Paranoid people can be exhausting. Having to live or work with someone who constantly feels slighted, who takes offence at the most trivial comments, and who is forever in need of reassurance and praise, grinds you down. Unfortunately, while extreme paranoia may be rare, such mild paranoia is common.
The Nature of Paranoia
Most people experience paranoia at some point in their life, particularly when gripped by strong emotions. First time parents often become paranoid, paying attention to news stories they would have previously ignored and seeing dangers where none exist. Fathers in particular can become paranoid about the safety of a teenage daughter. A nurse on a cancer ward may grow paranoid about her own health, convinced that every lump or cough means a tumour. Indeed, paranoia about one’s health is especially common and public health drives are the bane of a physician’s life. For example, a TV campaign intended to raise public awareness about testicular cancer will probably mean a queue of terrified young men at the local doctor’s on Monday morning, each one certain he has found a suspicious lump. Human beings are panicky, suggestible creatures, and a certain amount of paranoia is understandable.
True paranoia is much more serious, however, ending relationships, ruining careers, and even leading to violence. Paranoia can also be a symptom of mental illness. Schizophrenia, mania, and psychotic depression all include a degree of paranoia. Of course, the focus of this paranoia varies from family members to complete strangers, from specific individuals to entire races. And whereas one individual may develop absurd fears, becoming paranoid about alien abduction or the CIA listening to his phone calls, another may become paranoid about something plausible, like his wife leaving him or his bank account being hacked.
Fear of Persecution
One common form of paranoia is known as DDPT, or ‘Delusional Disorder of the Persecutory Type’. Those suffering from DDPT develop a false belief that hardens over time. And this delusion usually involves a single individual whom the sufferer believes is out to hurt them. In their dealings with everyone else, they may be quite normal. And yet when it comes to a work colleague they believe is trying to get them fired, the college professor who ‘hates’ them and gives them bad grades, or the friend who is trying to seduce their wife, they are irrational and obsessed. If someone suggests that their fears are groundless and that they are being paranoid, they will usually answer that everyone else is deluded, not them.
Unfortunately, the more you argue with the paranoid, the more convinced they become that they are right. They may even see themselves as blessed with greater insight and therefore duty bound to expose the monster who is out to hurt them – and possibly others. In extreme cases, this can lead to bizarre conspiracy theories involving murder plots and government cover-ups. In the most extreme cases of all, people can believe they have been singled out to fulfil a special mission, or that they must sacrifice themselves for a greater cause.
Whatever the nature of their paranoia, the paranoid all have one thing in common – they have lost touch with reality. And since the ability to grasp, face and adapt to reality is crucial to good mental health, no one gripped by paranoia could be considered mentally healthy.
Empathy
In dealing with the paranoid, it is important to realise that simply dismissing their fears will not work. On the contrary, it may entrench their paranoia and convince them that you too are involved. Tell a work colleague who believes everyone in the office hates her and is conspiring against her not to be so silly, and she will probably burst into tears and wail “I didn’t realise you hated me as well.” Unfortunately, the paranoid often create the very thing they fear. The woman who wrongly believes people at work hate her, talk about her behind her back, and are plotting to get her fired, may find that her colleagues grow so tired of her accusations and tears that they really do start to talk about her and even pester their manager to have her removed.
Try to empathise without confirming their suspicions. For example, if a hypochondriac buys you an expensive Christmas present and says “I know I won’t be here next year, so I thought I would get you something really nice,” do not reply “that’s a good idea” or “I wish I had spent more on you as well.” They will probably interpret this as you agreeing that they are going to die. Neither should you say “don’t be ridiculous; of course you will be here next year.” In other words, be careful neither to collude with the delusion nor to argue with it. Instead, empathise with her fear.
Paranoid people can be irritating and exhausting. But never forget that to them the cancer or bullying or whatever it may be is real – and they suffer.
Cognitive Behavioral Therapy
One of the simplest and most effective ways of treating paranoia is known as ‘Cognitive Behavioral Therapy,’ or CBT. The therapist begins by encouraging the individual to examine the way he or she thinks. So, for example, imagine a young man who is convinced that no one at his workplace likes him, that he is terrible at his job, and that they all talk about him when he leaves the room. The CBT therapist may ask him to keep a record of his thoughts and to note how extreme and simplistic these thoughts often are. “Do you really believe that everyone in the office hates you?” she asks. “Isn’t it more likely that one merely dislikes you?” And even if they do, that in itself does not mean you are unlikeable. She further points out that these people may dislike one another more.
Next, she asks him to consider the evidence for these beliefs and to note the way he fixates on anything that confirms his suspicions and dismisses anything that contradicts them. She also points out that all is a matter of interpretation and that you never really know what others are thinking; his work colleagues do not form a monolithic whole: they experience and interpret events in their own unique way. And, of course, they have lives of their own – and problems of their own. The idea that everyone in the office is preoccupied with him is naive.
Paranoia, like so many issues, can fester and build. The key is to catch it early, challenge it and then monitor your thoughts. If you are paranoid by nature, or know someone who is, try keeping a record of the day’s events and jotting down the way you or your paranoid friend interpreted them. Then, in the cold light of day, try to see how simplistic and extreme such thinking was. Ultimately, the most effective antidote is reason itself.