Paranoia: The 21st Century Fear

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PA R A N O I A

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PA R A N O I A TH E T WENT Y-F I RST CENTU RY F EAR

Daniel Freeman and Jason Freeman

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Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With ofﬁces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Daniel Freeman and Jason Freeman 2008 The moral rights of the authors have been asserted Database right Oxford University Press (maker) First published 2008 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Data available Typeset by SPI Publisher Services, Pondicherry, India Printed in Italy on acid-free paper by Lego S.p.A. ISBN 978–0–19–923750–0 1 3 5 7 9 10 8 6 4 2

AC K N OW L E D G E M E N T S

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Much of this book was planned in the Rookery Stand at Watford Football Club. We apologize to those who sit near us. Research is a collaborative endeavour and signiﬁcant roles in the academic work described have been played by Philippa Garety, Paul Bebbington, Graham Dunn, Elizabeth Kuipers, David Fowler, Mel Slater, Angus Antley, and Katherine Pugh. Important inﬂuences have been Aaron Beck, Richard Bentall, and David Clark. The perfect context for the ideas to develop has been provided by the close association of the Institute of Psychiatry, King’s College London with the South London and Maudsley NHS Foundation Trust. We are extremely grateful to the Wellcome Trust, an independent charity supporting research to improve human and animal health, who fund Daniel’s research programme. ■

We would like to thank the Department of Computer Science at University College London for supplying the two virtual reality images in Chapter 4.

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CON T EN T S

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1. Introduction Or, Why Fat is a Paranoid Issue

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2. A Nest of Traitors! What is Paranoia?

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3. ‘ They Tell You Lies’ Is Paranoia Increasing?

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4. Anxiety, Avatars, and Ink Spots Paranoia and Emotions

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5. ‘I Don’t Want to Sweep Alone’ Paranoia and Anomalous Experiences

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6. Doing the Camberwell Walk Paranoia and Reasoning

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7. A Downward Spiral? Combating Paranoia

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8. Conclusion Or, Enjoy the Fruit

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SO U RC ES I N D EX

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I NTRODUCTION

Or, Why Fat is a Paranoid Issue ................................................................................

Over the past few years, a new and deadly epidemic has stalked the land. Britain and the US, just like much of the rest of the world, are getting fat. Around 60 per cent of adults in the UK are heavier than they should be. It’s a similar story in the US, where two-thirds of adults are overweight or extremely overweight (obese). That’s a pretty shocking statistic, but we all know that keeping in shape when you’re trying to balance the demands of work and family life is tough. Who’s got time to get to the gym? Who has the energy to do more than heat up a ready meal after ten hours in the ofﬁce? Besides, we all get bigger as we get older, don’t we? It’s a metabolism thing—isn’t it? But if you think the statistics for adults are alarming, wait till you ﬁnd out how our kids are faring. In 2003, 27 per cent of children under 11 in England were either overweight or obese. In the US, where different methods to measure

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obesity are used, nearly 20 per cent of children aged 6 to 11 were classiﬁed as overweight or obese in 2004. The numbers have almost doubled in a decade. How did so many children get to be overweight before they’ve even reached the ripe old age of 11? How do you become overweight when so much of your day is taken up with charging round a playground or park, when you can’t drive, and when you’re not free—like the rest of us—to stuff your face at will with chocolate, crisps, and alcohol? The answer, of course, is a complex one. If adults are eating much less healthily than they used to, so are their kids. Instead of spending their evenings playing outside, children now have the delights of multi-channel television, computer games, and the Internet to choose from. And then there’s the fact that increasing numbers of us just won’t let our children outside on their own. Back in the mid 1970s, we were 6 years old. There were just three television channels in the UK, no Internet, and no personal computers. (Happy days!) Every weekday we’d walk a mile and a half to and from school, unaccompanied by an adult. Every summer evening, we’d play in the streets, gardens, and parks near our home. There were plenty of other children around, but we didn’t see an adult until they came looking for us at bedtime. And we weren’t the offspring of especially uncaring and neglectful parents—pretty much all the kids we knew had the same kind of licence to roam.

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Things are a little different today. More than 40 per cent of UK adults questioned in a recent survey thought that fourteen—fourteen!—was the earliest age at which children should be allowed to go out unsupervised. Two-thirds of 10year-olds have never been to a shop or the park by themselves, and fewer than one in ten 8-year-olds walk to school alone. And if you do let your little ones out, you might want to dress them in a GPS tracker jacket so you’ll always know where they are—unless, of course, they take the jacket off . . . What are we so worried about? It basically boils down to two main concerns: we’re afraid of our children being hit by a car, and we’re terriﬁed that our children are going to be abducted by a paedophile. And who wouldn’t be worried? We can see with our own eyes the huge increase in trafﬁc on our roads over recent years. All of us can call to mind horriﬁc cases of child abduction and murder. The world seems a much more dangerous place today than it did when we were kids. It’s a world in which no sane parent should let their child out of their sight. If that means our children adopting the same sedentary lifestyle of so many adults, that’s a small price to pay. In fact, despite all our parental vigilance, the number of children murdered in the UK has remained pretty much constant over the past 30 years—around 60 to 80 per year. In most of those cases, a parent is the principal suspect. In 2006, 55 children were killed in England and Wales;

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12 were murdered by strangers. In the US, between 40 and 150 children are abducted and murdered per year (in around 14 per cent of cases, the killer turns out to be the child’s parent). Seventy-one children were run over and killed on UK roads in 2006; 339 under-14s were killed in the US in 2005. In both countries the trend is dramatically downwards (though we don’t know for sure whether the primary cause is kids not spending as much time out alone, better road safety education, or some other factor). Next year approximately 150 children in the UK, and 500 in the US, will die either at the hands of a murderer (including their parents) or as pedestrians in a trafﬁc accident. These are grim statistics, to be sure. But they’re a drop in the ocean compared to the risks our kids are running by not going out. The number of obese or overweight children in the UK and US runs to millions. The less we exercise, the more likely it is that we’ll become overweight. And the more overweight we are, the greater the chances of us developing serious illnesses like cancer, heart disease, diabetes, stroke, and arthritis. So why, when the risks to our children of a sedentary lifestyle are so much greater than the risks of letting them out on their own, do we persist in ferrying them to school and allowing them to spend so much time in their bedrooms playing computer games? Each parent will have their own take on the issue, of course, and there are likely to be a range of explanations for their attitudes. But part of it is simply that we’re not

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good at comparing risks. We’re more frightened of events that almost certainly won’t happen (abduction) than things that quite possibly will (obesity). When you think of our fear of paedophiles, what many of us are gripped by is pure and simple paranoia. ■

Of course, we’re not just worried about paedophiles. We’re scared of terrorists, muggers, and rapists. We fret about hoodied teenagers and ‘feral’ youths. Our towns and cities, we are regularly told by the media, have become ‘no go zones’ on weekend evenings, ﬁlled with brawling lager louts. There are reckoned to be more than ﬁve million CCTV cameras in Britain—more than 20 per cent of the world’s total—but we don’t seem to feel any more secure. (CCTV is less prevalent in the US, but becoming increasingly common.) These days you’re not even safe from assault in your own car—who wants a knife pulled on them in a road-rage incident? Take a look at the newspaper most days and you could be forgiven for never setting foot outside the house (though that wouldn’t save you from marauding burglars). And that’s just the everyday horrors we know about. What about the bad guys we can’t see. Well, governments and other ﬁgures in authority may scoff, but lots of us are pretty sure they’re there nonetheless. Take the Aids epidemic, for example. The scientiﬁc consensus is that Aids is caused by the HIV virus, which originated in sub-Saharan Africa in the mid-twentieth

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century and was probably transmitted to humans from monkeys. But a surprisingly large number of people think the scientiﬁc consensus is pure hokum. For example, a 1999 survey of 520 African Americans found that 27 per cent believed Aids was ‘a man-made virus that the federal government made to wipe out black people’. A further 23 per cent were undecided—meaning that half of the people surveyed didn’t buy the ‘ofﬁcial’ scientiﬁc explanation. And a survey of African Americans in 2006 found that: r 48 per cent thought Aids was a man-made virus. 26 per cent believed it had been developed in government laboratories. r 53 per cent agreed that there is a cure for Aids but it’s being deliberately withheld from the poor. r 12 per cent believed HIV was created and spread by the CIA. Maybe it’s not surprising that African Americans distrust the authorities, given their history as victims of persecution and discrimination. So let’s look at the events of September 11 2001. We all know what happened on that terrible day, right? A devastating and entirely unexpected attack by Islamic terrorists, inspired and quite probably planned by al-Qaeda. No. Apparently, lots of us have major doubts about that

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particular version of events. Here are just a few statistics from the countless opinion polls carried out on the subject: r 49.3 per cent of New York City residents believe US leaders ‘knew in advance that attacks were planned on or around September 11, 2001, and that they consciously failed to act’. r Nearly two-thirds of respondents in a US national poll said it was possible that government ofﬁcials ignored warnings about the attacks. r 12 per cent suspect the Pentagon was hit by a military cruise missile rather than by an airliner captured by terrorists. r 22 per cent of Canadians believe ‘the attacks on the US had nothing to do with Osama Bin Laden and were actually a plot by inﬂuential Americans’. The death of Princess Diana? Thirty-six per cent of British Muslims questioned in a 2006 opinion poll believed that she was murdered by the security forces in order to prevent her marrying a Muslim (Dodi Al-Fayed). Alien life forms visiting Earth? Thirty-eight per cent of Americans surveyed in 2006 thought the US government was withholding proof of the existence of intelligent life on other planets. Whether it be the Apollo moon landings, the murder of John Lennon, the demise of Elvis Presley, or a whole host of other apparently straightforward incidents, many of us

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just don’t believe the ‘ofﬁcial version’. For the conspiracy theorists, these events are the work of a malign and secretive establishment that will do anything to preserve its power, including lying about its actions afterwards. For the rest of us, these theories are just so much paranoia. ■

It is one of the themes of this book that paranoia—the unfounded belief that someone is out to hurt us—permeates our society, more than we’ve ever suspected and possibly more than ever before. The popularity of conspiracy theories reﬂects this paranoia, but it’s really just the outlandish tip of a much more mundane iceberg. We may laugh at the idea that the moon landings were faked, or that MI5 assassinated the Princess of Wales. We may regard the periodic media campaigns against paedophiles as so much sensationalistic muck-raking. But that doesn’t mean we aren’t prone to suspicious thoughts of our own. Emily is a 34-year-old solicitor from London. She is married and has a 2-year-old daughter. I guess I can be a little paranoid. But I work in a really competitive company with a lot of very smart people. We’re constantly being judged by the senior partners. The staff get on well—superﬁcially—but I think there are a lot of people hoping their colleague screws up. So it’s probably part paranoia and part an accurate response to the way the place works.

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Alex is a 25-year-old graphic designer from Bristol. Occasionally I get what you’d call paranoid, I guess. Usually it’s when I’m feeling a bit down or tired. Like when I’m with a friend and someone calls them on their mobile. If my friend says he’s with me and then laughs at something the caller’s said, I might think they’re laughing about me. And sometimes I think friends are arranging to go out without me. I might be sitting at home on my own and I wonder whether everyone else is out having a good time. But I know it’s not true, really.

Emily and Alex are engaging, likeable people juggling demanding jobs and busy social lives. They are ‘regular folks’. They both have paranoid thoughts fairly frequently, though these thoughts don’t affect them much. And in their paranoia, as we’ll see, they’re regular folks too. Until very recently—the last 15 to 20 years in fact—no one suspected just how many people had paranoid thoughts. But several research projects have now lifted the lid—and the results are striking, to say the least. Here are just a few statistics from some of those studies. (Incidentally, all of the projects we mention here excluded from their survey people with a history of severe mental illness.) r In a survey of 8,580 UK adults, 21 per cent said there had been times over the past year when they’d felt people were against them. 9 per cent said they had believed that their thoughts were being controlled or interfered with by some outside force or person. 1.5 per cent said there had been times when they’d felt people were plotting to cause them serious harm.

