from schizophrenia patients, 30 patients in remission and 61 patients with acute schizophrenia symptoms). The results show that paranoia is present throughout the population, from non-clinical forms to more severe clinical samples, demonstrating a continuum of increased frequency and intensity until it reaches a delusional level. Environmental factors in the endorsement of such beliefs are also discussed.

2005

Journal of Marital and Family Therapy, 1983

An interactional basis for the evolution of a paranoid cycle ispresented, followed by its implications for clinical interwention. Deatment strategies and tactics are delineated along with a set of clinical examples. The major therapeutic principle advocated is for the therapist to help to build new action based upon old labels andpremises. The danger of using static labels ofpathology is clarified through the example of the paranoid cycle. Finally, the interactional view of the paranoid cycle is briefly related to the paradigm shift within our field. Due to strategic intervention tactics, the reframing of traditional labels used by the field in general is advocated as the best pathway to change. "Just because you're paranoid, it doesn't mean that everyone isn't out to get you." This paper has two major goals. The first and foremost is to clarify the concepts and consequences of viewing problems from an interactional or cybernetic view, often called "strategic." The second is to address the use and misuse of labels, both as they are used by clients, and as they are used by ourselves as therapists. Toward these ends, an interactional view of paranoia will be presented. A brief review of some other views of paranoia will be followed by a hypothetical example and an updated analysis of the evolution of a paranoid process suggested by Lemert (1962). A set of strategies and tactics for intervention along with case examples which draw heavily on the concepts of the Mental Research Institute (MRI) group (Watzlawick, Weakland & Fisch, 1974; Weakland, Fisch, Watzlawick & Boden, 1974; Fisch, Weakland & Segal, 1982) will be offered to clarify some of the therapeutic consequences of viewing paranoia from this interactional stance. Finally, the implications of this interactional view of paranoia and the use of traditional labels will be addressed, both as they apply clinically and as they apply to paradigm shift.

The British Journal of Psychiatry, 2005

2000

2011

Background. Paranoia is an unregarded but pervasive attribute of human populations. In this study we carried out the most comprehensive investigation so far of the demographic, economic, social and clinical correlates of selfreported paranoia in the general population. Method. Data weighted to be nationally representative were analysed from the Adult Psychiatric Morbidity Survey in England (APMS 2007 ; n=7281). Results. The prevalence of paranoid thinking in the previous year ranged from 18.6 % reporting that people were against them, to 1.8 % reporting potential plots to cause them serious harm. At all levels, paranoia was associated with youth, lower intellectual functioning, being single, poverty, poor physical health, poor social functioning, less perceived social support, stress at work, less social cohesion, less calmness, less happiness, suicidal ideation, a great range of other psychiatric symptoms (including anxiety, worry, phobias, post-traumatic stress and insomnia), cannabis use, problem drinking and increased use of treatment and services. Conclusions. Overall, the results indicate that paranoia has the widest of implications for health, emotional wellbeing, social functioning and social inclusion. Some of these concomitants may contribute to the emergence of paranoid thinking, while others may result from it.