#70 - Conspiracy And Paranoia

Repost from 2019, and includes links from much earlier.  I may comment further, but there's already enough here to keep people busy for a few days.

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Well, this got out of hand.  I thought I had written about conspiracy and paranoia a fair bit, but after reviewing the search bar results, I wonder if I have written about anything else. I gave up.  I may have missed the best ones.  Here is the original, 70th-most popular post that kicked it all off. As it concerns Lee Harvey Oswald and the KGB, it is likely that some of the traffic was driven by people search about the topic, not my friends and other sites telling everyone what a great post AVI had today. I wrote about that aspect at least one more time. Okay, two.

What has been more usual for me is writing that paranoia and belief in conspiracy theories precede an actual formed theory or focus. We do not become paranoid because of our experiences.  We interpret our experiences in a paranoid way after developing the tendency.  (I am willing to discuss this in the context of people under tyrannies if someone wants to go there.  I think that is somewhat, but not entirely different.) I did find some posts about that. Categories of Paranoia, Conspiracy and Blue Hats, Paranoia FYI'

The principle applies even when it is mild paranoia or mere suspiciousness. Distributed power. Suspicion and the Liberal Mind. Yet if people really believed even that much, wouldn't they take up arms?  Or leave the country?  No, that pretend paranoia is merely there for signalling, a Poetic essence.

Ted Goretzel talks about who believes in conspiracy theories. It can include PhD's. I discussed why it is hard to convince people Conspiracy theories are unlikely and unnecessary.They are too easy. The truth is harder to fix.

The object of Paranoia can change over time. You can ascribe your troubles to different conspiracies. (Yes, she has now included the Jews.) There are whole lots of these theories, pick one. Sometimes they actually are ture: Journolist. People try to create conspiracies all the time, but the more people you have, the quicker it is going to become public. Daily Kos noticed that George Bush quietly changed a law in 2007 so that he could declare martial law in 2009 and not step down.

Does our style of paranoia choose our politics for us, rather than the other way around? Does the mechanism for accepting blame and responsibility in our brains break before the paranoia? Do fiction or film increase our vulnerability to paranoia or belief in conspiracies?

I'm sure I've said other brilliant things elsewhere, but this is already well more than enough.

Paranoia Anecdotes.

I thought I would just include anecdotes about paranoia and comment on them as a way of getting information across.

Update!  One of the other social workers told me today that she thinks C19 is all just a coverup for all the damage from 5G.

Paranoid people also project.  What they think their persecutors or opponents are capable of doing is often a mirror of what they themselves would do.  The recent political example is the FBI and other agencies being so sure that Trump is dangerous enough to democracy that he would disregard the rules and protections for others that they dangerously disregarded the rules and protections for others themselves.

My uncle tells me that my grandfather, when he heard that Joe McCarthy claimed there were 300 communists in the State Department said “Is that all?  I would have thought it was more than that.” I believe that was a common sentiment in NH at the time. McCarthy played his cards poorly, partly because of his personality, and partly because there was a supportive culture that didn’t mind if accusers of communists didn’t bother with the niceties of actually nailing the information down.  However, it turns out in retrospect that the right-wing crazies didn’t know the half of it. Communist penetration of federal agencies was worse than even they thought. Alger Hiss was in fact guilty. The Rosenbergs were guilty. Venona confirmed a great deal of speculation. I don’t know how things would have been different if a savvier player than McCarthy broke the news, but it can hardly have been worse. He played for drama. Maybe that would work today. It didn’t work then. (Compare also to the paragraph above.)  Paranoid leftists were able to accuse anticommunists of paranoia for years. In DC politics I think that some paranoia is always justified.  People are conspiring all the time. Exactly who, and for what reason, is the issue, and determines how reasonable one’s paranoia is.

