Dealing With Paranoid People And Nations

While there is wide variation and crossover within each of these categories, there are actually only four solutions in dealing with deeply paranoid people. These are by no means mutually exclusive.
Lock them up
Give them medicine
Throw them in the deep end
Throw them in the shallow end

Lock them up. Meaning jails, hospitals, etc. Other types of isolation are usually self-imposed, and fit more in later categories. When people are imminently dangerous to themselves or others, they must be prevented from causing harm. It’s a great solution in the short run, and sometimes the only solution. But it has long-term consequences. People are removed from their supports. They can lose housing, jobs, family, friends, or possessions, reducing whatever incentives they had to keep themselves afloat on the outside later. They are also removed from the natural consequences of their actions, and a powerful teaching tool is lost.

The equivalent among nations is probably invasion. Dangerous governments are prevented from destroying either their own people or another people. It is a good short-term solution, and sometimes the only choice available. But it has long term consequences. Infrastructure is destroyed, previous business or cultural alliances are threatened, and jobs are lost. And as with individuals, the country is removed from the natural consequences of its actions.

Give them medicine. I know there are advocates of non-chemical treatments who claim success with behavioral, psychodynamic, or cognitive treatments of the intensely paranoid. I don’t see it in my part of the mental health industry, ever. Some personality-disordered patients, who have something like mild paranoia as an outgrowth of their misinterpretation of interactions, may have some benefit from these things. But frankly, my borderlines troubled with voices and demons, even though they are of a different type than classic hallucinations, seem to improve more quickly with a little clozapine.

For paranoid schizophrenics, I don’t see anything but antipsychotics working. Treatments on the horizon that purport to work on receptors farther back up the chain are intriguing, but they aren’t yet on the menu.

I don’t see an equivalent for nations in this analogy. I can entertain the fantasy of Abilify in aerosol form being sprayed over an Iranian cabinet meeting, but I doubt it would be effective (though if it were effective with only a few percent of well-placed ministers…see below) I don’t think there is any data on antipsychotic treatment of culturally paranoid individuals, and certainly none on groups.

Combining medicine with lock them up interventions are the coercive maneuvers of applying for guardianship or threats of lengthy commitments. You’re not leaving until you have had at least 2 Consta injections or the like. This is most of what I see five days a week: People who insist that they are well and don’t need medications being coaxed, bribed, cajoled, led, or forced into taking them.

Throw them in the shallow end. I have met people who have carved out remarkable niches for themselves even though they are deeply paranoid. They find some sort of endurable job, an apartment or isolated cabin to keep out the weather, and dozens of compensating strategies to get around whatever their paranoid obstacle is. We kid about the tinfoil hat crowd on the blogosphere, but I have known several folks who tried it, and one who believes it works to keep the radio signals out. People adjust, and decide that the food at one store is not poisoned, or to cover their thoughts well enough to move about in the world, following careful routines and rituals. It seems in many ways a sad life, but this is not always so. I think it is rare, and perhaps works mostly with those whose paranoia is mild enough to be passed off as an eccentricity, but I have known people who lived for decades this way with some pleasure and a narrow circle of friends. Sometimes writing consumes them, as they perhaps try to gain some mastery over their thoughts by putting them into a contained space.

This type of pressuring everyone in the society to conform to at least some minimal extent, so that the others can live unmolested, is exactly what nations do with each other as well. This is what works with all of us mildly to moderately difficult people. The needs of others create sharp edges in all cultures, and we all learn to get fed, have friends, and keep safe by moderating our own selfishness and eccentricity enough to at least get by. Nations have trade agreements, boundaries, alliances, products and services to buy and sell, armies, and treasures which they use to get other nations to act in acceptable ways. If you don’t sell us bread, we won’t sell you wine. If you put tanks on our border we’ll put tanks on ours. Among sensible nations, the elements of coercion are far removed from the negotiations. Though the Poles and Germans have fought many times and might someday fight again, negotiations between those countries now take place without thoughts of open hostilities clouding up the barley tariff agreements.

As all nations have some just measure of suspicion of each other, the flow of financial pressures across the globe works fairly well with not only sane nations, but even mildly paranoid ones. The other nations can step up the pressures to try and force the recalcitrant back into line. As disruption increases, nations band together and more openly arm-twist each other.

Throw them in the deep end. This is what families, landlords, and communities often end up doing. The hope is that under the pressure of homelessness, hunger, ostracizing, or other intense social pressures the person will change, or at least relent somewhat and make compromises. I am not experienced in this, as we only see the failures of this method when a person ends up in hospital. And as loss of freedom is a similar intense social pressure, I guess hospitals can be considered a “natural consequence” as well. My outsider’s opinion is that this is not successful, unless it results in a person capitulating and taking medicines. One would think that such draconian interventions would cause people to modify their behaviors, but what usually happens is that they dig in more deeply on the problem behaviors and adjust other things in their lives instead. They adjust to homelessness or isolation, they learn to find soup kitchens and to increase their substance abuse, but they do not change their belief that the people down the street are baby-killing Satanists. They merely find that there are more baby-killing Satanists all over town. The key behavior remains unaffected, even if the pressure is greatly increased.

I think this may have an interesting international analog. We believe that because increases in environmental (social, economic) pressure results in adjustments by sane nations, or even half-sane nations, then all we have to do is keep increasing the pressure and even a crazed nation will eventually get the message. We believe that a nation cannot manage well if its supports are eroded. But when a nation is completely paranoid, this no longer applies. When sanctions were place on Iraq, many things changed, but not the key thing we were after. North Korea is now a place where citizens are starving, and there are reports of cannibalism. The government has not changed its pursuit of sophisticated weaponry. North Korea has found the soup kitchen and a tent under a bridge, but has not made the one change that has any meaning: admitted that its approach is not working.

We believe isolation and sanctions will work. We also believe that if mentally ill people feel the pinch enough, they will have to capitulate. Apparently, neither is true.