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r A study of 1,005 adults in New York found that 10.6 per cent believed other people were following or spying on them. 6.9 per cent thought people were plotting against them, or trying to poison them. 4.6 per cent believed people were either secretly testing them, or experimenting upon them. r A French survey of 462 adults found that 25 per cent had, at some point in their lives, felt that they were being persecuted in some way. 10.4 per cent had sometimes believed there was a conspiracy against them. r A study of 1,202 British university students (aged 16 to 61) assessed their feelings over the previous month. 42 per cent said that, at least once a week, they had thought that negative comments about them might be circulating; 27 per cent had felt that people were deliberately trying to irritate them; and 19 per cent had thought that they might be being observed or followed. 5 per cent thought there might be a conspiracy against them. r More than a thousand older adults (aged 55 and above) in Brooklyn, New York, were assessed. 13 per cent had, in the previous week, experienced paranoid thoughts. Paranoia, then, is widespread—so widespread, in fact, that around 15 to 20 per cent of the population have frequent paranoid thoughts. Most of those people, like Emily and Alex, aren’t much troubled by their suspicious thoughts. But a further 3 to 5 per cent have severe paranoia—what

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psychologists call persecutory delusions. For this smaller group of people, their paranoia is serious enough to need medical treatment. These ﬁgures are pretty astounding, aren’t they? Around a quarter of us are having regular paranoid thoughts (and probably lots more of us are having them occasionally). Paranoia is so prevalent that there’s a very good chance that, at some point in your life, you’ll be among the 25 per cent. ■

Until the 1990s, no one—including the medical and psychological professions—had any idea that paranoia was so common. In fact, if you’d asked the average psychiatrist in, say, 1980 what proportion of the population had paranoid thoughts they’d have told you somewhere in the region of 1 per cent of the population. Now, that ﬁgure of 1 per cent is no accident. It just happens to be the number of people who suffer from severe mental illness, or psychosis to give it its medical term. And that’s the context in which paranoia was understood: as a symptom of psychosis. (Or ‘madness’, as it would have been called a few decades back.) People with severe depression sometimes experience persecutory delusions, as do those suffering from posttraumatic stress disorder. But the vast majority of the 1 per cent affected by severe paranoia are people with schizophrenia: around half of those with this illness experience persecutory delusions. A vivid description of what it’s

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like to undergo these delusions has been given by Andrew Cruickshank: At the height of my delusions, I believed I was being framed for a series of heinous crimes involving murder, rape, and paedophilia. The people framing me were my parents, siblings, and various friends and acquaintances from high school. I believed that the crimes for which I was being framed had been committed in Canada, the United States, Germany, and England. . . . I believed everyone and everything were put in my path as some sort of psychological test. I believed I had mini cameras implanted in my eyes and that there was a control room somewhere with people analysing the data they saw through my eyes. I believed the crows around me were designed to follow me unobtrusively.

Pigeon-holing paranoia as a symptom of psychosis had a couple of important consequences. The ﬁrst was a kind of logical error. If paranoia was a symptom of severe mental illness, people who weren’t mentally ill weren’t paranoid. No one tried to ﬁnd out how common paranoia was among the general population. Why should they? The question was hardly worth asking. How common is severe mental illness?: that was the crucial question. If you knew the answer to that—and hospital admissions gave a pretty clear indication—you also had the answer to the paranoia question. If you were interested. The second consequence of this view of paranoia has to do with the categorization of mental illness. Dating back to the early twentieth century, a distinction had been drawn

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between neurosis and psychosis. Here is the hugely inﬂuential psychiatrist Karl Jaspers, writing in 1913: The most profound distinction in psychic life seems to be that between what is meaningful and allows empathy [neurosis] and what in its particular way is ununderstandable, mad in the literal sense [psychosis].

Neurosis was seen as an ‘affective illness’. Psychosis, on the other hand, was ‘madness proper’. And you’ll gather instantly that it was better to be deemed neurotic than psychotic. People suffering from depression or anxiety, for instance, were neurotic. They were ill, for sure, but their illness basically amounted to an exaggeration of perfectly normal feelings. They were, in other words, perfectly sane. The same was not said, however, of people with psychosis. They were mad, and their madness remained—by deﬁnition, in fact—stubbornly resistant to all attempts to explain and understand it. Psychosis—including any accompanying paranoia—was regarded as fundamentally incomprehensible. And because it was hopeless to try to understand these delusions, why bother? Although it is a waste of time to argue with a paranoid patient about his delusions, he may still be persuaded to keep them to himself, to repress them as far as possible and to forgo the aggressive action they might suggest, in general to conduct his life as if they did not exist.

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That was the view of Clinical Psychiatry, a hugely inﬂuential textbook in the 1950s and 1960s. But it wasn’t just psychiatrists who thought paranoia not worth taking seriously. A number of psychologists developed techniques to help patients reduce the amount of time they spent talking about their delusions. There was no point in talking about them. They were, after all, just ‘empty speech acts’. And that was the medical consensus. Psychiatrists and psychologists—two professions dedicated to understanding the way the mind works—arguing that certain types of thoughts should just be repressed. Arguing that we should all—patient, doctor, and therapist—pretend that paranoia doesn’t exist. The irony is almost palpable. But the days when paranoia could be written off as a meaningless sign of insanity are long gone. In this book we put paranoia centre stage. It’s only right, because paranoia is centre stage in our culture and in our individual lives. Think of our fascination with conspiracy theories. Think of our terriﬁed obsession with the various bogeymen of the day. (Right now it’s paedophiles, muggers, terrorists; in the past it was witches, Jews, and Freemasons—plus ça change.) And remember that, at any one time, a quarter of us are prone to regular paranoid thoughts. Paranoia, it turns out, is as common as depression or anxiety—or, for that matter, happiness. But if paranoia is so common, why do we know so little about it? What is paranoia? Is it dangerous or unhealthy? What causes paranoia? Is there a connection between severe

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paranoia and everyday suspiciousness? Are some people more prone to paranoia than others? Are we more paranoid now than we used to be? How should we deal with our paranoid thoughts? How can we reduce the amount of paranoia in our society? We’ll try to answer all these questions in the chapters ahead.

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A N EST OF TR AITORS!

What is Paranoia? ................................................................................

November 5, 1611. London. At the court of James I, the king and his entourage settle down to enjoy the latest play by celebrated playwright William Shakespeare. The play in question is The Winter’s Tale, one of the clutch of so-called romances—along with Pericles, Cymbeline, and The Tempest—Shakespeare wrote before retiring back to Stratford, where he died in April 1616. Like Shakespeare’s other late plays, The Winter’s Tale offers a startling mixture of styles, oscillating wildly between pastoral comedy and intense psychological drama. It also includes a harrowing portrayal of extreme paranoia. Not that this could be guessed from the gentle opening of the play. Leontes, king of Sicily, is entertaining his childhood friend Polixenes, king of Bohemia. But having been away from home for nine months, Polixenes is anxious to return to Bohemia. Leontes pleads with him to stay, but Polixenes’ mind is made up. Or at least it is until Leontes asks his wife,

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Hermione, to speak to him. And though we might assume that Leontes will be overjoyed by Polixenes’ change of heart, what we see next couldn’t be more unexpected. Polixenes’ decision plunges Leontes into a savage spiral of paranoia. How was Hermione able to persuade his lifelong friend to stay in Sicily when his own efforts were futile? That’s simple: Hermione and Polixenes are lovers. Polixenes is the father of Hermione’s unborn child. And everyone except Leontes knows it: They’re here with me already; whispering, rounding ‘Sicilia is a so-forth’ Tis far gone When I shall gust it last.

What starts off resembling a bizarre attack of jealousy soon develops into much more. Suddenly, and without a shred of evidence, Leontes suspects everyone of plotting against him—including his faithful subject Camillo, whose only crime is the attempt to defend Hermione: You lie, you lie. I say you liest, Camillo, and I hate thee.

Leontes promptly orders Camillo to murder Polixenes. When Polixenes ﬂees to Bohemia, having been warned by Camillo of Leontes’ intentions, this only serves to conﬁrm and intensify Leontes’ paranoia: There is a plot against my life, my crown; All’s true that is mistrusted. That false villain Whom I employed was pre-employed by him; He has discovered my design, and I remain a

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Pinched thing; yea, a very trick for them to play at will. . . . Camillo and Polixenes Laugh at me, make their pastime at my sorrow.

Worse is to follow. Leontes has Hermione arrested and imprisoned, accusing her not only of adultery but of conspiring to murder him. Wracked by sleeplessness, and seeing treachery everywhere (‘a nest of traitors!’), Leontes will listen to no one who dares suggest that he is mistaken. When several lords assure him that Hermione is virtuous, Leontes simply tells them they are wrong: ‘I am satisﬁed, and need no more [proof] than what I know.’ When Hermione’s servant Paulina defends her mistress, Leontes blames her husband: ‘Thou, traitor, has set on thy wife to this.’ And when the Delphic Oracle pronounces Hermione innocent, he simply disregards it: ‘There is no truth at all in the oracle.’ The juggernaut of miseries set in motion by Leontes trundles remorselessly onwards. Hermione, he is told, has died in prison, shortly after having given birth to a daughter. Mamillius, the young son of Leontes and Hermione, expires from grief when he hears of his mother’s fate. And the new-born baby is abandoned on the coast of Bohemia, on Leontes’ orders, ‘where chance may nurse or end it’. At which point, and though he may have wished he hadn’t, Leontes comes to his senses. ‘I have too much believed mine own suspicion,’ he admits, with a somewhat startling new preference for understatement. But, though it

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takes sixteen years to materialize, he is eventually rewarded by what, under the circumstances, must count as a very happy ending indeed. Leontes’ baby daughter, now named Perdita, has survived and grown up into a beautiful if humble shepherdess. So beautiful is she in fact that she has won the heart of the handsome Prince Florizel, Polixenes’ son. For reasons too complicated to go into here, the young lovers travel from Bohemia to Sicily, win the blessings of their respective royal fathers—whose friendship is thereby rekindled at last—and arrange to be married. And ﬁnally, and most miraculously, Hermione is revealed to be still alive. (The wretched Mamillius has not been so fortunate, though no one is so indiscreet as to mention this.) Improbable though these developments may be, only the most ﬂint-hearted theatre-goer could ﬁnd themselves unmoved. And yet the rosy glow of young love and hardwon reconciliation cannot quite erase the memory of Leontes ﬂailing tragically at the treachery he sees in every face around him. And thus to all that Shakespeare has given us must be added one of the most compelling portrayals of paranoia ever seen on the English stage. ■

In 1621, just ten years after The Winter’s Tale was ﬁrst performed, Robert Burton published his Anatomy of Melancholy. Burton, who was born in Leicestershire in 1577, spent his entire adult life in Oxford, as a scholar and vicar.

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By all accounts, it was not an overly exciting existence. ‘I have lived’, he wrote, ‘a silent, sedentary, solitary, private life . . . penned up most part in my study.’ Burton wrote the Anatomy as part of his efforts to deal with his recurrent and persistent melancholy—a condition we now call depression. The Anatomy proved immediately popular with contemporary readers, going through six editions in Burton’s lifetime, but reputedly it was not his only self-help strategy: ‘when the melancholy weighed upon him, [Burton] would leave his study in Christ Church, stroll down to Folly Bridge and recreate himself by listening to the vigorous back-chat of the bargees.’ For Burton in the Anatomy, paranoia and depression go hand in hand: He [the depressed person] dares not venture alone, for fear he should meet the devil, a thief, be sick; fears all old women as witches, and every black dog or cat he sees he suspecteth to be a devil, every person comes near him is maleﬁciated, every creature, all intend to hurt him.

And he continues: Suspicion and jealousy are general symptoms. . . . If they speak in jest, he takes it in good earnest. If they not be saluted, invited, consulted with . . . they think themselves neglected and contemned; for a time that tortures them. If two talk together . . . he thinks presently they mean him . . . Or if they talk with him, he is ready to misconster every word they speak, and to interpret it to the worst; he cannot endure any man to look steadily at him, speak to him almost . . . He thinks they laugh or point at him . . .

This association with depression is typical of the way paranoia was seen until the rise of professional psychiatry in the

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late eighteenth and early nineteenth centuries. In Chapter 1 we described psychiatry’s distinction between neurosis and psychosis—or mental illness and madness. Paranoia, according to this schema, is very much a sign of psychosis. But not so for Burton and his contemporaries. A person may have paranoid thoughts from time to time, but that doesn’t mean they aren’t able to function normally: In all other things they are wise, staid, discreet, and so nothing unbeseeming their dignity, person, or place, this foolish, ridiculous, and childish fear excepted.