Secrets are hard to keep, and people rat out conspiracies every day. Whether a particular conspiracy is real can sometimes be estimated by how many people would have to be in on it, and what their motivation would be. 9/11 conspiracies that involve preinstalling something in the buildings fit that. Who, and how, exactly, put flammables and explosives in years ago?  Thinking Mossad or Cheney orchestrated it is also paranoid, but less bizarre.  A smaller number of people would have to be in on the deal.  Still too many for credibility, but closer. The idea that there are inexpensive natural cancer cures that “doctors” or “Big Pharma” don’t want you to know about because it hurts their business is hugely unlikely. An oncologist who broke the secret could write books, go on lecture tours, and be universally admired – not to mention quite rich.  What would be anyone’s individual motive to keep quiet about it?  To protect The Lodge? Really?   Attempts at conspiracies are frequent.  Governments, businesses, agencies, parties – these sometimes do try to suppress information.  How many would be required?  What is the motivation of each as an individual to go along?

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The following is part of a Facebook post by a Scientologist who until recently was a Trump supporter.  Now she thinks Trump is in on the game as well. Paranoia tends to expand, not shrink.

1.      1.  The other day he tweeted whoever is making the va((ine for Coronavirus needs to “speeden it up.”

2.      2.  Not one word about the gov boosting your immunity or taking high amounts of Vitamin C which is curing people in the east

3.      3. …more and more va((ine complaints from parents and 4 billion paid out in injuries

4.       4. He applauded the federal reserve the other day – said they “have our back” by lowering interest half a percent. Meanwhile JFK was murdered for saying we have to get rid of the federal reserve.

5.      5.  …he didn’t protect Julian Assange…

6.       6. No mention of halting or slowing down 5G like Switzerland did after finding it is definitely injurious to human health.

7.       7. Trump’s uncle, John Trump was in charge of checking out Tesla’s research … and for the next 30 years came out with findings similar to Tesla. Trump went to Freemason Jesuit school for a time.

8.      8.  Three countries who are not owned by a Rothschild bank: Cuba, Iran, and North Korea.

9.       9. Robert Kennedy is great and has a website about the environment, pestisides, va((ines and are suing against 5G!

1     10. There’s ID2020 to make a “digital” ID which has all your info in it including your vax records. Total gov overreach. Bill Gates funds this partly. Bill is working on the digital ID with other worldwide groups. Bill was involved in a simulation of this virus in Oct 19. Bill was ALSO on Jeffrey Epstein’s list of people who went to his island. No lie.

1    11. If this isn’t a very obvious new world order agenda to people, I don’t know when it’ll be more obvious

So, half a moment.  If Vitamin C successfully treated C19, you don’t think the PRC would be all over this with immense relief, passing the stuff out like candy? Also, how long would it take to do a good clinical trial on that to show that it worked?  Less than four weeks, you think they can do that? The anti-vaxxers have this standard phrase about people educating themselves, don’t they?  It seems to really push a button for them. That precise wording captures what they want to believe about themselves than other, similar phrasings. The inclusion of not only modern Jews like Soros but the Rothschilds and Rockefellers of 50-100 years ago catches the eye, doesn’t it?  This particular antisemitism has come down in a long chain, not 21^st C BDS.  Is that typical of Scientologists? Kennedy and the federal reserve would seem like old news as well.

