The Social Context of Paranoia

‘Psychiatry’, suggests Hornstein (2009a: 6), ‘is the most contested field in medicine’ and, as Bracken and Thomas (2001: 724) note, ‘[i]t is hard to imagine the emergence of “antipaediatrics” or “critical anaesthetics” movements’. But why is this so? One of the reasons is that there is often a fundamental disagreement about the meaning attributed to experience and, who has the right to confer that meaning. Experiences like paranoia are often decontextualized and stripped of meaning. For example, psychiatry variously classifies paranoia as a subtype of schizophrenia, a separate delusional disorder or as a type of personality disorder. Yet arcane discussions of the differences between diagnostic subtypes distract from commonalities in the way paranoia is experienced.

In this chapter I investigate the concept of paranoia, paying attention to its contested nature. I take a deliberately broad view, seeing it as an apparently unwarranted fear and belief that others intend to harm one in some way, leading us to respond to others in a fearful, wary and even hostile manner. Deciding on the best way to address such distressing feelings very much depends on what we think paranoia is and so, the chapter begins with an examination of some of the conceptual assumptions embedded in the notion.