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New Insights Into Paranoia

Different forms of paranoia and what they share in common.

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A new understanding of paranoia as a psychiatric syndrome has been gained in recent years, enriched by contemporary psychoanalytic thought. The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) has historically defined this disorder, like other mental illnesses, in "categorical" terms rather than "dimensional" ones, observes psychoanalyst Nancy McWilliams. In other words, you either have it, or you don’t. But McWilliams claims paranoia is a process rather than a trait, one we are all susceptible to under the influence of stress or regression.

There are different types of paranoia, yet all share two main features. The first is projection, in which unwanted feelings, impulses, or aspects of self are attributed to another: I’m not angry; she’s angry. Secondly, this projection is disavowed or disclaimed, and so the individual is unaware of having pinned these unwanted feelings onto someone else: A person in a paranoid process remains convinced that it is the other person experiencing such feelings.

McWilliams notes there are different forms of paranoia, although not all are classified as such by the DSM. Most of us are familiar with the expression of paranoid syndrome characterized by suspiciousness and fantasies of persecution. For people under the influence of this type of paranoia, love is perceived as dangerous and threatening. In response, the feeling of love is unconsciously inverted into hate and attributed to another. Freud formulated this change of function from love to persecution in this way: I don’t love him; I hate him; He hates me.

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Graffiti artist: Banksy
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Paranoia processes can be mobilized for professional success. Microsoft, for example, has long operated according to a kind of a corporate "paranoia principle ... no threat is too improbable to ignore," which drives it to pre-empt incursions from competitors. For example, after Netscape released its Navigator browser, Microsoft released Explorer. Many African Americans have seen persecutory paranoia as a survival tool. As activist Cynthia McKinney has said, “African Americans have always known that a little bit of paranoia was healthy for us.”


Megalomania is a disordered mental state rooted in paranoid processes. McWilliams describes it as a condition “in which shame, self-contempt, and grief over limitation are disassociated and projected … the greater the unconscious self-loathing, the stronger the draw toward megalomania.” In the throes of this disorder, an individual typically thinks: You are worthless, pathetic, and defective, whereas I epitomize all that is admirable and desirable.

This variant of paranoia is frequently active in politics and in the leader-follower relationship. Cult figure Jim Jones, infamous for the 1978 mass suicide of followers who drank cyanide-laced Kool-Aid, preached that he was the reincarnation of Jesus, Mahatma Gandhi, Gautama Buddha, and Vladimir Lenin.

However, less-intense experiences of megalomania exist among healthy people as well, as a subtle, often adaptive omnipotence, McWilliams asserts. This is one's sense of "I can do anything!"

A related kind of distortion was identified in 2008 by psychiatrist Joel Gold and his brother, neurophilosopher Ian Gold. The Golds coined the term “Truman Show syndrome” after the 1998 film The Truman Show. The Golds saw a growing number of patients claiming they were the star of a reality TV show, with their every action being filmed and broadcast live. The chronicling of one’s life for a live audience was inescapable: Hidden cameras, for example, were everywhere, behind mirrors and inside jacket zippers and shirt buttons.

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One sees in all forms of paranoia a certain grandiosity and intense self-reference. The idea is: Everything that happens in the world is in relation to me. Better to be important in this way, notes McWilliams, than to inhabit a victim narrative and feel that one is actually very weak and helpless among a world of powerful people.


Erotomania is another delusional condition that makes use of paranoid processes. Here, an individual is convinced that another person is in love with him or her. The afflicted person believes the secret admirer is declaring their affection through subtle glances, special use of objects, or messages in the media. In the early 20th century, French psychiatrist Gaëtan Gatian de Clérambault described a patient obsessed with British King George V. She stood outside Buckingham Palace for long periods, believing the monarch was communicating his desire for her by moving the curtains. More recently, David Letterman was stalked by Margaret Mary Ray, who broke into the star’s home eight times and once drove off in his Porsche, claiming to be his wife.

McWilliams claims that persecutory paranoia, megalomania, and erotomania arise from different kinds of anxieties. Persecutory paranoia is embedded in anxieties of annihilation, while megalomania and erotomania are rooted in fears of separation. These anxieties engage different aspects of our brain chemistry and occur through different neurotransmitters.

Persecutory paranoid dynamics are part of what Estonian-born neuroscientist Jaak Panksepp identified as the FEAR system in the brain, in which signals transmitted across a synapse from one neuron (nerve cell) to another "target" neuron do not use serotonin. Yet signals between brain cells activated by megalomania and erotomania do. This is why, McWilliams surmises, persecutory paranoia (based in fears of annihilation or death) doesn’t respond to serotonin drugs or SSRIs, the most commonly prescribed antidepressant.

Projection, central to all paranoid process, is a normal part of childhood development and plays a frequent role in adulthood also. What else do we do when we dream? We make adaptive use of projection in the creative process. What does a painter do when he or she puts images, perceptions, feelings onto canvas? Or when a writer identifies with a character in his novel or play?

Projection becomes problematic and veers into pathology when one’s identity can only be defined by what one is not. Identity for such an individual relies on contrast, and a person becomes fixated with a prolonged and intense need for “othering,” for finding other people onto which to hang the unwanted and painful parts of his or herself (e.g., anger, inadequacy, shame). There is ongoing confusion regarding boundaries between self and other, between what is inside and belongs to self and what is outside belonging to another. This becomes the only way of maintaining psychic equilibrium, and there is no possibility of mutual recognition in a relationship. Psychological separation is intolerable. As McWilliams puts it, “When the other is an indispensable part of self-definition psychological separation is not possible.”

As philosopher Robert M. Hutchins puts it, “This is a do-it-yourself test for paranoia: You know you've got it when you can't think of anything that's your fault.”

Paranoia originates in experiences of acute humiliation, a setting of early environmental chaos in which the child has insecure attachment to his or her primary caregivers and is vulnerable to insecurities about the dependable nature of those around them. At its core, all paranoid processes involve the struggle between trust and mistrust. Someone prone to paranoid states was often shamed for commonplace feelings as a child, learned that such affect was unacceptable, and responded by disavowing these aspects of reality and projecting them onto others.

Because it relies on mechanisms of projection and disavowal, paranoia is a psychic process readily transferred intergenerationally, McWilliams suggests. A child, who by definition has porous boundaries and a vulnerable sense of identity, is a susceptible target for a parent’s paranoid projections. So family can easily be an instrument for transferring this emotional experience between the generations.

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McWilliams, N. (2010). Paranoia and Political Leadership. Psychoanalytic Review, 97:239-261.