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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by wendy b. on March 31, 2003, at 18:36:52
From the NY Times web site - thought some people might be interested... ---- W.
April 1, 2003
Self-Protection or Delusion? The Many Varieties of Paranoia
By RICHARD A. FRIEDMAN, M.D."I am being harassed by the guy next door and I want him to stop," the woman in my office said with firm conviction. The man would leer at her in the elevator just to make her squirm, she said.
But when I inquired further, she described a lingering feeling of being mistreated by people she said were jealous of her. She was even sure that someone had once tried to poison her.
Then I asked a question that gave me a direct taste of her problem. Is it possible that you are mistaken?
Her pleasant manner instantly shifted to icy contempt before she denounced me for implying that she was paranoid.
Of course, she was right. And the unshakable nature of her belief was the clincher.
Certainly none of her ideas were bizarre or impossible. People are harassed and envied all the time. But her absolute absence of doubt was what made her psychotic. She could not imagine being wrong.
Probably no psychiatric term is bandied about as loosely as paranoia. But paranoia covers a broad terrain, from a stable personality trait to a symptom of severe mental illness.
Paranoia may even confer an adaptive advantage in some instances. After all, someone who is always watching his back and is mindful that his peers are driven by self-interest is more likely to have a competitive edge when one is needed.
In politics, mild paranoia is probably an asset; no politician could survive for long with a rosy and trusting view of the world.
But there is a world of difference between having a paranoid streak and harboring a delusion.
Some people, like my patient, develop a delusional disorder in middle or late life, having had no trace of paranoid thinking before. Their disorder is fairly rare but striking. These patients falsely believe that they are the objects of persecution, envy or even love. Yet they often function effectively at work and can superficially pass for normal in social settings.
Ian McEwan's "Enduring Love" describes a man in the grip of a mistaken but unyielding belief that he is loved by a complete stranger whom he meets by chance.
Celebrity stalkers often fall into this category. They insist that they are secretly loved by a powerful or famous figure. Clearly, there is more than a little self-importance at the heart of these delusions. Whether it is being persecuted or loved, it is all about being the center of attention.
And all attempts to convince them that their beliefs are mistaken fail. Because they have no doubt about their delusions, they are immune to reason.
The most common cause of paranoia is also the least understood by the public, schizophrenia. A chronic mental illness that is generally believed to affect 1 percent of Americans, schizophrenia is characterized by delusions, often paranoid in nature; hallucinations; and so-called negative symptoms that include social withdrawal and apathy.
Contrary to popular notion, schizophrenia has nothing to do with split or multiple personality. It is thinking and perception, not personality, that are so disordered in schizophrenia.
What is intriguing is that drugs can produce symptoms that mimic schizophrenia, and they have yielded clues about the neurobiology of psychosis. Cocaine and amphetamines, for example, flood the brain with the neurotransmitter dopamine, producing psychosis in vulnerable people. And the cocaine-induced delusions are easy to confuse with those of schizophrenia.
Antipsychotic drugs alleviate psychosis by blocking dopamine receptors in important brain areas. In doing so, they normalize the excess dopamine activity in schizophrenia and stimulant-induced psychosis.
Curiously, antipsychotic drugs, which are so effective in treating the paranoia of schizophrenia, are of limited use in delusional disorder. That suggests that the neurobiology of paranoia is diverse, just as the illnesses that produce it are.
An intriguing clue to the origin of psychotic thinking comes from recent brain imaging studies. Dr. David Silbersweig and Dr. Jane Epstein at the New York Weill Cornell Center used PET scans to study schizophrenic patients who were having delusions and auditory hallucinations while their brains were being imaged.
The paranoid subjects showed increased activity in the amygdala, a part of the brain involved in the emotional processing of fear and danger, not only in response to threatening words, but also to neutral words. Healthy people respond like this only in threatening situations.
The implication is that the brain is responding to a nonexistent threat, at least in these paranoid schizophrenic subjects. It is like a faulty burglar alarm set off in the absence of an intruder. The paranoid patient is correctly responding to real brain activity that indicates danger, but those neural circuits have no good reason to be firing in the first place.
To make matters worse, the schizophrenic subjects also showed decreased activity in the prefrontal cortex compared with healthy people. The prefrontal cortex serves an executive function, critically evaluating signals from brain regions and shaping responses to them. So in addition to having an overactive fear circuit, these paranoid subjects have an impaired ability to judge whether their fears are rational.
Sure, paranoid people, like the rest of us, do occasionally have enemies. But if these imaging studies are replicated, the results will mean that the real enemies of paranoid people are their own brains.
Posted by MelD on March 31, 2003, at 19:41:22
In reply to NY Times article on paranoia, posted by wendy b. on March 31, 2003, at 18:36:52
THANK YOU for posting this. My son is experiencing paranoia induced by Ephedra, pot and pills. Reading this article was so helpful and timely for us, and i cant thank you enough for sharing.