Paranoia is a type of fear, not a form of lunatic delusion. For Burton and his contemporaries, paranoia isn’t a sign of madness; it’s a sign of depression (an illness that psychiatry later puts ﬁrmly in the category of neurosis). ■

It is beyond the scope of this book to offer a detailed history of paranoia. But the myriad references to it in literature and history make it plain: paranoia, like the poor, has always been with us. (Whether it’s on the increase is a question we’ll come to in Chapter 3.) But if paranoia has always been with us, its meaning has undergone repeated, and often dramatic, changes. The word ‘paranoia’ was coined by Hippocrates, commonly described as the ‘founder of medicine’, who was born around the year 460 BC on the Greek island of Kos. Hippocrates used ‘paranoia’ to describe the kind of delirium people sometimes experience when they have a very

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high temperature. He did this by putting together the Greek words for ‘beside’ (para) and ‘mind’ (nous) to create a word that literally meant ‘out of one’s mind’. Such delirious ramblings might include irrational fears about other people, though Hippocrates’ use of the term wasn’t limited to these. Hippocrates’ sense of paranoia as derangement, of being out of one’s mind, made a comeback as a technical term in the mid-eighteenth century. This was a time of growing interest in mental illness, leading up to the creation of the new discipline of psychiatry at the beginning of the nineteenth century. When in 1763 the French physician and scholar François Boissier de Sauvages de Lacroix published his Nosologia Methododica, a hugely important work that attempts the ﬁrst scientiﬁc classiﬁcation of diseases, he devoted a substantial portion of the book to mental illness. As part of this effort, Sauvages revived the term paranoia, which he employed rather like Hippocrates had done. For Sauvages, ‘paranoia’ denoted a form of derangement, or madness, associated with high fever but also with dementia. The use of the term was then signiﬁcantly reﬁned by Johann Heinroth (1777–1843), who held the ﬁrst chair in psychiatry (at the university of Leipzig). Heinroth is credited with giving the world the term ‘psychosomatic’, but he also extended the meaning of paranoia to include delusions (or false ideas) that occurred without the presence of a fever. Paranoia was still ﬁrmly locked into a discourse of madness, irrationality, and delirium. But, within that discourse,

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Heinroth made room for delusions that resulted not merely from physical illnesses but also from disorders of the mind. This association of paranoia with madness quickly became entrenched in psychiatric theory. Thanks to the work of two of the founding fathers of modern psychiatry, Emil Kraepelin (1856–1926) and Eugen Bleuler (1857– 1939, and of whom more below), paranoia was principally regarded as a symptom of psychosis. And that, at least until very recently, is pretty much where the scientiﬁc view of paranoia has been stuck. Low-level paranoia—the sort that’s experienced by millions of us on a regular basis—doesn’t get a mention. So if we want to unpick that association of paranoia with insanity, we need to get back to square one. The meanings that paranoia has been given over the centuries are useful and informative, to be sure. But we need to answer the question for ourselves: what is paranoia? ■

Let’s start with a simple deﬁnition. Paranoia is the unrealistic belief that other people want to harm us. So far, so good, but a single-sentence deﬁnition raises as many questions as it answers. We need to dig a little deeper, to really get inside the experience of paranoia. What does it feel like to have these kinds of fears? What effect do they have on us? Do we really believe our paranoid thoughts? And what form does a paranoid fear take anyway? Who do we think might want to hurt us? Are we more scared of some

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types of people than others? What do we think these bad guys want to do to us—and why? Are they out to get us today, tomorrow, or some time in the future? It’s these kinds of questions that will help us understand the true nature of paranoia today. ■

In the late 1980s the psychologists Jerry Mitchell and Arlyn Vierkant discovered a battered cardboard box in a store room of Rusk State hospital in east Texas. The cardboard box turned out to contain details of more than 500 people who had been admitted to the hospital in the 1930s. Around 150 of those 500 were suffering from severe mental illness. Mitchell and Vierkant decided to compare the stories of those 150 patients from the 1930s with the stories of 150 patients with similar problems from the 1980s. In so doing, they were exploiting a rare and fascinating opportunity to compare paranoid thoughts across half a century. What they found was that, to some degree at least, people’s paranoid fears reﬂected the times they lived in. So patients from the 1980s believed they were under threat from the Secret Service, the Maﬁa, the Soviets, or—a little bafﬂingly—from lesbians. Telephones and houses were bugged. Radar and computers were being used to control people from afar. Clearly radar and computers weren’t going to feature in the accounts from the 1930s, but neither did the Secret Service, for example. These kinds of powerful organizations

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or groups were noticeably absent from the fears of 1930s’ patients, though God and other religious ﬁgures were often an element (east Texas has always been a heartland of fundamentalist Christianity). One possible explanation for this change is the advent of television, which brought a whole new world—and a whole new world of threats—to a generally poor, rural, and isolated population. Before television, the threats people perceived were likely to come from more personal, parochial sources. This focus on the ‘fear ﬁgures’ of the day is reﬂected in an account written in 1911 by the celebrated Swiss psychiatrist Eugen Bleuler. (Bleuler was the man who coined the term ‘schizophrenia’ and who treated the legendary ballet dancer Vaslav Nijinsky when he fell ill with the condition.) Bleuler wrote: ‘The Freemasons, the Jesuits, the “black Jews”, their fellow-employees, mind-readers, “spiritualists”, enemies invented ad hoc, are constantly straining every effort to annihilate or at least torture and frighten the patients.’ In the early twentieth century it’s Freemasons, Jesuits, and ‘black Jews’—all groups then rumoured to be conspiring to bring down society. By the 1980s it’s the Maﬁa or the Russians. Today it’s MI5, the government, or Al-Qaeda. (Some of our fears, on the other hand, have proved remarkably resilient. Witches, for example, were for many centuries prominent—and malevolent—ﬁgures in the popular imagination, as we can see in the quote from Robert Burton on page 21 above. And in the twenty-ﬁrst century, witches still seem a force to be reckoned with.

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In one survey, 21 per cent of Americans said they believed in witches. The ﬁgure is lower for the UK and Canada, 13 per cent, though this is still higher than one might have guessed. Surprising though these ﬁndings might seem, they are as nothing when compared to the hold that ghosts apparently continue to exert over us. In the same survey, 40 per cent of Britons, 37 per cent of Americans, and 28 per cent of Canadians professed a belief in haunted houses.) Both the Rusk State hospital study and Bleuler’s work focus on the paranoid delusions of people with serious mental illness. But most of us have paranoid thoughts from time to time. Who are we scared of ? If I walk past strangers in the street and they’re laughing, I always suspect they’re laughing at me. Paul, aged 21. At work, if I’m restocking the shelves and other staff members are nearby, I sometimes think they’re joking and talking about me, but I know they aren’t really. Doreen, aged 58. I once thought a housemate was trying to steal my possessions because I often caught her in the corridor near my room. I got really wound up about this and ended up locking some of my valuables in the garden shed. I began to have other thoughts—like she was trying to poison me because she was always asking me to eat food she’d cooked and giving me new foreign alcohol to try. Liz, aged 24. If I’m sitting on the tube and I catch someone’s eye repeatedly, I wonder why they keep looking at me. Chris, aged 30.

These comments are taken from a survey we carried out on a randomly selected sample of the general public. People

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in the street, as you might say. It turns out that, when it comes to our own personal bogeymen, the range is as diverse as you could imagine. Strangers, workmates, housemates, friends, family—you name it, we’re afraid of them. And sometimes we don’t even have a particular person in mind; instead, we feel a general, non-speciﬁc sense of threat. Incidentally, it might seem from this discussion that there is a clear distinction between the sorts of persecutors conjured by people with severe mental illness and those of us with ‘everyday’ paranoia. The former group tend to worry about external, remote, impersonal threats; the latter about people closer to us. Of course, like all generalizations the reality isn’t so neat. People with, say, schizophrenia are often fearful of family members or neighbours. And many people without mental illness distrust the government or other state agencies. What we can say for sure though is that paranoia will point the ﬁnger at anyone. Everyone is a potential threat. ■

If paranoia is the unreasonable fear that someone wants to harm us, exactly what kind of harm are we afraid of ? Once again, there’s an enormous range of answers to this apparently straightforward question. In the example we gave in the previous section, Paul and Doreen thought they were being ridiculed. Being ridiculed is what psychologists call social harm and other examples include being made to

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look bad in other people’s eyes, being excluded, or being the subject of malicious rumours—all of which commonly feature in paranoid thoughts. Liz feared her ﬂatmate was going to poison her and, again, physical harm—including being attacked or even killed—frequently crops up in paranoia. One of the most common examples of this, and one experienced by most of us at some point or other, is the fear that we’ll be mugged when walking home late at night. Besides social and physical harm, people often worry that they’re being watched or talked about. Or they think people are using hints and double meanings to threaten them without anyone else noticing. They might believe other people are trying to upset or annoy them (we call this psychological harm), or steal their money or possessions (in other words, inﬂict ﬁnancial harm). Paranoid thoughts can revolve around the idea of an enemy—perhaps someone at work we see as a rival—who wants to ruin or get rid of us. And in some severe cases, people feel their actions or thoughts are being controlled by someone else. One interesting aspect of paranoia is the degree of personal reference. Who exactly is being threatened? Usually, it’s the person with the paranoid thoughts. But it can sometimes involve friends and family (Angela, a 39-yearold patient, was convinced that ‘a strange force’ was trying to take her children). In other cases, the paranoia is curiously selﬂess: everyone is in danger (Charles, a 44-yearold man with schizophrenia, believed the government was

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designing a series of medical experiments to carry out on society). So any kind of harm can feature in paranoia. But intriguingly, there’s evidence to suggest that the precise form this harm takes may vary from country to country—in other words, it’s culturally determined, at least in part. A comparison of 500 mentally ill patients in Tokyo, Vienna, and Tübingen in Germany found high levels of paranoia in all three countries. But the Japanese patients were much more likely to be worried about people slandering them than the European patients. The researchers put this down to Japan’s ‘shame culture’, which places huge importance on the perception of the individual by wider society and in which the fear of public disgrace is much more powerful than in Europe. ■

What reasons do people give for being threatened? In one of the opening scenes of Woody Allen’s 1977 smash hit Annie Hall, Alvy Singer, a comedian played by Allen, is observed walking down a pretty, tree-lined street in Manhattan with his friend Rob.  I distinctly heard it. He muttered under his breath, ‘Jew’.  You’re crazy!  No, I’m not. We were walking off the tennis court, and you know, he was there and me and his wife, and he looked at her and then they both looked at me, and under his breath he said, ‘Jew’.

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 Alvy, you’re a total paranoid.  Wh——How am I a paran——? Well, I pick up on those kind o’ things. You know, I was having lunch with some guys from NBC, so I said . . . uh, ‘Did you eat yet or what?’ and Tom Christie said, ‘No, didchoo?’ Not, did you, didchoo eat, but Jew eat? Jew. You get it? Jew eat?

