Part Two: Categories of Paranoia

There are two categories of paranoia, and they may not be entirely related. If you follow this link   from the site above, then glance at the other things Ms Stuter has written , we will use these as both as illustrations of the two types.

While it is true with both that the paranoid outlook comes first (I think genetic or prenatal) and the specific content comes later (I think environmental), that is also true for depression, anxiety, buoyancy, and many other attributes.* That’s not enough explanation.  There seems to be a qualitative difference in the paranoia of those who have a single fixed idea that is orthogonal to the experience of the rest of us, versus those who have overlapping paranoid explanations about many things. Diagnostically, it is the difference between a thought disorder versus a personality disorder. 

 

With the former, a person often has an accompanying physical experience (interpreted broadly) which their brain explains for them in paranoid fashion.  If they hear something, their brain will soon tell them it is a voice or a meaningful signal, which rapidly becomes the embedded explanation. Or they may have waves of a sense of heightened importance in the moment, which they connect to whatever was happening at the time. (“A helicopter went over just as I was getting on the bus, and I just knew it was important.” “I just knew that the TV announcer must be talking directly to me.”) Thirdly but not exhaustively, the sufferer will have an overwhelming impression that things are just not right. In the grip of that, they may think that objects have been moved or replaced, and conclude that someone must be coming in while they are gone, teasing them as a warning or a torment.  Or they no longer believe their family members are real, but have been replaced by imposters. (Capgras Delusion. Can include pets.) This can get frightening when a woman believes such about her young children.

This sort of paranoia is often of later onset, so that the person’s skills and adaptation have proceeded quite typically before the disorder started.  They thus have a lot of functioning intact initially and can continue to work or live independently for years.  But delusions capture more and more of their lives and their impairment increases. My patient whose attempts to prove her delusions put me on to the site linked in Part One believes that she is being “gang-stalked,” and interprets the shouts of kids skateboarding and random marks on the nearby school as evidence that these gangs are trying to torment her. She brandishes Ms. Stuter’s essay with relief and triumph as evidence that she is not crazy, because someone else knows about this. No amount of discussion, forceful or gentle, dissuades her even 1%, nor arouses the slightest doubt.  She knows.

The other type has earlier onset, and applies more to the conspiracy theorists and other political types. They are generalists rather than specialists in their paranoid attribution, and their ideas are more likely to change slowly over the years. If you read Ms. Stuter's essays you don't find further references to gang-stalking (I admit I didn't read it all). If she suffered from this belief, as my patient does, she would be unable to refrain from mentioning it repeatedly. What likely happened is that someone reported this delusional experience to her and she, being a conspiracy-tending person, accepted the story as plausible, reporting it for the benefit of others.

Folks like this don't tend to deteriorate in functioning so sharply. They make lifelong accommodations - to work at jobs that aren't impacted, choose when to let their opinions out and when to keep silent. They can redirect their energies to small victories on school boards or working for causes.  some few have a charisma rather than that "stay away" vibe that paranoid personality disorders give off, and can become successful leaders of nonprofits or writers with an audience. There are plenty of folks against Common Core - with some good reasons - but these would be the most intense of that group, the opponents who not only think it is bad educational practice, but part of deeper plots. Even that is not quite paranoia.  Only when it gets to naming specific individuals or groups would I crest over to calling it that.

So it may actually be a good sign if you are paranoid about more things.  It makes your suspicion more diffuse, less intense.

Here's an interesting bit of interchange I've seen play out.  The specialist, psychotic paranoids are often drawn to the generalists, thinking "Ah, here is a person who gets it. Finally, someone who understands." I speculated that's what happened in Ms. Suter's case. Yet it doesn't play out that way.  The paranoia generalist shakes his head and says "No, you are not the center of the world's evil plots. The few are oppressing the many.  You're one of the many."

It gets interesting

*“I am physically daring because in my neighborhood you had to…” “I have always been disciplined about being on time because my parents instilled…”  No, unlikely.  More likely, you shared much of that quality with one or both parents right out of the gate.  I don’t discount parental intervention and peer influence entirely, but it is weaker than we have said for years.