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The term paranoia is used by psychiatrists to designate a wide variety of mental disorders ranging all the way from mild paranoid tendencies ’ up to true paranoia. Many of these abnormal mental states are more accurately described as paranoid trends. The distinguishing characteristic common to the various types of paranoia is the presence of systematic delusions concerning the subject’s own importance. He readily comes to believe himself the center of everything happening around him.
True paranoiacs are frequently dangerous if left at large, and paranoia in all its forms is a potential source of danger both to the subject and to his associates. Although true paranoia is somewhat rare, the existence of paranoid trends in otherwise apparently normal individuals is frequently observed. Most such cases never go beyond the stage of harmless “cranks,” but a certain percentage develop by degrees into more serious forms of paranoia. One of the valuable services which psychiatry has to render is to educate the public to recognize the existence of paranoid trends while there is yet time to correct them.
Paranoid trends can sometimes be detected even [ p. 11 ] in the nursery, but they ordinarily first appear in late adolescence or early adulthood. Although no two cases show exactly the same symptoms, certain characteristics are more or less common to all. In the analysis to follow we include only those which are relevant to the purpose for which this chapter is written — namely, to provide the basis for a subsequent diagnosis of paranoid trends in a nation. To describe all the symptoms would take us off the main path to our destination.
Suspicion. The paranoid characteristic first to assert itself is suspicion. Parents and teachers are often alarmed at the appearance in young children of such traits as lying and stealing. To the psychiatrist, however, shyness and suspicion are more serious causes for alarm. Extreme shyness is frequently a first symptom of the schizoid type of personality, and extreme suspicion of the paranoid trend. Hence the presence of either of these traits in children may well merit the attention of the psychiatrist. Suspicion does not always indicate a paranoid trend, it is true, but paranoid trends always include suspicion as an outstanding characteristic.
One aspect of this trait takes the form of extreme sensitiveness. Of course, many people are sensitive, but paranoids are sensitive in a way all their own. They tend to project their feelings and anxieties out [ p. 12 ] upon their surroundings and especially upon other people. It is with reference to slights and insults thus projected out of their own imaginations that they are peculiarly sensitive. Their suspicions feed upon these imagined wrongs.
As the paranoid grows up through adolescence into early adulthood, he becomes increasingly ingenious in misinterpreting the ordinary events of life. Commonplace things happen to him just as they do to his friends and neighbors, but they come to have a different and peculiar meaning to him. On some social occasion, if a paranoid sees two people talking in a low tone, he is quite likely to conclude they are talking about him, and that they are saying critical and unfavorable things. It seldom occurs to him that they may be saying favorable things about him. This perverted trend of misinterpretation increasingly causes him to feel that his neighbors and associates are unfriendly and hypercritical, or even hostile. He is constantly worrying about what others think of him, and after years of this worry and anxiety he later develops a peculiar and characteristic form of disdainful and contemptuous bravado.
Psychiatrists use the term self-reference to characterize individuals who tend to apply to themselves in a purely personal way everything that occurs in their environment. To the paranoid the universe is always unfriendly. Life swarms with conspirators who are his confirmed enemies, and who are devoted [ p. 13 ] to making life miserable and unbearable for him.
Egotism. Another characteristic of the paranoid trend that usually asserts itself at an early age is the habit of thinking and talking overly much about oneself. The typical paranoid is inordinately conceited and persistently egotistic. Often this is only a compensatory reaction to an inferiority complex. Deep down in his heart such an individual, at least during the earlier stages of his disorder, is usually haunted by feelings of inadequacy. To hide these feelings from himself he covers them over with an exaggerated show of self-importance. He becomes stubborn and proud. In time he grows disdainful of the opinions and rights of others.
At the same time his inflated ego craves attention and recognition. The longing to be highly regarded by his fellows often becomes pathological in its intensity. Under the name of status anxiety, this is a trait well known to the psychologist.
Envy and Jealousy. Paranoids are usually envious of the success and the prosperity of their neighbors. They regard the possessions of others with jealous eyes and habitually scheme and connive to obtain some equivalent advantage. Failing that, they resort to belittling the achievements of others and to glorifying their own superior virtues.