Alvy believes people pick on him because he’s Jewish. And feeling threatened because of who we are is very common. Individuals who see themselves as popular and successful may conclude that they’re being victimized out of jealousy. On the other hand, people with low self-esteem may believe they’re being singled out precisely because of their deﬁciencies. Sometimes it’s not a question of who we are but rather what we’ve done. So the threat is a punishment, sometimes justiﬁed, sometimes not. Richard, a 22-year-old student, explained his worries in just these terms: Because I won’t take part in some activities that everyone is doing and I decide to stand out and not give in to peer pressure, I think they talk behind my back. And for some people, there is no explanation. They haven’t a clue why they’re being victimized—unless it’s the fact that their persecutors are just unpleasant people. ■

The content of paranoid thoughts, then, varies enormously. And so too does the effect these thoughts have on us. It’s always a sliding scale. Some people believe their paranoid thoughts totally; others are only susceptible when

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they’re feeling especially stressed or anxious. Some refuse to entertain any suggestion that their paranoid thoughts might be unrealistic; other people are only too keen to ﬁnd an alternative explanation for the way they feel. In some cases, it feels as if the paranoia is always there; in others it’s a rare occurrence. Some people, particularly those with serious mental illnesses, ﬁnd their paranoid thoughts very distressing. This is especially true of scenarios in which the imagined persecutor is believed to be extremely powerful. A classic example of this is fears about the secret service or some other government agency—organizations who, should they wish to, could really cause someone a lot of trouble. On the other hand, many people aren’t at all distressed by their paranoid thoughts. If it gets out of hand, paranoia can lead to people withdrawing into themselves and consequently having big problems functioning normally. But many more of us are able to get along just ﬁne with the occasional paranoid moment. We don’t dwell on it and it doesn’t have much of an impact on our emotional state. It’s that sliding scale again. And the notion of a sliding scale is crucial to our understanding of the prevalence of paranoia. We’ve seen that there’s huge variety in the forms that paranoia takes, both in content and effect on us. It runs all the way from Alex, the graphic designer we met in Chapter 1, who occasionally thinks he’s being left out by friends but doesn’t let it bother him greatly, to someone like Jeanette, a 60-year-old woman in anguish because she is convinced her former

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husband is persuading friends, family, and doctors that she is mad. In fact, Alex and Jeanette’s experiences seem so dissimilar that it’s tempting to feel they’ve nothing meaningful in common. This is pretty much the view that dominated psychiatry and psychology until very recently. But, though there are obviously big differences—in the plausibility of the fears, the degree to which Alex and Jeanette believe them, and the effect it has on them, for example—they are more alike than ﬁrst impressions might suggest. In reality, they’re both points on what we call the spectrum of paranoia—at opposite ends of the spectrum to be sure, but related to one another in critical ways. If we want to assess where someone’s paranoia ﬁts in the spectrum, we need to look at four key factors: r How much the person believes the paranoid thoughts. r How preoccupied the person is with the thoughts. r How distressing the thoughts are. r How much the thoughts interfere with everyday life. Imagine you were to score responses to these questions from 1 (for ‘not at all’) to 10 (for ‘totally’). It’s people with scores nudging 10 for each one that are most likely to end up being seen by psychiatric services. Most of us, of course, are just your regular, everyday paranoiacs. As such, our scores are going to be way lower. But we’re still on the same spectrum of paranoid experience. How exactly the amazing

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variety of paranoid experiences are related to one another— the similarities they share, as well as their differences—we’ll explore in greater detail later in this book. ■

In 1932 researchers in Tuskegee, Alabama began to look at the effects of syphilis on sufferers and the success or otherwise of various treatments for the disease. The subjects of this research study were African American sharecroppers, most of them illiterate, all of them poor. No one troubled the sharecroppers with the facts about the research study. In fact, they weren’t even told that they had syphilis. Instead, they were informed that they had ‘bad blood’ and offered ﬁnancial incentives to participate. The study ran for forty years. By 1947 the outlook for syphilis patients had changed dramatically. What had once been an incurable fatal illness could now be successfully treated with penicillin. But the Tuskegee researchers opted not to give the sharecroppers penicillin, and actually prevented them seeking treatment elsewhere. Why? Because they wanted to see how the disease progressed. The scandal was eventually exposed in the early 1970s and the research study was closed down in 1972. In 1997 President Clinton made an ofﬁcial apology to the participants. As we saw in Chapter 1, signiﬁcant numbers of African Americans believe that Aids is a government-led plot to target black people. At ﬁrst sight that might seem a crazy

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idea, but look at it in the context of the ‘Tuskegee Study of Untreated Syphilis in the Negro Male’, not to mention centuries of discrimination, neglect, and persecution. In this light, black views on Aids appear much more understandable. This raises a thorny question. When is a suspicious thought paranoid and when is it a justiﬁable response to a real threat? Far from being paranoid, aren’t African Americans who believe the government has used Aids in a bid to wipe them out simply learning the lessons of atrocities like Tuskegee? And in a similar, if much more prosaic, way am I really being paranoid if I think the hoodied youths approaching me at night may well be about to mug me? Aren’t I just responding sensibly to a proven danger? In truth, it’s often difﬁcult to completely rule out the possibility that a paranoid thought is actually correct. And it’s precisely because it’s so difﬁcult that paranoia can thrive. Paranoia feeds on uncertainty and ambiguity. The answer is to judge the suspicious thought on the current evidence of threat—and to exclude past experiences. Easier said than done of course, but there are some guidelines we can use to help us. Essentially, the more accurate the following statements are, the more likely it is that the suspicious thought is exaggerated or unrealistic. r No one else shares the suspicion. r There’s no indisputable evidence to support the suspicion. r There is evidence against the thought.

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r It’s unlikely that the person would be singled out. r The person still has the suspicious thoughts despite reassurance from other people. r The suspicions are based on feelings and ambiguous events. ■

With all this talk of paranoia, you may be wondering how paranoid you are. Well, here’s your chance to ﬁnd out. Have a look at the sixteen statements on pp. 36–7. Use the scale from 1 (not at all) to 5 (totally) to rate how strongly you agree with each of the statements in the light of your thoughts and feelings during the last month. Once you’ve completed the questionnaire, add up your score. About 40 per cent of people will score 16 (i.e. report no paranoid thoughts). About 45 per cent will score between 17 and 31. About 15 per cent will score above 31, indicating an above-average level of paranoia. People with the sort of severe persecutory delusions that we see in clinical practice generally score between 40 and 70 on this scale. ■

One of the tricky aspects of paranoia is the fact that it often closely resembles other psychological experiences. Shyness and social anxiety, for example, make us fearful of meeting other people. They won’t like us; they’ll ﬁnd us boring or stupid or out of place.

Somewhat

Totally

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2. I have de nitely been persecuted

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3. People have intended me harm

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4. People wanted me to feel threatened, so they stared at me

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5. I was sure certain people did things in order to annoy me

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6. I was convinced there was a conspiracy against me

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7. I was sure someone wanted to hurt me

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1. Certain individuals have had it in for me

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Not at all

Not at all 9. I was preoccupied with thoughts of people trying to upset me deliberately

Somewhat

Totally

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10. I couldn’t stop thinking about people wanting to confuse me

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11. I was distressed by being persecuted

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13. The thought that people were persecuting me played on my mind

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14. It was dif cult to stop thinking about people wanting to make me feel bad

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15. People have been hostile towards me on purpose

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16. I was angry that someone wanted to hurt me

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© 2008 Reprinted with permission from Cambridge University Press

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Compare these feelings with those of Amanda, a 28-yearold librarian, who told us: I hate social events. I’m convinced no one wants to talk to me, that they’re all laughing at me and wondering why I’m there at all. Although Amanda’s anxieties could be taken for shyness or social anxiety, they’re actually much closer to paranoia— and here’s why. Shyness and social anxiety may make us think the other dinner-party guests won’t like us, but we don’t assume they deliberately want to make us feel bad. If our host forgets to offer us another glass of wine, we might conclude that she has neglected us for other more engaging friends. But we don’t think she’s letting us go thirsty on purpose. Paranoia, on the other hand, is all about believing others intend to do us down. Our glass is empty because our host wants to make our evening as uncomfortable as possible. Post-traumatic stress disorder (PTSD) can also easily be confused with paranoia. PTSD is triggered by a traumatic event—a road accident, for example, or a mugging or rape. Often, PTSD sufferers ﬁnd themselves preoccupied with the trauma long after it’s occurred. They may experience ﬂashbacks, when it seems as if the event is happening all over again. Obviously these experiences can be enormously distressing, and they can lead to sufferers steering clear of any situation that reminds them of the original trauma. The victim of a violent mugging may be reluctant to leave the house after dark. A woman who has been

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raped may avoid being alone with men she doesn’t know well. So PTSD can make us believe that other people want to hurt us—which is pretty much a deﬁnition of paranoia, isn’t it? Actually, there’s a crucial reason why PTSD is not identical to paranoia, despite the obvious similarities. And that reason is the link to the traumatic event. People with PTSD may well be frightened of other people, but it’s always as an echo of the earlier catastrophe. The roots of paranoia, on the other hand, are much more complex (as we’ll see in Chapters 4 to 6). Incidentally, while we’re on the subject of what paranoia isn’t, we need to brieﬂy revisit our discussion of conspiracy theories in the Introduction, because conspiracy theories per se aren’t paranoid, according to our deﬁnition, unless we’re worried about ourselves (or our loved ones) coming to harm. So believing the Apollo moon landing was faked isn’t paranoia. On the other hand, arguing that the ‘cover up’ is evidence of the threat posed to us all by unscrupulous and deceitful governments probably is. ■

We began this chapter with a discussion of Shakespeare’s The Winter’s Tale, a play that amply demonstrates—if demonstration were needed—the resonance of paranoia throughout history. But if paranoia is not new, its meaning has been regularly reinvented—from the effects of a high fever for the

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ancient Greeks to a manifestation of madness for the modern period. Continuing in this tradition of reinvention, we’ve attempted in this chapter to present a contemporary understanding of paranoia, one based on the most up-to-date scientiﬁc data. But understanding what paranoia is takes us only so far. In fact, it’s merely the ﬁrst step towards tackling other, bigger questions. What causes paranoia? What can we do to reduce it? And is it true that paranoia is on the increase? It’s that last question that is the focus of our next chapter.

3

‘TH EY TELL YOU LI ES’

Is Paranoia Increasing? ................................................................................

On the evening of 15 February 1996, the 147,000 tonne tanker Sea Empress ran aground on rocks at the entrance to Milford Haven harbour in south-west Wales. (The ship’s pilot, it later emerged, had been making his ﬁrst ever solo attempt at the manoeuvre.) Over the next week, 72,000 tonnes of crude oil and 360 tonnes of heavy fuel oil seeped from the wreck into the sea, contaminating 200 kilometres of the Welsh coastline, much of it part of the exceptionally beautiful and ecologically diverse Pembrokeshire Coast National Park. More than 50,000 birds were killed or injured. The devastating effects of the Sea Empress disaster weren’t conﬁned, however, to the ﬂora and fauna of the National Park. In the wake of the oil spill, local people found themselves experiencing a range of health problems, including headaches, nausea, and skin irritation. And yet when we look closely at these accounts, something curious emerges. The ﬁrst symptoms were reported as early as the ﬁrst

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day of the incident. But at that stage very little oil had escaped from the wrecked tanker. Whatever was causing these ﬁrst headaches and feelings of nausea, it wasn’t the Sea Empress. Indeed, people living on stretches of the coast that were entirely unaffected by the spill also complained of symptoms. How do we explain physical symptoms without an obvious physical cause? In the case of the Sea Empress disaster, it’s likely that they were the direct result of anxiety. It’s an established formula. Take one catastrophe, add extensive media coverage, and watch public anxiety grow. Think back, for example, to the anthrax scares that swept the US in September and October 2001. During these weeks, letters containing anthrax spores were sent to a number of senators and media organizations. Five people died and a further seventeen were also infected. (To date, the case is still unsolved.) With anxiety in the US already ratcheted to unprecedented levels by the September 11 attacks, hundreds of people soon began reporting that they too had been the victims of anthrax poisoning, with many complaining of symptoms. In one case, a teacher and student reported minor chemical burns after opening a letter containing some type of powder. Subsequent analysis revealed that the envelope contained no such powder. All in all, there were more than 2,300 such false alarms. The responses to the Sea Empress oil spill and the 2001 anthrax scares point up something fascinating about the way our minds work—or, as psychologists put it, the way we

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reason. Put simply, the more often we hear about something, and the more emotive that event is, the greater its impact on us. We’re susceptible, suggestible creatures, easily moved by the appearance of things, and much less inﬂuenced by the way things actually are. And this has a direct bearing on the question we ask in the title of this chapter: is paranoia increasing? Because, although we don’t—and now won’t—have the sort of historical data that would allow us to produce a conclusive answer, there are grounds for believing that paranoia is indeed on the rise. And one of these is related to precisely the kind of reasoning that the Sea Empress disaster, and the anthrax scares, so compellingly illustrate. ■

Paranoia, as we’ve seen, is the exaggerated or unrealistic belief that other people want to harm us. Or to put it another way, it’s what happens when we’re bad at judging risk. From the comfort of our armchairs, assessing risk can seem a straightforward business. All we need to do is calmly and logically assess the available evidence, right? Regrettably, however, human beings do not usually think logically. Pioneering research by the cognitive psychologists Daniel Kahneman, Paul Slovic, and Amos Tversky has shown that, instead of logic, we use all kinds of short cuts, hunches, and rough-and-ready rules of thumb to make sense of the world. These reasoning heuristics can be helpful, saving us time and effort and speeding along the decision-making process. But

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they aren’t always great at helping us get an objective view of events. The availability heuristic, for example, means that our view of something—and especially our sense of its prevalence or likelihood—is hugely inﬂuenced by how easily we can remember or imagine it. Suppose, for example, we were to read out to you the names of ﬁfty men and women, some of them regulars in the celebrity gossip magazines, the remainder chosen at random from our local newspaper. If we were then to ask you whether the list contained more men or women, the chances are you’d make your judgement not on how many obviously male or female names you’d heard, but rather on the number of famous (or notorious) names you were already familiar with. So if you recognized the names of seventeen women and only four men, say, you’d probably guess that the list contained more women’s names—even if it didn’t. In other words, your assessment would be skewed. We pick up on stuff we’re familiar with; the rest just drifts by. This is especially true when the event in question has signiﬁcant emotional resonance for us. For example, people habitually rate air travel as more dangerous than making a trip by car, though the opposite is true. One of the reasons for this misjudgement is that the idea of a plane crash is entrenched in our culture as the spectacular epitome of tragedy. The emotional impact, or stickiness to use a term coined by Malcolm Gladwell, is so great that mere facts make little impression.

