More From Psychblogger Days - Paranoia

I have stressed many times since putting this post up that the symptom of paranoia precedes its target and exists independently of the target. Part of my best evidence for this was watching a patient over their first few admissions.  At first, they would only know that "something" was wrong, and that forces of some sort were against them. On a second admission they had discerned it had something to do with their sister, and by the third admission that their sister must be trying to screw them out of some inheritance by making them appear insane. Ten years later, the sister had long since died, there was no mention of an inheritance until I asked about it, and the patient was certain that the police were trying to frame him.

An update is the discussion of Conspiracy theorists over at The Studies Show a couple of weeks ago.  I thought it was almost balanced, though they are clearly liberal themselves. For example, they find the analysis in The Psychology of Conspiracies interesting in its thoughts but go on to point out that there isn't much solid research in it.  It touches on possible reasons for conspiracy beliefs - epistemic, existential, and social - and cites social science research along the way, but said research is often ill-defined or biased itself.  I concur.  It reads more like a persuasive essay to convince us of the authors' preloaded opinions.  And as Tom Chivers says on TSS, "After a bit I think I'll just go back to my own ideas."

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From 2011.  One of my paranoid patients uncovered the site Are You Targeted (no longer exists) in his searching the internet for proof that he is being harassed by Hollywood and popular music, with messages directed specifically at him. He takes the existence of this site as evidence that his paranoid delusions are true: See, this is happening to other people, too! That different things are happening to those people, and they each have different experiences from each other, with only minor overlap, fazes him not. It's all tied in together somehow.


My other really bright paranoid patient - she was a software developer up until a decade ago - has a different, nonelectronic set of delusions. A homeless person has been stalking her for at least three years, across three states, and recently revealed his existence by mistakenly leaving a purse she had lost in 2007 in a box in her apartment.

Here's the saddening, infuriating, and fascinating part. Both of them are now on medication, and are far more organised and relaxed. Both are able to coherently put on paper or into speech what they were unable to only a month ago. Then, additional notes up the side of the page, or between lines, or underlined and arrowed onto the back made their work unreadable. Now they can write in sentences and paragraphs. (I am overdrawing that somewhat, but the difference is dramatic.) Yet their delusions are absolutely untouched, with the possible exception of the fact that no new material is being added.

So there are two - at least two - parts to the illness, one which is treated by the medication and another which is untouched.