Desire to Dominate. Most paranoids become very ambitious. They crave to live on a level above their fellows. They demand special privileges and hold [ p. 14 ] themselves above the rules and restraints of society. In whatever group they find themselves, they are domineering and imperious. They recognize no one as their superior and are not content until they imagine themselves in authority over others. Some paranoids possess considerable ability as leaders, but whether they have the ability or not, they all seek to lead. Some of them try their hands at invention, others at remaking the world. As time goes on, the paranoid grows increasingly aggressive.
Irrationality. Paranoids do not reason out situations the way normal persons do. They tend to “short-circuit” their logic and to jump to conclusions by imagining things to be as they want them to be. Frequently they can argue so plausibly as to convince their associates as well as themselves. Preconceived ideas play a very large part in their reasoning processes. They become very clever at alibis and in shifting responsibility for their own mistakes. The other fellow is always to blame when something goes wrong. These traits are all part of a deep-rooted tendency to treat the world as a mirror in which they can see only their own image.
Not only do such persons misinterpret present realities ; they habitually falsify past happenings as well. They remember the past not as it actually was, but as their subconscious minds would have liked it to be. Their memories are very inventive, and always in a way flattering to their own sense of importance. [ p. 15 ] This retroactive falsification is a peculiar and diagnostic characteristic of the paranoid personality.
Persecution Complex. Sooner or later every paranoid comes to the firm conviction that he has not had an even break in life, that he has been denied a square deal. Victims of this disorder are always seeking justice. Many of them appear repeatedly in courts, suing individuals or corporations for imaginary injuries of one sort or another. Usually they develop the fixed idea that they are being persecuted by some group of people, such as the Jews, the Masonis, or the Catholics. They imagine all kinds of reasons why their persecutors should “have it in for them,” and it is utterly impossible for anyone to talk them out of their complex.
For one thing, paranoids do not have a normal sense of humor to which one can appeal. They are in dead earnest about everything they believe and do. And no amount of kindness or compromise will appease them. A paranoid is simply unappeasable. Any attempt at appeasement is bound to be rewarded with further demands. Their thirst for what they egotistically consider “justice” is insatiable.
In its fully developed condition their abnormal state of mind becomes a martyr complex. The victims of such a complex readily accept the role of martyr and fairly revel in the halo of importance which it sheds upon them. Their minds dwell upon the martyrs of old who suffered persecution, and they fondly [ p. 16 ] imagine themselves worthy members of that distinguished company.
Megalomania. As the years pass, this tendency of the paranoid to magnify his own importance becomes more and more pronounced. There slowly grows up in his mind a belief that he is singled out by destiny to perform great deeds. He imagines himself called upon to right some cosmic wrong, to accomplish some tremendous reform, or to inaugurate a new world order. If given the opportunity, a paranoid individual now and then may go some way toward the achievement of his grandiose aims. Most such individuals however find their place in the socalled “lunatic fringe” that inevitably gathers about every social movement.
It is characteristic of this trend that the individual never experiences any feeling of guilt for the mistakes and crimes which he may commit under the compulsion of his idea of destiny. In his own thoughts he stands above right and wrong, a law unto himself. Whatever he chooses to do is right for him, and woe unto the person or thing that gets in the way. Moreover, the paranoid is never deterred by defeat. He is as incapable of recognizing defeat as he is of admitting error or guilt. He will make the same attempt over and over again with only a change of tactics. His idea of destiny is “fixed” beyond possibility of change.
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Delusions. By the time the paranoid becomes fixed in his idea of destiny, he is already on the verge of true paranoia. That final stage is reached with the onset of delusions. By then he is definitely psychotic — or insane. Up to this stage paranoids do not harm people. They are not homicidal. They may start lawsuits, build spite fences, write harassing letters to ministers, public ofiicials, and political leaders, but not until delusions appear are they dangerous to society.
When these delusions appear, when they begin to hear voices, they will presently start to systematize both voices and delusions. Shortly they will go forth to carry out that which the voices have told them to do. They very cleverly systematize their delusions, and they can do it so expertly that many times their friends believe in them. They sometimes convince the courts they are right, and they are even able sometimes to impose upon physicians who have not given much thought and study to paranoia.
At first the paranoid’s delusions are likely to be those of persecution. Someone is conspiring to make trouble for him. Some group is “out to get” him. But as time passes, he reasons that to be the object of so much attention he must be a person of great importance, and he forthwith begins to indulge in delusions of grandeur. He soon imagines himself to be a Napoleon Bonaparte, the Messiah, or some other famous personage of history.