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Our fondness for the dramatic can be seen in a study that asked people to estimate the relative prevalence of various causes of death. Homicides, for instance, were rated— incorrectly—as more common than deaths by stomach cancer and diabetes. What about the comparative frequency of homicides and fatal strokes? The participants in the study rated them equal. But in fact strokes claim around eleven times the number of lives as homicides. Deaths by tuberculosis, asthma, and emphysema? All underestimated. Deaths caused by ﬂoods, tornados, botulism, insect bites and stings were all overestimated. So when it comes to judging risk, we’re up against it. We seem to have an in-built bias towards noticing things that we’re already familiar with, and which are emotionally ‘sticky’. Everything else we’re inclined to discount. And there’s another problem. We’re hopeless at using statistical information. In one research study, people were asked to rate the relative dangers of a disease that kills 1,286 people out of every 10,000 and one that kills 24.14 out of 100. They tended to say the ﬁrst was more of a threat, when in fact the ﬁgures show the second as twice as dangerous. Part of this is doubtless explained by the fact that lots of us are not great at arithmetic. But, on a basic emotional level, the size of the numbers involved also probably makes a difference. Because a disease that kills 1,286 people seems patently more dangerous than one that kills 24. (The context for these ﬁgures is what really matters, but our brains seem to focus on headlines rather than contexts.)

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Let’s explore this in more detail by looking at two sets of data from the year 2001. First, we have the 9/11 attacks, a catastrophic event that is burned into the memory of us all. Ask anyone on the street how many people died that day and chances are they’ll answer correctly: around 3,000, in the deadliest act of terrorism on US soil. We don’t know how many of those guys on the street would know the ﬁgures for road trafﬁc fatalities, but not many is surely an understatement. It’s difﬁcult to get a sense of the trafﬁc accident numbers because typically we only hear about one incident at a time. In fact, in 2001 almost 38,000 people died on US roads, with a further two million injured. Which means that even in the worst ever year for US mainland terrorism, trafﬁc accidents killed twelve times the number of Americans. And yet what scares us most: getting in our car or sitting next to a young Asian man reading the Koran on a plane? Clearly the relative impact on us of 9/11 and road trafﬁc accidents isn’t simply a function of the way the numbers are presented, but it’s a factor nonetheless. What, for instance, if we rephrased the statistical information? What if we told you that the 9/11 attacks killed 0.0001 per cent of the US population? What if trafﬁc accidents weren’t reported as isolated incidents, but instead we were reminded of the (rapidly rising) total fatalities ﬁgure for the year? Or if you knew that a crash occurred every ﬁve seconds, that someone was injured every eleven seconds, and someone killed every eleven minutes? Restating the facts in these ways doesn’t diminish the horror of 9/11, but it might make us think

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differently about the relative dangers of terrorism and road travel. ■

The way we think about the world, then, is hugely inﬂuenced by the number of times we hear about an event and by the magnitude of its emotional impact on us. Objective facts cut much less ice. This means we’re vulnerable to all kinds of irrational, unjustiﬁed fears—to paranoia, in other words. And if you’re inclined to doubt it, think back to how you felt about swimming in the sea after having seen Jaws for the ﬁrst time! For most of us, what we know about the wider world comes largely from the newspapers, TV, and— increasingly—the Internet. And the media can have a peculiarly forceful effect on us, especially when it comes to descriptions of traumatic events. The mass panics caused by the reporting of the Sea Empress disaster or the anthrax attacks are potent examples. Several research studies have looked at the inﬂuence of television viewing on people’s responses to 9/11. One survey of 2,000 New Yorkers four months after the attacks found that the more TV coverage people had watched the greater the chances of them having symptoms of PTSD. Another study showed that PTSD was particularly likely if viewers had seen the immensely distressing footage of people falling or jumping from the World Trade Center. Now if the media play such a big role in inﬂuencing the way we think, we’d better hope that their coverage is calm,

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objective, and accurate—because, as we’ve seen, our own reasoning is often just the opposite. Unfortunately, the view of the world we’re presented with by the media is often a distorted one. Part of the problem is encapsulated in the newsroom cliché ‘if it bleeds, it leads’. Much of the media prefers one-off episodes of conﬂict, death, and disaster, preferably involving clearly identiﬁable victims and culprits—or at least items that can be made to ﬁt this template. Complicated, on-going stories are seen as much less newsworthy. So a murder or terrorist scare is a lead item; several thousand people dying each day from starvation rarely merits a mention. After all, something that happens all the time lacks the element of novelty that the news, by deﬁnition, demands. If its underlying causes are uncomfortably complex and systemic, the chances of the item making the evening news are even slighter. September 11, the anthrax scare, and the Sea Empress disaster all play to the media’s liking for dramatic stories of death and destruction. (No doubt the media would argue that it’s the public’s preference too.) Which is ﬁne: these were major events that fully merited extensive coverage. But the media’s sense of what is newsworthy can sometimes mean that certain stories are over-reported. Dangers are exaggerated; threats magniﬁed. Fatal air crashes, for example, always make the headlines. In fact, an analysis of coverage in the New York Times showed that stories about airline accidents far exceeded stories about deaths from Aids, cancer, homicides, suicide,

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or car crashes—all of which kill many more Americans each year. Which no doubt helps explain why fear of ﬂying is so widespread. What are the biggest causes of death in the UK? In 2005 it was cancer (140,000 people) and heart disease (120,000). But if you made a guess solely on the basis of what you’d read in the papers, you might opt for murder and terrorism. In reality, 2005 saw 300 murders and 50 terrorism-related deaths (the latter is an unusually high ﬁgure that includes the London attacks of 7 July). In the last three months of 2005, the mass-market tabloid the Sun mentioned murder 899 times and terrorism 390 times. Cancer got 517 references and heart disease a relatively paltry 166. So although cancer kills more than 450 times the number of people who are murder victims, murder gets almost twice the amount of coverage. Your chances of dying of heart disease are approximately 2,400 times greater than your chances of being killed in a terrorist attack. But you’re more than twice as likely to read about terrorism in your morning paper as you are to see coverage of heart attacks. This bias isn’t conﬁned to the tabloids. In fact, it seems even more pronounced in the ‘quality’ broadsheets. Analysis of The Times during the period October–December 2005 shows 923 mentions of murder and 840 references to terrorism. The ﬁgures for cancer and heart disease are 624 and 280 respectively. The media loves stories about bad guys, and clearly we media consumers ﬁnd them fascinating too. But for many of

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Terrorist

Paedophile

Criminals

Mugger

Asylumseeker

us these kinds of stories can help build a paranoid view of the world, in which the prospect of grisly death at the hands of a murderer or terrorist is out of all proportion to the reality of the risk. As we saw in Chapter 2, every age has its bogeymen. And we can see the emergence of our own bêtes noirs in the papers over the past ten years. The table below gives the number of references to these hate ﬁgures in the tabloid Daily Mirror and the broadsheet The Times.

1995 (Oct–Dec)

Mirror

98

10

282

24

12

Times

157

15

515

6

49

2000 (Oct–Dec)

Mirror

158

84

526

20

41

Times

190

56

626

12

76

2005 (Oct–Dec)

Mirror

296

64

631

27

49

Times

583

48

843

21

89

2006 (Oct–Dec)

Mirror

208

132

844

25

26

Times

443

73

837

14

52

The trend is almost always upwards. In the last quarter of 2006, for example, the number of references to terrorists in

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The Times was almost three times the ﬁgure for the same months of 1995. (The ﬁgure for 2005 is even higher, though this is isn’t surprising given that 2005 was the year of the London bombings.) The events of 9/11 and the so-called ‘war on terror’ are clearly part of the explanation for this rise, although it’s interesting to note that the number of references is already up in 2000. And remember that the UK wasn’t blissfully insulated from the threat of terrorism in 1995. Although the situation in Northern Ireland was improving, the IRA was still considered a serious threat. ( Just how serious was amply demonstrated just a few months later when the IRA detonated a huge bomb in Manchester, injuring 200 people and devastating the city centre.) And look at the rise in references to criminals. These have shot up, even though for much of this period the crime rate has fallen. It seems that, whatever complex reasons lie behind the upward curve of these data, there isn’t always a simple correlation with the objective reality of the number of incidents or the level of threat. Over-reporting of dangers fosters a culture of paranoia. After all, it’s hard to stay cool when everyone else is panicking. The way we reason makes us particularly susceptible to the power of the media. The more something is repeated, and the more graphic and emotional it is, the greater the impression it makes upon us—and of course repetition and graphic emotion are the media’s stock in trade. It’s not possible to say whether the media is now exaggerating dangers more than ever before, though anecdotal

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evidence suggests it may be. But what we do know is that the reach of the media is greater than ever before, with a proliferation of television channels and radio stations and, most signiﬁcantly, the extraordinary inﬂuence of the Internet. And if the reach of the media is greater, so too is its capacity to feed and inspire paranoia. But our belief that paranoia is increasing isn’t based solely on our understanding of the way human beings think and the inﬂuence of the media. A number of social factors are also involved, and it’s these factors that we now turn to. ■

We’re living through a momentous shift in the development of the human race. For the ﬁrst time in our 200,000 year history, half of humanity now lives in urban areas. There are now more than ninety cities with populations in excess of 3 million and nineteen so-called ‘megacities’ with more than 10 million residents. Two thousand years ago, when the world population was around 200 million, there were only forty cities with more than 50,000 inhabitants. The overwhelming majority of the population lived on the land. Although industrialization, imperialism, and other changes began a slow migration to cities in the eighteenth century, in 1800 only 5 per cent of the world’s population lived in urban areas. By 2030 that ﬁgure is likely to rise to something like 65 per cent. The vast majority of the current growth in the urban population—around 90 per cent—will take place in less

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developed countries, which is urbanizing as rapidly today as were the US and other more developed countries during the ﬁrst half of the twentieth century. In 2000 there were around 2 billion people living in urban areas in less developed countries. By 2025 that number is predicted to rocket to more than 3.5 billion. This enormous growth in the urban population is going to result in more and larger megacities. Lagos, for instance, is likely to almost double in size, from a population of 13 million in 2000 to 23 million in 2015. Dhaka will bloat from 12 million in 2000 to 21 million in 2015. As the epidemiologist Tony McMichael has commented: ‘This ongoing move from countryside to city is as momentous a change in human ecology as was the ancient move from hunter-gatherer itineracy to agrarian settlement.’ Predictably, a shift of this magnitude has the potential to create both enormous beneﬁts and huge problems. On the plus side, moving to a city can provide people with a lifechanging range of opportunities: for example, for better employment, education, and healthcare. Life in a shanty town on the fringes of a megacity, on the other hand, is unlikely to offer any of these advantages. For many people in less developed countries, greater urbanization is likely to bring only poverty and disease. One interesting consequence of this increase in urbanization may be an increase in paranoia. We’ve known for many years that rates of mental illness are much higher in cities than in rural areas and recent research bears this out. For example, a 2004 survey of all Swedes between the

