The mind or the brain is a labyrinth.We live in a world where chaos reigns in many parts. Life is not for the faint hearted. 
But for many, in this inner-world that we call our mind, our brain, the enemy is deep within. We are now confronted by two big questions – What is reality and what is illusion? Our happiness, our hope, our peace of mind, our health, our families, our future, the welfare of our society and even the future of our country, it all depends on these two questions. In the case of Paranoia, the early detection and treatment is very important as we need to bring down the psychosis before it adversely affects a persons’ life. If we delay identification and treatment, there can be irreversible damages to those areas of life and a person may not be able to reach his/her potential.
National Institute of Mental Health, Consultant Psychiatrist, Dr. Malsha De Silva points out that some people with paranoia are in fact able to have brief breakthroughs in to the realm of reality and feel that what they believe may not be entirely true. However, this ability is entirely dependent on what the cause of their paranoia is. Paranoia could be due to different reasons. It could be due to a mental illness or it could be a feature of that person’s personality. It could be a delusion, an overvalued idea, a preoccupation or a way of viewing the world around them.
“For each of these types, paranoia is the reality as far as they are concerned. However, the mechanisms are different for each type of reasons mentioned above. For example, a delusion is a strongly held belief without any justifiable reasons to support it and it is unshakable even when the person is presented with evidence to say that what they are believing is false. The lack of insight is the hallmark of a person who is holding a delusion. A paranoid overvalued idea or a preoccupation is a belief that has taken precedence of the persons’ life above everything else and the person is completely and overwhelmingly engaged with the thought. They will briefly let down their conviction when confronted with facts against their belief but will go back to holding on to it soon after.
Then there is another type of paranoid thoughts which are called obsessions. A person who holds an obsessive paranoid thought is aware that what he thinks is not possibly true, but he just can’t get rid of it. In fact, he would try to stop the thought from coming, and also feel distressed, but fail to resist it. This is a feature of Obsessive Compulsive Disorder or in short, OCD.
She added that if an otherwise normal person is having paranoid thoughts related to a specific event or a person, then they might realize that they are being irrational in that particular instance and their paranoia is probably groundless. It could be a sense or an intuition that they can’t shake off from their head. This could be due to being subconsciously aware of patterns (of behaviour, of circumstances) that their brain has learned over the years to identify as dangerous but really can’t name what they are. This is when someone says “I feel that there is something not right about him”. This is not to say that this feeling is always true, but it indicates that there are similarities in this person to someone who had wronged in the past and the brain is flagging the same pattern as dangerous.
“Paranoia is multifactorial. In those who have paranoia as a result of a mental illness, this symptom could be due to schizophrenia, persistent delusional disorder (paranoid type), drug (of abuse) induced psychotic disorders or other types of transient psychotic episodes due to many reasons. In addition, paranoia can occur as a result of a disease of the brain or body. Dementia, which is an illness that occurs in elderly due to destruction of brain cells characteristically leading to memory loss. Here one of the reasons for paranoia could be that the person does not remember where he kept an item and therefore he thinks someone had stolen it.
The person developing paranoia as a result of a physical disease can present with paranoia even prior to developing any physical symptoms. This is especially seen in illnesses that impact the brain, such as infections, certain inflammatory conditions leading to encephalitis (inflammation of the brain substance). Illnesses leading to abnormalities in the hormones in the body can lead to paranoia too. These are some of the instances where a person might present with paranoia. Usually in those who develop paranoia as a part of the illness, their ability to reality check is lost. In other words, they are unable to compare their belief against the reality outside. This is when we say that their insight in to their own thinking is lost. Therefore, understandably, however much you try to disprove their ideas with evidence to the contrary, their belief is not going to shake, till you treat the condition that gave rise to paranoia. We call such strongly held beliefs Delusions,” explained Dr. De Silva.
You may come across people who are more paranoid than others. Then there are others who change from their usual self to a person with significant paranoia.