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When the stage of true paranoia has been reached, the individual is a menace to society and fit only for confinement. Under the delusion that he is hearing voices, he is perfectly capable of plotting and executing the most fiendish crimes imaginable. If the “voices” order him to assassinate some prominent personage, he will, unless restrained, obtain a gun and endeavor to obey the command. Too frequently such individuals are taken into custody only after they have committed a serious crime. They should be apprehended at the first appearance of dangerous delusions and confined in a hospital for the insane.
The foregoing discussion of paranoid trends fits a typical case, but many such individuals do not live long enough to develop the dangerous behavior of the final stages of the disorder. It will perhaps have occurred to the reader that many of the distinguishing traits of the paranoid personality are in some measure characteristic of the human species as a whole. This is quite true. It is not the fact that a person is suspicious, conceited, or envious that brands him as a paranoid. Rather it is the presence of these traits in excess and in peculiar association that constitutes a paranoid personality. The early symptoms of paranoia are not easily diagnosed. And many cases of paranoid trends never develop into a real paranoia. Most such persons, though generally recognized as queer and obnoxious by their associates, live out their days in relative peace.
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Whether or not a paranoid can be helped depends upon the existence and extent of a clear area within his personality. The majority of paranoid individuals have many experiences not essentially different from those of normal persons. With sufficient patience and understanding the skillful psychiatrist can very often successfully expand this clear area to the gradual exclusion of abnormal experiences peculiar to paranoia. This is the only way the trend can be arrested and brought under control, and the chances of success are proportionate to the area remaining clear of paranoiac abnormalties.
When the paranoid once begins to hear voices, it is usually too late to do anything for him. His clear area is too far reduced for effective treatment. But until that stage is reached there exists the possibility that the patient may be helped. Much can be accomplished if he is still normal enough most of the time to realize the paranoid character of his abnormal moments.
One very important first step in treating this ailment consists in getting it recognized for what it is by the family and near associates of the patient. The members of a paranoid’s family or intimate circle can do much to aggravate the condition if they are not instructed in the proper way of dealing with him. Usually they either humor or resent him. Neither method ever proves effective. The paranoid does [ p. 20 ] not respond to kindness or criticism as normal persons do. He must be treated in a manner appropriate to his abnormal condition. This means resisting his paranoid aggressions patiently but nevertheless firmly. Above all, he must not be permitted to think that his associates are being taken in by his strategems and delusions.
Paranoia is a mental disorder whose victims range all the way from harmless “cranks” up to dangerous psychopaths.
Suspicion is the outstanding symptom of paranoids. They are peculiarly sensitive and tend to project their fears out upon other people.
Their ingenious misinterpretations of what goes on around them creates the belief that they are victims of numerous slights and insults.
They are victims of “self-reference” — the unwarranted practice of applying wholly irrelevant happenings to themselves.
The paranoid is inordinately conceited — persistently egotistic. Though often disdainful of public opinion, he still craves recognition.
Paranoids are envious and jealous of the achievements of others ; they belittle them in order to glorify themselves.
They are domineering and imperious. They are ambitious and aggressive, and crave authority.
Paranoids do not think and reason like normal [ p. 21 ] persons — they “short-circuit” logic and formulate conclusions to suit their own projects.
They even falsify history — they recall the past so as to justify their present attitudes and flatter their feelings of self-importance. They are expert at inventing alibis.
Paranoids have a persecution complex — they are always seeking “justice.” Many even develop a martyr complex. They lack a sense of humor and are utterly unappeasable.
The paranoid becomes obsessed with the conviction of “destiny.” He drives on oblivious to right or wrong and becomes a law unto himself.
He is a stranger to all feelings of guilt, and he is never conscious of defeat. He relentlessly pursues his goal.
Sooner or later delusions appear. Paranoids eventually begin to hear “voices.” At first these delusions are persecutory, but presently they become grandiose. The paranoid imagines himself to be some great personage.
The hearing of voices means that the paranoid has become a menace to society. This is the psychotic, or insane, stage and calls for confinement.
Paranoids can be helped if there is a sufiicient “clear area” to enable them to recognize their own paranoid tendencies, and if they are co-operative. It is highly important that their associates also recognize the disorder.