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ages of 25 and 64 (4.4 million people) revealed that people living in the most densely populated parts of the country had almost twice the rate of psychosis of those in the least populated areas. Similarly, a study of 1.75 million people in Denmark showed that those born in Copenhagen, the capital city, were more than twice as likely to suffer from psychosis as people born in rural areas. And when researchers have looked at less severe psychotic-like experiences, the ﬁndings are remarkably similar. A study of 7,000 people in the Netherlands, for example, found that people in the most urbanized areas were twice as likely to report occasional, mild hallucinations and delusions as people in the least populous parts of the country. If we’re more likely to suffer mental illness in cities, it seems inevitable that the current rapid growth in urbanization will bring with it an increase in rates of mental illness. Some of that increase will be at the severe end of the mental illness spectrum (psychosis), but most of it will be in the form of relatively mild problems. Paranoia, of course, features prominently right across the spectrum. So whichever way you look at it—whether you focus on psychosis or on everyday mental health issues—an increasingly urbanized population is likely to be an increasingly paranoid one. ■

Cities are places where millions of people are lonesome together, wrote the nineteenth-century philosopher Henry David Thoreau. Loneliness and isolation aren’t the exclusive

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preserve of urban locations, of course. But social bonds are often much looser and more ﬂuid in cities than in smaller, rural communities. Living in a village gives us a ready-made, relatively stable social network. City-dwellers have to build that network themselves—a much harder task. It’s ironic but, as population density increases, the cohesion of that population seems to decline. Now social isolation isn’t just an unfortunate drawback to urban life. It’s also closely associated with mental illness—in fact, it’s almost certainly one of the reasons rates of mental illness are higher in cities than they are in rural areas. As early as 1939, in their ground-breaking study of mental illness in Chicago, Mental Disorders in Urban Areas, the sociologists Robert Faris and H. Warren Dunham noted that schizophrenia was particularly common in the ‘roominghouse’ districts of the city—that’s to say buildings where residents have a single room and share the kitchen, bathroom, and other communal areas. ‘Anonymity and isolation’, they wrote, ‘characterise the social relations in this area; no one knows his neighbours and no one cares what they might think or say.’ Recent research seems to back up this association between isolation and mental illness. The study of 7,000 people in the Netherlands we mentioned above found that people who lived alone were twice as likely to report relatively low-level psychotic-like experiences. A US survey revealed that psychosis was much more prevalent in single, divorced, or separated people. And in an Australian study

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of 1,000 older adults, people living alone and having less contact with friends and family were more likely to suffer from paranoia. Simple explanations for psychological experiences are often inconveniently elusive, and it’s no different here. We don’t know for sure whether social isolation causes mental illness. In some cases, isolation may be a consequence of psychological problems. And, as Tony McMichael has noted: ‘there is some evidence of a tendency for restless, agitated and psychotic people to move from rural districts to city centres, where anonymity may fulﬁl a desire for social isolation.’ But if there is a causal link, as many researchers have suggested, it’s one more challenge posed by galloping urbanization. Think of the thousands of rural communities in the developing world that are disintegrating as their populations migrate to the cities. And in the already heavily urbanized developed world, think of the increase in the number of people living alone. In Great Britain, for example, there were 7 million people living alone in 2004—nearly four times as many as in 1961—with the rates highest in London (by far the largest city in the country). This amounts to almost a third of the total number of households. Greater levels of mental illness—including greater levels of paranoia—seem likely to follow as a result. ■

Urbanization and isolation aren’t, however, the only social factors that may be contributing to an increase in paranoia. We might add to these an increasingly ﬂexible employment

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market, in which the idea of a job for life has long gone, replaced by much greater mobility of employees, and more reliance on short-term contracts and part-time positions on the part of employers. All of which breeds uncertainty, stress, and fuels competition in the workplace, encouraging us to see our colleagues as rivals and potential threats. And migration also seems to play a signiﬁcant role in the development of paranoia. A recent research study looked at rates of serious mental illness in three parts of the UK: south-east London, Nottingham, and Bristol. The results were striking. In all three locations, schizophrenia was nine times as common in African-Caribbean people, and six times as prevalent in black Africans, as in the white British population. (Paranoia is, of course, a frequent feature of schizophrenia.) Now these ﬁgures are way in excess of rates of mental illness in the Caribbean or in Africa. Being black, in other words, doesn’t increase your chances of developing schizophrenia. But being an immigrant does. The UK study is just one of many to ﬁnd a link between migration and mental illness. As far back as 1932, researchers found that rates of schizophrenia in the Norwegian-born population of Minnesota were twice those of Minnesotans born in the US. High rates of psychosis have been found in Surinamese and Dutch Antillean immigrants to the Netherlands. And the story is the same at the more everyday end of the mental illness spectrum. A study of over 11,000 Australians, for example, found that immigrants from non-English-speaking countries had higher levels of

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mild to moderate psychological problems than native Australians. Rates of migration have been steadily increasing over recent years. According to United Nations ﬁgures, the number of international migrants around the world has risen 200 per cent over the last twenty years, from 100 to 200 million people each year. (Considerable though this ﬁgure is, in the light of current frenzied debate about migration it’s worth remembering that it amounts to only around 3 per cent of the global population.) In 2001, 4.9 million people in the UK were born overseas (8.3 per cent of the population)—more than double the 2.1 million in 1951. The decade from 1991 to 2001 saw the biggest leap in immigration to the UK—1.1 million—since before the Second World War. The UN Global Commission on International Migration notes that: Migrants are often viewed with suspicion by other members of society . . . In parts of the world, certain politicians and media outlets have found it easy to mobilize support by means of populist and xenophobic campaigns that project systematically negative images of migrants. . . . ﬁrst-generation migrants suffer disproportionately from physical, mental and reproductive health problems. . . . they have lower educational attainments than nationals and generally live in poorer quality accommodation. Migrants also tend to occupy low-wage and low-status jobs and are more likely to suffer from longterm unemployment than other members of society.

Given these challenges, it’s unsurprising that migration makes people more susceptible to paranoia and other

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psychological problems. Add to them the upheaval of being uprooted from their homeland, having to cope with a strange new culture, and quite possibly learning a new language, and we can see how migrants might well feel at odds with their new surroundings and threatened by the people around them. The growing waves of migration, then, are likely to bring in their wake an ever-increasing swell of paranoia. ■

Understanding the causes of psychological problems is generally a tricky business. As we saw when we looked at the relationship between isolation and mental illness, it’s often difﬁcult to know for sure that factor X is responsible for psychological problem Y. On the other hand, there are occasions when the evidence is overwhelming—and one of those occasions is the link between mental illness and traumatic life events. Research study after research study has shown that people who experience trauma (for example, a serious illness, accident, or assault, or the death of a loved one) are at greater risk of mental illness, including paranoia. The same is true for people who’ve been victimized (for example, suffering discrimination, bullying, or physical and/or sexual abuse). A British survey of 8,000 people, for instance, found that people with a history of victimization were twice as likely to suffer from paranoia. In a 2002 study of patients admitted for the ﬁrst time to a New York hospital with psychosis, more

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‘ T H EY T E L L YO U L I E S ’

than two-thirds of the patients reported suffering some kind of trauma in their lives. Almost half of them had had to deal with a life-threatening situation, and a third had been victimized as a child (suffering rape, sexual or physical abuse, or neglect). Fourteen per cent said that they had PTSD. In one particularly compelling piece of research, 2,500 people aged between 14 and 24 in Germany were asked to describe any traumatic experiences they’d undergone in their lives. Follow-up interviews were carried out around three years later, from which it emerged that the young people who’d originally reported serious trauma were almost twice as likely to have gone on to develop psychosis as those who hadn’t experienced any trauma. Several studies have shown that the greater the number of traumatic experiences you’ve had, the more likely it is that you’ll develop psychological problems. All of which probably doesn’t come as a huge surprise to you. Being raped or bullied or violently mugged are not experiences one can take in one’s stride. And they aren’t likely to do much for our faith in other people either. After having suffered these kinds of traumas, paranoia can seem less a delusion than a reasonable viewpoint on the world. So if trauma and victimization can lead to paranoia, are they—and hence paranoia—on the rise? For many of these experiences, the detailed historical data don’t exist. For example, it seems reasonable to suppose that, as migration increases, so too will experiences of discrimination, but we don’t have the evidence to know for sure.

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61

The ground is much ﬁrmer though when we look at crime ﬁgures. Being the victim of a crime—even a relatively trivial, non-violent crime—is often an enormously traumatic event for individuals. In 2005–6 around a quarter of the adult population of England and Wales—approximately 10 million people—were victims of crime. That’s a vast number, of course, but it’s a big improvement on the ﬁgures for 1995, when almost 40 per cent of people were victims. The story is similar in the US where, in the period from 1996 to 2005, the number of violent crimes fell by 26.3 per cent and crimes against property decreased by 22.9 per cent. Now, although crime has fallen over the last decade or so, this is small beer when compared to the dramatic increase in offences since the 1950s. In England and Wales in the mid1950s, for instance, there were around 5 crimes per thousand of the population; in 1997 that number was 89.1. (And these ﬁgures only include reported crimes; it’s reckoned that more than half of offences go unreported.) In 1955 there were 6.3 homicides in England and Wales per million of the population; in 1997 that number had more than doubled to 14.1 per million. In the US there were 5.1 homicides per 100,000 people in 1960; that ﬁgure reached 8.6 per 100,000 in 1973, peaking at 9.8 in 1979 and 1991. In 1996 it was back down to 5.7 per 100,000 people (though this was a rise of 0.1 per cent on the previous year). Violent crime rose from 160.9 incidents per 100,000 people in 1960 to 758.1 in 1991. By 1995 it had

62

‘ T H EY T E L L YO U L I E S ’

subsided to 469.2, its lowest ﬁgure since 1973 (again, 2006 saw a small rise). Interestingly, whether the ﬁgures are rising or, as in recent years, actually falling doesn’t seem to make much difference to our perception of crime rates. Most people, whether in the UK or the US, say that crime is increasing. When US crime rates dropped sharply in the 1990s, for instance, the public perception of the problem remained stubbornly unmoved by the good news. For example, for the past eighteen years researchers have asked a sample of the American public whether they feel there is more crime in the US than a year ago. In all but two of those eighteen years, more than half of people questioned said that there was. So a dramatic rise in crime over the past half century has not just made millions of us victims of traumatic events. It seems also to have seeped into our consciousness, making us feel increasingly threatened and vulnerable. And, it almost goes without saying, stoking our sense of paranoia. ■

Urbanization, isolation, migration, and victimization— experiencing just one of these is likely to increase our chances of becoming paranoid. But many people have to cope with several of them—or even all of them. And this puts them at even greater risk of psychological problems. Migrants, for example, typically live in cities. Indeed, government ﬁgures for 2001 show that 45 per cent of the nonwhite UK population live in London alone. Migrants may

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63

well feel isolated from their native communities and social networks. When it comes to their economic and social welfare, they can certainly seem cut adrift from the mainstream of British society. Black children, for example, consistently fare worse at school than white students. People from nonwhite ethnic minorities are generally three times more likely to be unemployed. This marginalization creates stresses that we know increase the risk of mental illness. ■

We overheard the following conversation not during an extensive research study of paranoia, but while popping down to the local post ofﬁce to mail a parcel:  Those clocks don’t agree. Look: that one says 11.48 and the other one says 11.50.  They’re trying to confuse us.  Yeah. That’s typical of the government.  They tell you lies. When the documents are released ﬁfty years later you ﬁnd out they lied.  And now they’re trying to stop us living so long and discovering the truth by making us eat genetically modiﬁed food.