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My patient Bill was in Desert Storm. He was not in Special Forces of any sort, but he eventually concluded he must be somehow, because he knows things that other people do not, perceives and understands things that the rest of us can’t, and it started a few months after getting back.  He eventually concluded that someone implanted a computer chip in his brain that tells him things, and this was supervised by Special Forces at some point while he was asleep in Iraq. He thinks they still control the chip, or someone in the government does. He believes this is un-American and all patriots should rise up and protest things like this happening to decent citizens. He usually arrives irate and threatening about something. When someone is admitted, I call family and agencies to gather collateral information, a sort of detective work to figure out what is true and what is not. I knew I was in for a long hard slog on his first admission when I called his mother, who said in a German accent “Billy was fine until the government put zat chip in his brain.” She had been part of some resistance in Nazi Germany, and was brought to America immediately after the war because of the danger she and her husband would still be in if there. Details aren’t clear.  One would think this sufficient explanation for anyone to be paranoid, and make it likely that any children are paranoid as well. But that’s not what’s happening.  When Bill is on medication, part of the paranoia vanishes very quickly.  He no longer thinks there is a chip, or communications into his brain, or any connection with Special Forces. His more general paranoia remains.  He thinks that un-American people staff all areas of government, including the DMV (he can’t get his license back), the VA doctors, Social Security, county Sheriffs, the judges in Strafford County, massage licensing, and even Fish & Game are unpatriotic at best, and possibly communist or jihadist sympathisers. This is clearly a different type of paranoia.  I myself think there are likely unpatriotic people scattered about the government, and more likely to have wormed their way into places of influence than the regular card-punchers.  I just think that it’s nuts to believe it’s all of them.  Incompetence, yes. Personality-disordered arrogance or sadism, possibly. Concerted effort to bring down the republic via the Bureau of Land Management, unlikely. That half of Bill’s paranoia is more gray area.  Personality structure?  Illness?  Upbringing? The ongoing trauma of succeeding at nothing? I think the extreme rigidity part is illness.  The rest…I can’t say.

I worked peripherally with a Vietnam vet in the late 70’s who was paranoid. He was afraid we were putting psychiatric medications in the water, so he wouldn’t drink any, nor would he take any of the bottled water, soda, milk, or juice we offered.  All were suspect.  He would not even take a shower, where he could have snuck some water without us seeing, because he thought that tainted as well.  Yet he did not dehydrate. This made it harder for us to get a guardian for him, as we had to wait for the lack of food instead of water (abetted by his poor hygiene at court) to show dangerousness sufficient to deprive him of so many of his rights. We didn’t get the whole story until after he was treated against his will and became nonpsychotic.  He explained that he had pretended to be a smoker (we gave out rolled cigarettes for free in those days) in order to have something to trade.  Then he would get other patients to secretly get water for him from the tap he had identified as the one staff used to make its coffee. So despite his paranoia, other cognitive functions worked.  He did not have insight into his lack of hygiene, and he was deeply ill, but seven out of eight cylinders were firing just fine.

We do get people suspicious of the water, food, or the medicine they are being given.  A majority of them will relent if we offer these items from sealed packages.  As it is at least plausible that we could find some way around that it we wanted to poison or medicate the person, I don’t know why that works as often as it does. They may apprehend that distant companies are more likely to be uncaring than antagonistic to them, while folks directly involved with their care may have been influenced or bought off.

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What about living in places where paranoia would seem to be the only sensible attitude? I am thinking of the Bloodlands, or post-Yugoslavia – of the French Revolution or Great Leap Forward. I think it is still possible to distinguish between functional and nonfunctional paranoias. Specifics matter. With overlapping categories you might get the opponents only half right, and the wrong half. Paranoia as an illness is rigid.  Retaining some flexibility in figuring out who is dangerous to you is likely important. I used to kid with a fellow commenter at the old blog “No Oil For Pacifists” that he was too worried about what the federal government might do to him, when it is the local government that is far better placed to ruin his life.  We were able to laugh about this, where a nonfunctional paranoia would be rigid.

Note to survivalists – people who have been in societal meltdowns come to the conclusion that your best survival is a network of trusted people, not constant hardening and extending your own supplies.  There is much greater danger of any of a hundred smaller emergencies than the One Big One where we’re all shooting each other and secretly planting corn deep in the forest.

Paranoias

I thought it was going to be easier to generalise between liberal and conservative and liberal paranoias, and trends would emerge that would allow me to say something brilliant.  But after reading about QAnon as a reverse game, with guided apophenia making you the playing field instead of the player, I am chary of seeing patterns just for the fun of it.