“Starting from one’s birth, the paranoid nature could be inherited from parents. Some families have genes that increase the risk of paranoia more than the others. These could lead to a higher risk of developing a mental illness like schizophrenia, a hall mark of which is paranoia. Then comes the early experiences. The manner the child was raised and the environment he or she was exposed to, would impact on their paranoid tendencies. For example, if the child did not receive a proper response when his/her basic needs needed to be fulfilled. Or if the child was subjected to abuse, then he/she will develop a mistrust towards the world around him/her. They will struggle to build intimate and mutually trusting relationships during later lives. Being a victim of abuse is a situation where the child is powerless, and his or her rights and needs are violated in the most inhumane ways. Childhood is the phase of life where a person learns to trust others and build mutually respecting relationships with others. When this process is hindered due to childhood abuse and not been healed with a trusting relationship, it may lead to an adult who has trust issues and paranoia towards actions of others,” pointed out Dr. De Silva.
Then there are other factors that will predispose a person to paranoia such as socio-cultural, religious and personal experience factors. Especially those who have been subjected to violence such as robbery, assault and rape, they are more prone to be paranoid due to their experiences.
If Paranoia is due to a mental illness or a disease of body or the brain, then treating the mental illness or the disease will bring an end to the paranoia. However, if the paranoia is arising as a part of the personality, it may be difficult to completely get rid of it. But, there are psychological therapies that would help to bring it down and minimise harm.
“Paranoia can come as a result of using drugs of abuse such as cannabis (ganja, weed), methamphetamine (ice) and other stimulant pills and substances. Paranoid psychosis can be an immediate effect due to being under intoxication of the substance or as a long-term result of having used the substance. In fact, cannabis has been shown to increase the risk of developing schizophrenia, which is a severe mental illness. Many admissions to my hospital, the National Institute of Mental Health, Angoda, are due to use of these psychoactive substances. Therefore, one of the main ways of reducing paranoia in society would be to bring down the use of these substances,” she pointed out.
She pointed out that as a mental health professional who has been working in this field for many years, she observes a rise of general paranoia in the society due to many factors. This is partly to do with the wide reach of public media which tends to highlight certain emotionally traumatic events such as murder and terrorism, and a person gets exposed repeatedly to these events narrated, increasing the emotional upheaval of the person.
“We have seen over the years how news items fueling racism and religious extremism brought about paranoia among members in the same community to inflict unthinkable violence against each other. This landscape of sensationalized news has gotten out of hand with the advent of social media, and we see that a substantial portion of ones waking hours are spent on social media platforms. The fact that anyone can put information out there without any censorship has led to a pandemic of paranoia as the social media is exploited by multiple parties with different agendas.”
Is paranoia/anxiety/ fear always connected to each other? Are they almost always related to each other? Senior Lecturer and Consultant Psychiatrist, University Psychiatry Unit, Teaching Hospital Ragama, Dr. Chamara Wijesinghe, says YES and NO.
“Paranoia and anxiety are two separate entities from a psychological perspective but usually co-exist. Paranoid thinking involves persecutory beliefs that have no rationale, or are even delusional. .e.g. A person who thinks his neighbours are trying to kill him though this is not the case. As you can imagine once this person has such a belief they become both anxious and fearful. However, the primary thought process is paranoia,” he said.
Anxiety and fear are very similar and sometimes used interchangeably and co-exist. However, from a psychological point of view anxiety is a psychological and physical response to a perceived or actual threat. Whereas fear is an emotion in response to danger.
“The first thing to do is to identify the root cause of the anxiety or fear. Then to see if the threat or danger is real. If it is real, then it needs to be dealt with in order to achieve psychological stability. If, however the cause of anxiety or fear is irrational or based on a wrong belief, the individual will require counseling or psychotherapy to change his/her thought process. The natural evolutionary instinct among all animals and humans is “fight or flight” in the face of paranoia, anxiety and fear. This is counterproductive and can lead to prolongation of the condition, as well as lead to disastrous consequences like violence or suicide,” explained Dr. Wijesinghe.
He added that many cultures as a first point of contact use traditional healing methods. Various pooja’s, Sura, thovil and exorcisms are commonly used to this date in Sri Lanka. “In certain situations, brought on by social problems or stress, these provide a culturally acceptable explanation and can aid the individual and family. However, the risk of these rituals is if the problem is due to a serious psychiatric illness like depression or schizophrenia. In this event the ritualistic treatment will delay the person getting suitable treatment. Quite often as psychiatrists what we tell patients and their families is to take treatment and engage in therapy, while also engaging in religious practices according to their faith, but to avoid witch doctors/ healers who are usually con artists out to make a buck from another person’s suffering,” pointed out Dr. Wijesinghe
Social media is a double edged sword, and though very useful and enjoyable, can negatively influence mental health conditions. “While social media per se is not known to cause paranoid illnesses such as delusional disorders or schizophrenia, if an individual is predisposed to such illnesses, social media can aggravate the situation. For example, a teenager who is paranoid about others due to illness, will misconstrue a comment made by his/her classmates on social media, as being about him/her and attack them. When patients are very paranoid due to mental illness we prescribe a break from social media due to this reason.”