In this chapter we’ve identiﬁed two important factors behind a possible rise in paranoia. The ﬁrst of those factors is the interaction between the way we reason, and particularly the haphazard and generally unreliable fashion in which we assess risk, and an increasingly powerful media. The second is a number of social trends, such as urbanization, isolation, migration, and victimization. But there’s one more

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inﬂuence we’d like to highlight here, and that’s our growing awareness of conspiracies and cover-ups. The idea that genetically modiﬁed food represents a deliberate attempt to poison the population is, it has to be admitted, a rather eccentric one. But the notion that governments lie has become almost a commonplace. After all, who doesn’t believe that our leaders are, from time to time at least, economical with the truth? Of course it’s not just politicians. All sorts of once unimpeachable authority ﬁgures—doctors, teachers, judges, police, even royalty—are now regularly shown to have feet of clay. Hardly a week seems to go by without some doctor being struck off, or the police having to defend themselves against charges of incompetence or negligence (or worse). And we can all bring to mind without much effort a very long list of scandals and controversies, from Tuskegee to Watergate, Enron to the Iraq dossier, Thalidomide, IranContra, Olympic drug cheats, cash for honours . . . and so on and so on. Thanks to the media, which loves this kind of story, and the rise of the Internet, which gives unprecedented opportunities for information (both genuine and fanciful) to circulate, we’re all increasingly aware—and suspicious of— cock-ups, conspiracies, and cover-ups. Now in many respects this is a welcome development. Gone is the unthinking deference of former days—and out into the open come a

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whole host of murky dealings we’d previously have known nothing about. But there’s a less positive aspect to this change. Because, for many people, healthy scepticism has been supplanted by a total breakdown of trust. We expect our leaders to hide things from us. We expect those in authority to care only about their own interests. And these kinds of feelings lead naturally to paranoia; or, as the debate in the post ofﬁce so neatly put it, the belief that everyone lies.

4

ANXI ET Y, AVATARS, AN D I N K SPOTS

Paranoia and Emotions ................................................................................ What causes paranoia? That’s a tough question to answer, and for at least a couple of reasons. For one thing, there’s no simple explanation. Paranoia, like so many psychological experiences, is the result of a complex interaction of numerous factors—as we’ll see over the course of the next three chapters. But there’s a bigger, more fundamental problem. How can we accurately and scientiﬁcally observe paranoid thinking? Paranoid thoughts don’t pop into our heads out of the blue. They’re generally our attempt to make sense of something we’ve experienced—perhaps a colleague ignored us at lunch or someone looked at us oddly on the bus. We can ask people about their paranoid thoughts, but how do we get at the truth of the situation? How do we even know for sure whether their thoughts are genuinely paranoid? Perhaps the colleague ignored us because our existing paranoia makes us

PA R A NO IA A N D EMOT IO N S

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reluctant to socialize. Or perhaps our fears are a legitimate response to a threatening situation. Maybe the guy on the bus really was looking for trouble. Any rigorous, scientiﬁc study of paranoia would need to expose a statistically signiﬁcant number of people to exactly the same experience to see which of them reacted in a paranoid way. Once you had these data, you could start probing to see whether there was anything distinctive about the paranoid group. But how on earth can we arrange for hundreds of people to experience exactly the same everyday event in laboratory conditions? It’s impossible, right? Actually, there is a way, and it’s one we used in a groundbreaking recent experiment. That way is virtual reality. ■

In the summer of 2006, we sent a leaﬂet to all households local to King’s College London. The leaﬂet announced a study of virtual reality at the college and invited people to participate. In the end we recruited 100 men and 100 women of varying ages from 18 to 77, and from very diverse socioeconomic backgrounds. The mix, in fact, was pretty representative of the UK as a whole. We didn’t tell the volunteers that we were researching into paranoia until we’d completed the experiment. The test involved participants wearing virtual reality headsets that simulated a four-minute ride on a London underground train. The sounds of a typical tube journey—

68

A N X I ET Y, AVATA R S , A N D I N K S P OT S

PA R A NO IA A N D EMOT IO N S

69

the rumble of the train, passengers’ conversations—were played to the participants through headphones. Just like a normal journey on the underground, the train carriage was crowded, though this time the other passengers were computer-generated characters (or avatars). These avatars were programmed to be absolutely neutral—neither friendly nor threatening. Some of the avatars would glance at the participant, though only after the participant had been looking at them for a while. One avatar would smile if the participant gazed at them. The tests, which we devised with the help of Mel Slater and Angus Antley, two clever and exceedingly patient computer scientists at University College London, began in September 2006—fourteen months after the terrorist attacks on the underground. After their ‘journey’, the participants were interviewed and were also asked to ﬁll in questionnaires about their experience. One of the curious things about virtual reality is that, although the experience is clearly artiﬁcial—how could it not be when you’re wearing a headset and headphones?— our mind and body behave as if it were absolutely real. For example, virtual reality has been used to help people with anxiety disorders such as fear of heights. The idea is that if you expose people to the situation that scares them, you can show them that the disaster they fear— falling to their deaths, for example—won’t actually occur, and thus help them to overcome their phobia. (This therapy is called desensitization.) And exposing people to virtual reality heights is just as successful as exposing them to real

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A N X I ET Y, AVATA R S , A N D I N K S P OT S

heights. So we can be sure that the reactions of our virtual reality tube travellers are what they would be in a real-world situation. Most of the participants thought the other ‘passengers’ behaved in the neutral fashion they had been programmed to adopt:

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r They just seemed normal. r I thought they were like people on the tube—some smile at you, some ignore you. r I didn’t really think they’d noticed me. r It felt like a normal tube journey—people just trying to get where they want to go. r I thought everyone kept themselves to themselves. r They were all getting on with their own business. Nobody seemed to notice me. Some participants had very positive comments: r It was nice—much nicer than a real experience. I thought they were pretty friendly. r The man in the pink jumper might have chatted me up. r There were people smiling at you, which was nice. r People were generally very friendly. r One guy was checking me out—very ﬂattering. Other participants, however, found the experience much less enjoyable: r One guy was spooking me out. I tried to get away from him. Didn’t like his face. I’m sure he looked at me more than a couple of times, though I might be imagining it. r A girl kept moving her hand. Looked like she was a pickpocket. r There was a guy who tried to stare me out. But I didn’t give him any ammunition.

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r There’s something dodgy about that guy. Like he was about to do something—assault someone, plant a bomb, say something not nice to me, be aggressive. r I thought a couple of the men were stuck up and nasty. A lady sitting down laughed at me when I walked past. r I felt trapped between two men in the doorway. As a woman, I’m a lot more suspicious of men. The guy opposite may have had sexual intent. How do we account for the fact the participants responded in such radically diverse ways? In particular, how do we explain why 45 per cent of the volunteers had at least one paranoid thought? Well, we know it has nothing to do with the virtual reality train ride. After all, everyone had the same experience: it’s the interpretations of that experience that differ. And we know—as we can almost never know with real-life situations—that the 45 per cent of people who felt threatened on the train were reacting in a genuinely paranoid fashion. The avatars, remember, were programmed to be strictly neutral in their behaviour. So the external, albeit virtual, environment isn’t going to give us the answers we’re looking for. We need to look a little deeper. We need, in fact, to look at the personalities and psychological make-up of the participants. Before the participants got to take their ‘train ride’, we put them through ninety minutes of psychological questionnaires and tests. And when we correlated the results of

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these assessments with the reactions of the participants to the experiment, some very intriguing results emerged. What we found was that the people who responded in a paranoid way had three distinct emotional characteristics: r A greater tendency to worry. r Higher levels of anxiety. r Negative feelings about themselves and other people. In other words, we don’t have paranoid thoughts because of the events we experience. We have them because the way we feel about ourselves, other people, and the world around us causes us to view those events in a paranoid way. In the next few pages we’ll look at each of these emotional factors in detail. But before we move on, let’s take a moment to consider the astonishing fact that 45 per cent of participants had at least one paranoid thought. What this suggests is that, contrary to decades of scientiﬁc consensus, paranoia isn’t conﬁned to people with severe mental illness. Indeed, we deliberately excluded from our study anyone with these kinds of problems (schizophrenia, for instance). It’s the clearest demonstration yet of the remarkably high levels of paranoia in the general population. ■

The fact that people who worry a lot are more likely to have paranoid thoughts has been shown by a number of recent research studies. After all, if you’re a worrier,

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you may well fret about what other people think of you. Around two-thirds of the people with persecutory delusions we see in our clinic are prone to above-average levels of worry (and not just about the situations that spark their paranoia). Not only that, but the people who worry most also seem to be the most distressed by their paranoid thoughts. When we worry, we tend to focus on the negative, and we can spend a lot of time agonizing about things that probably won’t happen. We become very skilled (and imaginative) at the sort of ‘what if ?’ thinking that always foresees the worst possible outcome for any situation. Psychologists call this ‘what if ?’ thinking catastrophizing. No incident is too trivial for a practised worrier to catastrophize into a death sentence. Witness Woody Allen, the poet laureate of worry, in a scene from his 1986 movie Hannah and her Sisters. Mickey Sachs, played by Allen, is a TV producer who has recently visited his doctor complaining of minor hearing loss in one ear:  I can’t keep my mind on the show.  [his assistant] But there’s nothing wrong with you.  If there’s nothing wrong with me, then why does he want me to come back for tests?!  Well, he has to rule out certain things.  Like what?! What?  I don’t know. Cancer, I——  Don’t say that! I don’t want to hear that word! Don’t mention that while I’m in the building!  But you don’t have any symptoms!  You—I got the classic symptoms of a brain tumour!

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 Two months ago you thought you had a malignant melanoma.  Naturally, I, I——Do you know I——The sudden appearance of a black spot on my back!  It was on your shirt!  I——How was I to know?!

We analysed patterns of worry in thirty people with severe paranoid delusions. What we found was that the more they catastrophized, the worse was their paranoia. The danger they thought they were in was more serious and, in their view, more likely to happen. In addition, the more they worried, the greater the chance that their paranoid thoughts would still be bothering them three months later. These examples, of course, are drawn from the most extreme end of the paranoid spectrum. But our virtual reality study shows a clear link between worry and even the most everyday forms of paranoia. And this is a good illustration of the usefulness of the concept of a spectrum. Because, for all their obvious differences, mild suspicious thoughts and serious persecutory delusions aren’t entirely unrelated phenomena. Quite the opposite, in fact. When we look closely, we see that they are actually manifestations of the same psychological experience. ■

A few years back, researchers examined data that had been gathered from 5,000 people as part of a UK national population survey. All 5,000 had been born in the same week in 1946.

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It emerged from looking at records kept by teachers that the most anxious children at age 15 were the ones who were at greatest risk of subsequently developing schizophrenia. And when the children had rated themselves at age 13, it was those with the highest levels of social anxiety who were most likely to later develop the illness. This is just one of several studies to ﬁnd an association between high levels of anxiety and mental illness. When it comes to paranoia, perhaps the link isn’t surprising. Because paranoia is, in some respects at least, a type of anxiety. Let’s unpick this a little. Anxiety is all about the anticipation of threat. It’s our early warning system, letting us know that we’re in danger. So when our neighbour’s crazy pit bull terrier comes tearing towards us with slaughter in its eyes, our anxiety is going to ensure we take rapid—extremely rapid—evasive action. But although anxiety can be a life-saver, it’s sometimes unreliable. We can become anxious in situations where we’re not actually in danger. Fleeing from a lunatic pit bull is sensible; fretting every time we see a poodle in the street isn’t. Our poodle anxiety stems from awareness of a real danger (being mauled by a murderous dog), but it’s become somehow exaggerated and irrational, way out of proportion to the reality of the danger. And anxiety tends to feed on itself. The more anxious we are, the more on edge we feel, even in the most innocuous of situations. It’s the same with paranoia. Sometimes it’s right to be anxious about other people. After all, if a guy comes towards

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us carrying a knife, we need to be sufﬁciently alert to get ourselves out of danger. But when legitimate anxiety about other people turns into unjustiﬁed fear, when we get jumpy about any young men we see on the street—well, that’s the very deﬁnition of paranoia. When anxiety gets out of control it can make us act in some pretty unusual ways. For example, people frequently develop routines—called safety behaviours by psychologists— designed to minimize the chances of them coming to harm. The most common type of safety behaviour is avoidance. So someone worried about being attacked might avoid leaving the house after dark. But safety behaviours can take other forms too. We might try to placate the people we think are out to get us (this is called appeasement), or we might try to protect ourselves by keeping constantly on our guard. Safety behaviours are a typical feature of paranoia. Indeed, when we recently looked at this issue in 100 patients with persecutory delusions, we found that 96 of them had used safety behaviours in the past month. Of course it’s perfectly natural to try to avoid danger. But what we’re actually doing with safety behaviours is depriving ourselves of the opportunity to discover whether our fears are justiﬁed or not. In our virtual reality study (which you’ll remember took place just a year or so after the terrorist attacks on the tube), people who used the underground least were more likely

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to have paranoid thoughts. And that’s doubtless because, merely by travelling by tube, any anxieties we may have about it are put to the test. Not only that, but we discover that these anxieties are unfounded. On the other hand, if we don’t test our fears, it’s easy to believe that the reason we’ve not been mugged is that we never go out at night, not that the risk of getting mugged is actually slight. Or to conclude that the reason we’ve not been blown up or harassed on the tube is that we always take the bus. Safety behaviours, then, aren’t helping us. In fact, all they do is legitimize and intensify our fears. ■

I am unloved. I am worthless. I am weak. I am vulnerable. I am bad. I am a failure. Other people are hostile. Other people are harsh. Other people are unforgiving. Other people are bad. Other people are devious. Other people are nasty.