Ultimately, though, that won't stop me. The seriously paranoid groups seem to come more often from the right.  There are few of them in relation to the whole, but the paranoia goes deep and quickly includes worldwide forces.  I repeat the examples I gave before, of the Endtimes 666 groups of the 70s and 80s, the Trilateralists and New World Order believers (Henry Kissinger overlapped with these groups), the old Illuminati and newer Bilderberg worriers, the guys showing satellite photos of Obama's FEMA camps.  Liberals have their paranoias, but the style is different.  They believe crazy things about Monsanto and GMO foods, but they don't think the Pope, Queen Elizabeth, and Donald Trump are in on it. A greater percentage of liberals are involved, but it's less global.  A mile wide and an inch deep, while some conservatives are trying to tunnel a single well to the center of the earth. Why is that?

This has been shifting recently, but I don't think it is because of Donald Trump.  I think he got elected because that more generalised paranoia has been increasing. He used to be quite liberal, remember, and in many ways is a liberal turned inside-out now. The conservative fears now have a fair bit of real stuff to draw on, however much people add in ridiculousness like goat-horn signs.

Even though the Buffalo Springfield claimed that paranoia strikes deep, that was mostly just getting the crowd excited. The left was paranoid then, more visibly so, but it was vaguer, and had that same wide distribution.  It wasn't a relatively small cadre of powerful people colluding to oppress us, it was the richest 10% in general, creating a system that oppresses.  That still holds true today, with the idea that the even narrower 1% has designed a system that works for itself but the rest of us participate in perpetuating it. Conservatives make it personal.  It's a few people, and they have evil, not merely selfish intent. They are much less likely to say "We have set up a system which rewards politicians for intervening, for doing any damn thing, so they keep making up rules" and more likely to say "Governor X is a fascist who wants to make people dance to his tune."

Into all this neat division I have pretended is the story comes some messy data. The black community, especially urban black communities, have both types of paranoia, that it's a system, and also that the CIA or FBI is running experiments on the black community in specific, and that very specific politicians are thoroughgoing racists who spend a lot of their energy on keeping black people down. Just one example. Anti-vaxxers are present on both sides of the spectrum. [Tangent: Interesting research reported by Jonathan Haidt, that anti-vaxxers show an unusual pattern of moral foundation, very high on purity scores and low on respect for authority scores, which does indeed draw from both left and right.] The belief in toxins being everywhere and demanding constant vigilance to keep them at bay is found on both left and right, as is a lot of alternative medicine.

I will mention again that liberal fear of conservative paranoia and vice versa may have a lot to do with projection because of the style. If - and I am speculating - liberals sense that among their own tribe the extreme suspicion that is sometimes paranoia is widespread, then when they see paranoia among conservatives they may assume it is similarly universal. News reports that focus on extremes would certainly feed that idea.  Putting that idea in the mirror, conservatives may fear liberal paranoia more because they sense among their own that when it is bad it is very bad, needing to be contained and shuffled off to the fringes, and worried that liberals don't seem to be doing any such containment, but letting environmental catastrophism or critical race theory just flow over the landscape. But liberals don't tend to all believe those things in any intense way. They say on paper that they agree that we are in big trouble on both counts, but then they don't do much about that.  They just go on with other things in their lives, almost as if they didn't really believe it at all. 

Next up, I'm going to try and get some historical perspective on whether this is worse or better than usual, and more importantly, is it going to get worse. 

By the way, the song was written about the closing of  dance club in Los Angeles and the protests about that.  Just a reminder about people getting completely unhinged about universal oppression of a generation on the basis of rather trivial events.

Paranoia Strikes Deep

The song was originally about the enforcement of curfew while the Buffalo Springfield was the house band of a popular club in Los Angeles, which attracted a protest of young people. The idea that "step out of line, The Man come and take you away" was the classic performative paranoia of the time. There were actually riots on the Sunset Strip, and I'm not sure what they expected the police to do in response to that other than move people away - some arrested, some merely warned. If they really thought that they were going to be taken away (with the implication of being disappeared indefinitely rather than processed through usual actions and likely home that night or possibly the next), they would have been heading for another jurisdiction, up to and including going to Canada. Note that while the Flying Burrito Brothers talked about moving to Canada, singing Steve Earle's "My Uncle" - long after the draft was over - none of them actually did. So paranoia strikes shallow. And there are a few rhymes for that, so that excuse won't fly.