DR. WIJESINGHE’S ADVICE ON SITUATIONS
When you feel anxiety and fear, it is like your heart is being squeezed from the inside. It is a very unpleasant situation. The situation is worse if you are an introvert, because you are forced to interact with situations. Sometimes you would like nothing better than to escape from a crowd and go home!
“Extreme anxiety to a specific situation is a phobia. And the difficulties introverts face in interacting with crowds are due to elements of social phobia. This is different from normal shyness as it affects life adversely. e.g. inability to perform well at a job interview or to speak to a potential partner they are attracted to. Take the example of a young executive in a new job, asked to make the monthly sales performance of firm to the director board. He starts to feel very anxious and fearful. He worries that others will criticize or laugh at him. He notices a pounding of the chest, difficulty breathing, sweating and a sense that he is about to get a heart attack or even die. He rushes off the stage and friends take him to the emergency department and doctors find nothing physically wrong with him. This is what a panic attack is, and can be extremely distressing,” explains Dr. Wijesinghe.
What should one do in such a situation?
The psychological principle which helps is “systematic desensitization” and is what a therapist will do to help the above executive. Here he has been thrown into the deep end too soon. He should be first asked to make the presentation alone, then to a family member or partner, Before the day of the actual presentation he should be exposed to the room and do the presentation in the actual setting to a few friends. This can be coupled with relaxation methods like breathing exercises. If the condition is severe there are anxiety reducing medications which can be used in the short term to alleviate acute distress and better face the situation.
If you feel you or someone else is suffering from paranoia, then what steps should you take? How do you get help?
The first step is acknowledging that there is a problem. However, that would be one of the most difficult steps too, as those with paranoia may not be open for discussions or revelations of their internal fears and worries. If you feel that someone is having paranoia that is affecting them and the people around them, offering help at a personal level (to discuss the issues) will be helpful. In this discussion if one feels that paranoia is significant, then seeking professional help is necessary.
In Sri Lanka, mental health services are available in both government and private sectors. In the government sector, most hospitals have Mental Health Clinics. Therefore, if someone needs help with a mental health issue, (themselves or a known person) they can go to the out- patient department (OPD) of their closest government hospital and meet a doctor there. They will be referred to a Mental Health Clinic if it is indicated. In the private sector, they can consult a consultant psychiatrist to get a mental health opinion and treatment.
HISTORICAL BASIS FOR PARANOIA
EXPLAINED BY DR. MALSHA DE SILVA
“I think it is a part of human nature to be paranoid. In fact, when you think about it, you can even see behaviours suggestive of paranoia in animals. There is a deep evolutionary reason behind this. Humans started civilisations only during the last five thousand years of history. Therefore, most of the life span of our species was spent in the jungles as cavemen or hunter gatherers. These humans faced many dangerous conditions such as being attacked by animals, other tribes, epidemics and natural disasters. Among these early humans, those who possessed paranoid traits were on the lookout for dangers more than those who weren’t paranoid. Therefore, ones with paranoid traits survived better than the others, as they were more likely to avoid dangers. These humans were able to live longer and produce children, so their quality of paranoia was transferred to the next generation through their genes. As a result, we can say that we are hailing from ancestors who were more prone for paranoia and we have those traits in our genes too. In short, sometimes we just can’t help it!The problem is that our surroundings have changed drastically over the last few thousand years and the challenges we face now are much different to the ones that we evolved in. Therefore, the trait of paranoia may not be appropriate to some of the current circumstances. Having said that, all of us know there’s no harm being a little weary of trusting a new person or a situation before you know more about it!”
Factors that prevent people reaching out to psychiatric departments early in their illnesses
* Lack of awareness
* Belief in myths about medications
* Seeking help from entities such as soothsayers, and other self-proclaimed healers who do not have professional qualifications or training to treat mental illnesses. This will increase the duration of untreated psychosis and in turn lead to poor prognosis of the illness.