Posted by WorryGirl on March 31, 2003, at 19:51:15
In reply to NY Times article on paranoia, posted by wendy b. on March 31, 2003, at 18:36:52
Wendy,
Thanks for sharing.> Of course, she was right. And the unshakable nature of her belief was the clincher.
>
> Certainly none of her ideas were bizarre or impossible. People are harassed and envied all the time. But her absolute absence of doubt was what made her psychotic. She could not imagine being wrong.
>This helped me feel better because there are times I've had these kinds of thoughts; the difference was if someone were to confront me, I could possibly be convinced I was wrong.
> Paranoia may even confer an adaptive advantage in some instances. After all, someone who is always watching his back and is mindful that his peers are driven by self-interest is more likely to have a competitive edge when one is needed.
>I used to work at a brokerage and understand this. I often wonder if it didn't permanently leave me in a semi-paranoid state (or "paranoid state" as you quoted).
Posted by Ron Hill on March 31, 2003, at 20:23:02
In reply to NY Times article on paranoia, posted by wendy b. on March 31, 2003, at 18:36:52
Posted by wendy b. on March 31, 2003, at 21:15:30
In reply to Can't read article 'cause they're watching me (nm) » wendy b., posted by Ron Hill on March 31, 2003, at 20:23:02
...but are you unshakable in that belief?
very funny....
maybe when they look away for a moment?
W.
Posted by ayuda on March 31, 2003, at 21:19:15
In reply to NY Times article on paranoia, posted by wendy b. on March 31, 2003, at 18:36:52
One of the interesting things about all these studies concerning the physical causes for "mental" illnesses such as depression, paranoia, etc., is that medicine and psychology are now turning Freud on his ear, the father of psychology! I teach college history, and my students just got done studying what was unique about Freud, that he saw emotional and psychological (non-physical) causes for physical ailments, and now we are seeing just the opposite! Thanks for the article, Wendy B.
Posted by wendy b. on March 31, 2003, at 21:25:26
In reply to Re: NY Times article on paranoia, posted by MelD on March 31, 2003, at 19:41:22
> THANK YOU for posting this. My son is experiencing paranoia induced by Ephedra, pot and pills. Reading this article was so helpful and timely for us, and i cant thank you enough for sharing.
well, that's great, i'm really glad it was relavent to your situation and maybe offers perspective on your family's issues. i do try to cut and paste any new articles on mental health i run across from the times.empathy for your son will allow him to feel validated and cared about, and reports like this help in that regard... it gives us even more reason not to "blame the victim," in this case, the paranoid personality, since findings like these show that abnormal brain activity could very well be the culprit. and this may be brought on by the drugs and the pot in your son's case. the people suffering from these symptoms would will them away if they could, but it's hardly that simple.
best to you and your son,
Wendy
Posted by wendy b. on March 31, 2003, at 21:35:07
In reply to Re: NY Times article on paranoia » wendy b., posted by WorryGirl on March 31, 2003, at 19:51:15
> Wendy,
> Thanks for sharing.noooo problemo.
> > Of course, she was right. And the unshakable nature of her belief was the clincher.
> >
> > Certainly none of her ideas were bizarre or impossible. People are harassed and envied all the time. But her absolute absence of doubt was what made her psychotic. She could not imagine being wrong.
> >
>
> This helped me feel better because there are times I've had these kinds of thoughts; the difference was if someone were to confront me, I could possibly be convinced I was wrong.
that is, i guess, the litmus test, from the perspective of this doctor. it seems to make sense to me. shades of gray vs. black/white thinking. possibilities for being mistaken.
> > Paranoia may even confer an adaptive advantage in some instances. After all, someone who is always watching his back and is mindful that his peers are driven by self-interest is more likely to have a competitive edge when one is needed.
> >
>
> I used to work at a brokerage and understand this. I often wonder if it didn't permanently leave me in a semi-paranoid state (or "paranoid state" as you quoted).
sure, cut-throat business practices and the desire to "win" at any price would probably be great breeding grounds for paranoia in general, maybe some kind of mass paranoia. watch your back, somebody else might steal all your toys...
glad you found it interesting...wendy
Posted by MelD on April 1, 2003, at 20:33:48
In reply to Re: your son » MelD, posted by wendy b. on March 31, 2003, at 21:25:26
Wendy, again i thank you. You are so right that he needs a great deal of understanding and that we must listen to him and try to calmly reassure him, rather than just deny that his feelings are valid. At the onset of his symptoms, all that mattered to him was that he be believed. He is responding well now to medication and lots of talk and is becoming calmer and more reasonable already. We are hopeful that any damage that was done is not permanent, but of course we will deal with that as it comes. Again, you have our thanks.
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