The celebrities who swear they are going to move to Canada "if (insert this year's Republican) is elected" - they never do. 

Which brings me to today.  I had a followup commenter to one of my comments over at another site.  He assured me that requiring masks was indeed a very big deal, because it was an introduction to making us do anything, to making women wear the hijab, and to send us to camps if we refused.  If he really believed this he would be gone, probably to another country, but at minimum to some remote location to go off grid. (Yeah, I know, any day now, just one more thing, that will push him over the line.) He certainly wouldn't be publishing comments where "they" could track him on a public site. It is a performative paranoia.

I don't think it is quite the same as getting away to another state or county where you don't think you will be interfered with so much, or taking care to protect your online privacy.  Maybe it is just a more intense version of those and I am just making excuses for those others because I understand that better. Yet I did work with paranoia for decades and have written about it and thought about it a fair bit in my life, about the now-discarded psychoanalytic theories and the difference between those whose perceptions or physical interpretations are unwired for medical reasons. The demented can become paranoid, as events happen around them that they do not understand and cannot explain, like people taking food out of their refrigerator or moving important items from where they carefully put them.  That is more gradual than the psychotic varieties, and maybe this rampant shallow paranoia that people cannot possibly believe but keep saying anyway is something like that.  They do not understand what is happening around them and begin to make up stories about what is happening, because the brain needs explanations or it cannot rest.

But I don't think that's it either.  It is ultimately cynicism swollen out of proportion, and of course an immense arrogance that they are among the few who somehow see the handwriting on the wall that the rest of us sheeple are oblivious to. They know (tapping temple).  You can't fool them.  They've seen through their little games. Then they bind themselves into this escalating pattern of increasing the level of warning if people don't believe them.  "They" are not just going to tell you you're wrong, they're going to take down your name...they are going to keep you from getting a promotion...don't believe me?  Well, my brother was in line for a promotion but...still don't believe me?  They are going to take your wife. They are going to make you disappear.  The intensity of the thing that will supposedly happen to you increases, but what they really mean is that they are increasing their volume.  They are already at three flags warning with no way of going to four, so they find a different set of intensifiers.  They want to show that they are really worried and angry.  No really, really worried and angry.  Pay attention here I am really, really, really - what do I have to do to get your attention?

As James quoted from CS Lewis about two weeks ago "The problem with trying to make yourself stupider than you really are is that you so very often succeed." (The Magician's Nephew)

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.

Chess Paranoia

I have read about chess tournaments since the days of Bobby Fisher, though I am a poor player myself.  Reading about the lead-up to this year's World Championship, I was struck again by how frequently flat paranoia seems to enter the picture.  Is it because many of the players come from Eastern Europe and Central Asia, from environments where paranoia might not be that unreasonable?  (Note also there are many top Jewish players, and used to be more.)

Does paranoia confer some advantage, whether in the skill, the intensity, or the psychology?

Or perhaps most likely, is there a cast of mind which is extreme in over-interpreting simple things, which leads to both paranoia in everyday life and protective caution in chess?

Paranoia

I have written often about paranoia, right from the start, and you can get more detail by entering that word on my search bar.

I have a new and interesting update.  One of my claims is that the paranoia strikes the brain first - both in the psychotic illnesses and in the milder political forms of paranoia - and the human then goes in search of the explanation.  Feeling precedes data.  The paranoid is sure that "something is up," and tends to draw on whatever culture floats his way after that.  Thus the focus of the paranoia can change, albeit very slowly, over time.

I have a favorite story about a patient who came in around 2007, complaining that everything had been going fine until the government implanted that chip in his head after the First Gulf War.  I called his family and community providers to get some background information.  His mother told me everything had been fine until the government had implanted that chip in his head after the First Gulf War.

