Help! I Think I’m Paranoid!

No you’re not. This is one of the places where the old adage, “If you think you’re crazy, it proves you’re not” actually holds some water. In “Real Hallucinations” I pointed out an example of a neurological disorder where people hallucinate but don’t have a mental disorder– they see things, but they’re not crazy.  In this case, it’s just that a word has escaped from the psychiatry lexicon into the street lexicon.

Originally, a  paranoid was someone having delusions– irrational false beliefs, typically of influence or persecution; someone’s out to get me, the CIA is broadcasting messages into my fillings. However, beliefs can be bizarre, or not bizarre. So if I think people are out to get me because they’re following me around in my neighborhood, I might be delusional in a non-bizarre way. Or I might live in a bad neighborhood full of muggers. As technology advances, we might have to admit that the CIA has the capacity to broadcast messages into fillings, but as of now, it would be considered a bizarre delusion. To be safe, let’s say I believe that aliens are doing the sending through a tooth that was genetically modified while I was in utero through an injection of nanobots. That’s pretty safe as bizarre delusions go. But  historians of mental illness will tell you that delusions like this will typically keep ahead of real technology.

But the reason “paranoid” escaped from the psychiatric world into the street is because there are many reasons in the modern world to be extremely suspicious and on guard. Just to take one, let’s suppose you’re a drug dealer, selling (and using) lots of methamphetamine. And you’ve ripped off your supplier, and you’ve sold into the territory of a competitor. You might be paranoid from doing too much meth, but  you also have some very valid reasons for being very suspicious and on guard: your supplier is gunning for you, your competitor is gunning for you, and the cops are also looking to bust you. As the saying goes, even paranoids have enemies.

The key thing is, you believe the delusion, even while others know it’s not true. I can think of a friend of mine who has had severe mental illness for many years. At times, he has no symptoms. At times, he may worry that his kitchen counter isn’t clean and be very scrupulous about cleaning it. And when he’s sick, no matter what he does, he believes it’s contaminated– has no rational or reasonable thing he can think or do that makes it OK. So there’s another angle to the whole thing– Becoming delusional is not a binary process. It’s possible to have worries that you know are irrational, but you can’t kick them– at least by any reasoning process. With the delusion of contamination, there’s a certain element of truth, too– microbiologists will tell us that we can’t get rid of all the germs, but the fact that we can’t get rid of them doesn’t make us obsess that everything is somehow dangerously contaminated (there are versions of this which would qualify as a phobia, also).

It helps to have friends to do a reality check with. But if your friend pulls a gun on you and says, “give me all your money and your meth, I’m from the competition,” you weren’t being paranoid enough. See what I mean? The word has irrevocably escaped from its original psychiatric meaning.


About jamesmatter

Marriage and Family Therapist (MFT) in private practice in San Francisco. I work with adults, adolescents, and couples, with focus on substance use and abuse and co-occurring disorders (having both a mental illness and an addiction).
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