Paranoia - A Journey Into Extreme Mistrust and anxiety

Do you sometimes wonder if people on the bus are judging you? Or do you get the feeling that maybe a colleague is sabotaging your work? That your friends are talking behind your back?

According to clinical psychologist Daniel Freeman, thoughts like these classify as a form of paranoia. This is because paranoia—deep mistrust of those around us and their intentions towards us—comes in many forms and exists on a spectrum, says Freeman. In many cases, it is subtle and presents in thought patterns like those mentioned above. Some people, however, experience debilitating paranoia that wrecks their lives. Living with persecutory delusions, they might be convinced that the government spies on them or that their neighbors conspire to harm them.

But what makes someone become paranoid to such a degree? While genetics are thought to explain some of the variability found on a population level, Freeman warns about overestimating this influence and applying it to individuals. Instead, specific experiences and lifestyle factors often play a bigger role in the development of paranoia.

These experiences include bullying as well as discrimination, harassment, and abuse. Of course, these are valid reasons for people to grow suspicious of others. The problem, however, arises when they apply this suspicion to other, non-threatening situations. Their trauma becomes like a veil through which they interpret what's happening around them. As a consequence, many patients self-isolate and withdraw from day-to-day life—their relationships with loved ones break down. Besides traumatic experiences, research suggests that cannabis consumption and sleep problems contribute to paranoid thoughts, but Freeman warns that causality is hard to establish in many cases.

Based on this, it will not surprise you to hear that paranoia often goes hand in hand with other mental health conditions such as anxiety, depression, and low self-esteem. Similar thought patterns occur in all of these conditions, including the inability to come up with alternative explanations for events and the tendency to only consider evidence that confirms preexisting beliefs.

All of this makes paranoia a complex mental health phenomenon, but it also opens the door for a variety of treatment strategies. Improving patients' quality of sleep alone can go a long way. For patients with persecutory delusions, a therapist can become a person of trust alongside whom they can train for and experience new situations. In this context, Freeman and his colleagues have pioneered virtual reality (VR) technology as a tool to learn more about paranoia and to treat patients by exposing them to challenging situations. Barriers remain enormous in access to mental health treatment, and innovative approaches like this one help combat this.

Freeman's book fosters understanding. The stories he shares from his experiences with patients show that someone who feels like they are the target of some conspiracy or hears voices is not a crazy person. With the help of others who listen, acknowledge their situation, and support them in building trusting relationships, they have a chance to get their lives back.

And it’s not only patients with delusions that benefit from building more trust. By improving self-esteem and "cognitive flexibility", especially in younger people and other vulnerable groups, Freeman envisions creating an "infrastructure of trust". The ability of societies to combat challenges depends on this.