That's when I knew it was going to be a long day.

The patient and his family were involved at the edges in a few paranoid causes - the Ed Brown Tax-Protest standoff, for example - but had been rejected by nearly all because he was just too crazy and threatening for them.  When the people who are into colonics as an adjunct to their dentistry find you too ill...

His case is fascinating in itself, and I could disguise the information well enough to protect his confidentiality (far better than he protects it himself), but that's not my point.  He was brought back to the hospital, accompanied by a different group of visitors who come in and mutter with him now.  His mother is still part of the mix, but the rest of the crowd has changed.  He is still paranoid, and has a theory about why he was brought in now, involving powerful forces arrayed against him that he is going to expose - but no more implanted chip.  Now the story is that Special Forces subjected him to brain experiments while he was in Iraq, and the government has been trying to silence him with "state-sponsored terrorism" ever since. Similar, but not the same.  There has been a migration in the delusion.

His mother has also dropped the chip idea.  She now hears "them" talking about her son from all over America when she is on conference call every night.  The other visitors come from categories of believing other paranoid things about the government* or other world forces, and have concluded that if my patient is being so persecuted, then he must be very near the center of this whole battle, and what he says must therefore be correct, and they should get involved with his battle against the state because clearly, important things ride on it.

That this is entirely circular they cannot accept.  If you tell them that the patient's condition is not that uncommon, his symptoms not that unusual, and the whole thing rather small, they take it as proof that it is big - because clearly the hospital is trying to hide something.  You can refresh your memory on anosognosia if you wish by throwing in that search term up top as well.

*The breakdown seems to be about one-third sounding rather right-wing/libertarian, a few sounding very green/WTO left, but most caught up in their own personal persecution by the various towns they live in.

Trying To Reason With the Paranoid

Brought forward from August 2006.  Since then I have related lack of insight to some variants of autism as well.  That one can be very strange, frankly, as many autists have pretty good insight and are even humorous about it, laughing when they realize what they missed: the poor boy! Here he was always getting me into tickle-fights and I loved to join in, not realising that there was this huge sexual undertone. So we go to a conference together for our project and when he asks if we should share a room to save money, I say Sure! We get there and he's about as socially clumsy as I am and tries very unskillfully to seduce me, and I yell at him, shocked!  Shocked, I say, and then I laugh at him and he is just crushed. But OF COURSE he thought I was interested in him sexually and would be at least somewhat receptive.  I had been signalling that for three months...  It worked out.  We got back together three years later and got married! But the blood still goes out of his face when I bring it up. Yet there is another subset that will hear none of it.  There is nothing wrong with them and they are tired of other people suggesting that there is. They do not well-understand what others' motivations and thoughts are, so they just make it up out of what they think is likely, with um, highly-variable hit rates on those predictions. And even when it goes very badly it doesn't occur to them to step back and rethink the whole thing.  If you asked them as a general question whether people should do that sort of rethinking they agree.  Everyone knows that! Neither side ever fully understands the other, neither side is 100% right or 100% wrong! Yet they don't actually do it in real life.

I have come to the vaguely-professional opinion that lack of insight often comes from impaired or diminished functioning of the anterior cingulate gyrus, one of the storytelling areas of the brain, predicting what other people are thinking and comparing it to ongoing results. It has almost a Bayesian quality, and when it's not operating, it takes an overwhelming amount of contrary evidence to even get them to go Hmm...

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On my 13-bed acute involuntary unit seven of the current patients are paranoid, an unusually high percentage. I have therefore spent a lot of the last week trying to reason with paranoid people, and I am wondering whether there is any insight to be gained for use in reasoning with paranoid governments or leaders. It is difficult to separate out the obsessions and misinterpretations by victim cultures from true paranoia; in unstable countries, it is also hard to tell what actions by leaders are actually paranoid, as it is true that some people are plotting against them and want to kill them. Most importantly, paranoia of the schizophrenic variety is a brain illness, not a cultural or personal expression, and it may not illuminate the cultural paranoia of nations in any way.

