Paranoia: Contested and Contextualised

In this chapter we discuss how paranoia might best be conceptualised and responded to. By paranoia we mean experiences of perceiving and relating to others that are characterised by suspicion, mistrust or hostility. Whilst such experiences are common in the general population, amongst people who receive clinical interventions they often include complex, self-insulating belief systems, distorted perceptions and marked distress. In psychiatry these experiences are usually associated with diagnoses of schizophrenia, delusional disorder and paranoid personality disorder. The problems with the reliability and validity of these diagnostic categories are well known (Bentall, 2004; Boyle, 2002; Pilgrim, 2001). One alternative approach is to focus on specific problematic experiences and behaviours (Boyle, 2002) or ‘complaints’ (Bentall (2004) rather than heterogeneous diagnostic categories. Doing so addresses the problem of heterogeneity – but how might we then conceptualise these experiences? Drawing on a discussion of Bleuler’s notion of schizophrenia, we present an approach to paranoia that considers both its social context and its embodied character. We then investigate the notion of ‘distress’. Given the well-established finding that many people have experiences similar in content to those of mental health service users but without any accompanying distress, we discuss the importance of context in the generation of distress – in particular how it may arise because of a lack of ‘fit’ in the way they negotiate their beliefs and unusual experiences with their social world. Finally, we discuss how one might offer help or support differently in relation to paranoia.