Still, I will follow the trail and see where it leads.

It’s easiest if one doesn’t have to deal with them at all, of course, and it is best not to go looking for extra arguments solely for the purpose of telling them their world-view is wrong. But the nature of hospital commitments – as well as life in general – is that they must be approached to have various rights explained to them, questions asked of them, signatures sought, and life-tasks to accomplish (like getting up, eating, hygiene). I am heavily involved in the first three of those. Do you want an appeal hearing? Can we call your parents?

Simple questions provoke angry tangents. “Why the f- am I here? Do you think it’s fair for the police to break in without knocking and drag me to the ER where I didn’t see a doctor, just a b- nurse who lied to me…” Fierce anger may be apparent even under the attempt to appear calm. “I’d prefer that you not call anyone. I’ve decided that those relationships are toxic for me. My mother has been very interfering.” Suppressed rage, voice dripping with polite venom, can be worn as a badge of honor – supposed proof that the speaker is in control and gentle, surrounded by angry, out-of-control others. This is more common in women, but I won’t guess whether that is biological or socially conditioned.

Interviewing a patient for information may elicit anger, but the interviewer can adopt a pliant or accepting posture to deflect confrontation. Others are not so lucky. When the law requires not only that a patient must have his rights explained fully, but signatures and permissions acquired, the sidestepping of anger can go on endlessly, until a halt must be called. “You may have valid complaints, but that’s not what we’re discussing now. I need you to decide if you want an appeal or not. You can change your mind later. There is no wrong answer. It’s entirely your choice…” Non-decisions must at some point be declared decisions, and then that has to be explained to them. There are some stalemates that cannot go on forever. You must move from here or we will move you.

Paranoid patients are not the only ones to present this difficulty, but the intensity is greater at the point of conflict. It is also more surprising, because it can surface after a pleasant conversation on other subjects. Especially in late-onset paranoid schizophrenics, much of the personality has been formed competently before the intrusion of the voices or delusions, and the patient can rattle on with easy animation about sports, literature, or humor.

The fury proceeds from some issue that is of overriding importance to the patient. The police really are beaming infrared rays into their apartment. Other people really must hear those voices, but pretend not to. Mites really do infest all the clothing, and must be sealed off. A personality disordered patient may grudgingly acknowledge that his father is merely stupid and selfish rather than vindictive. People with depression can understand that there may be another way to look at things, even if they cannot bring themselves to it. But a person with paranoia will have none of that. There is a fierce insistence on a single interpretation of the issue – there is no other way to understand events. The rest of the world may not believe that satellites are beaming messages into some people’s brains, but it is true nonetheless.

To person in the grip of paranoia, this issue must be dealt with and acknowledged by others before any discussion can proceed. The things the doctors and nurses want to talk about are considered merely derivative issues. I was only violent because I was falsely accused and mistreated by the police. Of course everyone should eat, but I refuse to eat the flesh of babies. If the exterminator had done their job right and gotten rid of the bugs, I wouldn’t have had to set the floor on fire. If the priest had preached on the prophecy I wrote to him, I wouldn’t have said that God should strike him dead.

If this is sounding a bit like Iran or North Korea to you at this point, I am wondering that myself.

To try and prove themselves right on this key issue, people of many diagnoses, but especially those with paranoia, will fasten on the most amazing details as evidence, rapidly twisting them out of recognition. You’re saying that what I put into my body isn’t important… (No, I’m saying that side effects that you don’t have aren’t important to discuss) You won’t let me meet with my attorney… (You may meet with your attorney when she comes here. You cannot go there.) The replies in parentheses are more hypothetical than the complaints, because you usually don’t get to complete your sentence. Those are the types of things I am usually trying to say.

This sounds more like Hamas and Hezbollah than Iran, actually.

Next up, a look at what strategies work, or more usually, don’t work.