Among the battery of psychological tests we carried out on the participants in our virtual reality experiment was the Brief Core Schema Scales, which were designed to assess how the participants felt about themselves and other people. The results were fascinating. Because the people who went on to react to their virtual train ride in a paranoid way were the same people who agreed with one or more of the unhappy statements above.

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Perhaps this shouldn’t come as a big surprise. If we feel badly about ourselves, we may well assume that the people around us share that view. And if we believe that other people are inherently malevolent and cruel, we’ll probably worry that someone as vulnerable as we are is going to be mocked, picked on, maybe even attacked. The world is a hostile place, full of aggressors and victims—with people like us always in the role of victim. So these negative feelings about ourselves and others provide a foundation on which progressively more severe paranoia can build. In fact, we can think of these feelings as the ﬁrst level in a hierarchy of paranoia (see p. 80). Of course, almost everyone goes through periods when they don’t feel great about themselves. And almost everyone ﬁnds themselves occasionally doubting the people around them. So it’s hardly surprising that paranoia is so common. It’s these kinds of feelings that form the substance of most everyday, low-level suspiciousness. Remember those social factors we identiﬁed in Chapter 3 as possible inﬂuences on the development of paranoia? Well, for some of them, that inﬂuence may take the form of changing the way we feel about ourselves and the people around us—of creating, in other words, the ﬁrst level in the hierarchy of paranoia. We know, for example, both that strong social networks are crucial to self-esteem and that urbanization often undermines these networks, leaving people lonely and isolated.

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SEVER E TH R EAT

(e.g. people trying to cause you significant physical, psychological, or social harm; conspiracies known to wider public) MODER ATE TH R EAT

(e.g. people going out of their way to get at you) M I LD TH R EAT

(e.g. people trying to cause you minor distress, such as irritation) I DEAS OF R EF ER ENCE

(e.g. people talking about you, or watching you) N EGATIVE VI EWS OF ON ESELF AN D OTH ERS

(e.g. fears of rejection, feelings of vulnerability, feeling that the world is potentially dangerous)

1. The hierarchy of paranoia

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And how about migrants? Not only are most migrants citydwellers, with all the problems that can entail, but they also have to cope with the challenges involved in making a new life for themselves in a strange country. Given this, not to mention the hostility and discrimination the host population generously supplies from time to time, it’s not surprising that migrants can feel especially vulnerable. Or take trauma and victimization. We recently carried out a study of 200 students. It revealed that those students who’d been the victims of sexual abuse or physical assault, or who had a history of childhood trauma (emotional, physical, or sexual abuse), were much more likely to have negative views about themselves and other people. And they were also much more likely to experience paranoid thoughts. We found the same thing when we looked at data on the participants in the virtual reality experiment. When a research team contacted 500 Londoners seven months after the attacks on the underground of 7 July 2005, they found not only that a signiﬁcant proportion were still fearful of travelling on the tube, but that almost 25 per cent had a more negative view of the world since the bombings. This time it’s the trauma of terrorism that sparks the sense of vulnerability characteristic of the ﬁrst level in the paranoia hierarchy. ■

In 1903 Paul Schreber, a well-known judge in the German city of Dresden, published Memoirs of My Nervous Illness. The

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book is a remarkably candid account of Schreber’s mental illness, and in particular his paranoia. Foremost among Schreber’s many delusions was his conviction that he was being forcibly transformed into a woman. Initially he regarded his doctor, the ‘soul-murderer’ Professor Flechsig, as his principal persecutor (and sexual predator). But Schreber gradually came to believe that God Himself had singled him out in order to save the world: I came to see beyond any doubt that the World Order simply demanded this emasculation, whether it suited me personally or not, and that reason dictated that I had no choice but to reconcile myself with the thought of being transformed into a woman. The only possible result of the emasculation was, of course, fertilization by the divine rays with the purpose of creating new human beings.

The Memoirs formed the basis for Sigmund Freud’s analysis of Schreber’s case (Freud never met Schreber), published in 1911. Freud’s case study represents his most developed analysis of paranoia and his conclusion, in a nutshell, is that paranoid delusions are the result of repressed homosexual urges. Okay, you say, taking a metaphorical deep breath, how does that work? Well, here’s how Freud explains it. Underlying and provoking Schreber’s paranoia is the unconscious thought: I, a man, love him (‘him’ in this case being Professor Flechsig). No, you don’t, says the outraged ego, which supplies a more acceptable version: I, a man, hate him. A little further work transforms this into the even more legitimate:

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He hates me, so I am justiﬁed in hating him. And love completes its transformation into paranoia with the thought: I hate him because he persecutes me. For Freud, the persecutor in paranoid thoughts is always someone of the same sex who we are actually—albeit unconsciously—in love with. Elegant, entertaining, and imaginative though the theory may be, there’s just one problem: there’s no convincing evidence to back it up. In which case, you might ask, why bring it up? Because it’s a great early example of one of the historically dominant ideas about paranoid delusions. We call this idea the delusionas-defence theory and it argues that we blame other people when something bad happens in order to head off any negative thoughts about ourselves. So I choose to believe my colleague opts not to sit at my lunch table because he hates me, rather than confront what, deep down, I know perfectly well: that I’m frequently awkward and unfriendly and someone who you’d only sit next to at lunch if the alternative was squatting on the ﬂoor. Or I conclude that my boss has ﬁred me because she thinks I’m a threat and has been plotting to get rid of me for months, so that I don’t have to admit that I’m hopeless at my job. Our understanding of the causes of paranoia runs counter to the delusion-as-defence theory. We think paranoia isn’t an attempt to mask negative emotions. Far from it: paranoia is actually a direct reﬂection of those emotions. Our delusions don’t allow us to forget that we feel badly about ourselves. Instead, they are a manifestation—a product—of these

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feelings. Paranoid thoughts, it turns out, are no defence at all. ■

Complexity has its virtues, but who doesn’t prefer a simple explanation? And messy psychological speculations are all very well, but what about hard scientiﬁc fact? Scientiﬁc fact doesn’t come much harder than genes and their precious cargo of DNA. Genes, we are told, will help us deal with some of our most intractable challenges. As Bill Bryson has written: ‘Exultant scientists have at various times declared themselves to have found the genes responsible for obesity, schizophrenia, homosexuality, criminality, violence, alcoholism, even shoplifting and homelessness.’ All we have to do is deal with the offending gene and—hey presto!— impossible problem simply solved. (We don’t, by the way, believe that homosexuality is a problem.) So, is there a genetic explanation for paranoia? Can we tweak some rogue gene and thereby rid the world of unjustiﬁed suspicion? Although some work has been done on the inﬂuence of genes on schizophrenia, it hasn’t looked at the very much wider, low-level occurrence of paranoia. So we simply don’t know. When it comes to schizophrenia, there’s no easy answer either. The general view is that our genetic make-up may play a big role in determining whether or not we develop the illness, but that no single gene is responsible. Schizophrenia is the result of a complex interaction of genes—an

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interaction that may in fact also be responsible for other mental illnesses. Not only that, but even if we have a genetic predisposition, schizophrenia may only develop under particular environmental conditions (in what’s called a ‘geneenvironment interaction’). So the causes of schizophrenia are a mix of nature and nurture. But there’s an intriguing footnote to this discussion. A research team in Germany recently looked at the relationship between genes and persecutory delusions, though their focus was on a selected group of patients with bipolar disorder (what used to be known as ‘manic depression’) and not the general population. The team identiﬁed one particular gene that they believed might play a role in the development of paranoia. (That gene, in case you’re interested, is the D-amino acid oxidase activator (DAOA)/G30 locus.) Now this is a gene that has also been associated with anxiety disorders—so perhaps this is the genetic foundation for the link we’ve identiﬁed between paranoia and anxiety. But before we get too excited, we need to remember that it’s early days for this kind of research. And genetic data on psychological problems are notoriously difﬁcult to replicate. The German research provides a tantalizing glimpse of the possibilities, but no more than that. ■

Travelling by tube can be many things, but scientiﬁcally important is rarely one of them. Granted we had to shift

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our tube journey from the bowels of London to a small university room, but by doing so we didn’t merely get to work on time. We were able to demonstrate just how prevalent paranoia is—and the major role that our emotions play in producing that paranoia. In the next chapter, we’ll look at another key group of causes of paranoia: a set of odd and intriguing feelings that psychologists call anomalous experiences.

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‘I DON’T WANT TO SWEEP ALON E’

Paranoia and Anomalous Experiences ................................................................................

Oh my gosh. I just had a great idea! She could come to the party tomorrow and read Gwen’s lips for me. . . . She can tell me what Gwen is saying about me!

Thus George Costanza, nebbish anti-hero of hit sitcom Seinfeld. George is desperate to know why his girlfriend Gwen has dumped him. (‘It’s not you—it’s me’ is her somewhat unhelpful—and utterly implausible—offering on the subject.) But all is not lost. Jerry, George’s best friend, has just started dating Laura, who is deaf. And what better way to discover what people are saying about you than have a friend read their lips? It’s a scheme that appeals to the paranoid in all of us. As George tells Jerry: ‘If we could just harness this power and use it for our own personal gain there’d be no stopping us.’ Well, Laura does indeed lip-read Gwen’s conversation with Todd, the host of the party, and she duly provides

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George with a running commentary in sign language. So far, so good. But George doesn’t understand sign language; it has to be translated for him by ‘hipster doofus’ Kramer:  ‘Hi Gwen, hi tide.’  Hi tide?  Hi Todd. ‘You’ve got something between your teeth.’  What?  No that’s what he said. That’s interesting. ‘I love carrots, but I hate carrot soup. And I hate peas, but I love pea soup.’ So do I.  I don’t envy you, Todd. The place is going to be a mess.  Maybe you can stick around after everybody leaves and we can sweep together.  ‘Why don’t you stick around and we can sleep together.’  What?!?  ‘You want me to sleep with you?’  I don’t want to sweep alone.  He says ‘I don’t want to sleep alone.’ She says, oh boy, ‘love to.’

You can guess the rest. This sad tale points up a crucial element in paranoia. Because, although by deﬁnition paranoid thoughts are unjustiﬁed and exaggerated, they aren’t completely irrational. Life is full of confusing or unsettling experiences and paranoid thoughts supply an explanation (albeit not an especially useful or accurate one) for these ambiguous experiences. They are acts of interpretation gone awry. Now imagine how much more confusing the world appears when we can’t hear what someone is saying. Few of us would think of using a lip-reader to help us eavesdrop

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on a private conversation. But millions of people, and especially the elderly, suffer from hearing loss. And numerous studies have shown that deafness makes us more susceptible to paranoia. The link is especially strong in people who aren’t fully aware of their hearing problems. And this isn’t surprising. Because, after all, if you know you’re going deaf, you have a ready-made explanation for a bafﬂing, half-heard comment or a mysterious whisper. On the other hand, if you don’t know you’re losing your hearing, those odd auditory experiences are going to seem a lot more disturbing. This was demonstrated in a classic study carried out in the early 1980s by Philip Zimbardo and Susan Andersen from Stanford University and Loren Kabat from the State University of New York. Eighteen male college students were hypnotized and given instructions on how to behave when they awoke. The students were then brought out of their hypnosis and asked to take part in a role play with two actors, which was monitored by observers hidden behind a one-way mirror. The students then ﬁlled in questionnaires about how they felt. The results of the observation, and the data gathered from the questionnaires, were revealing. Because, although all eighteen volunteers had been hypnotized, the instructions they were given differed. Twelve of the participants were led to believe that they were partially deaf. But, of these twelve, only six knew the source of their deafness; the others had no idea why their hearing had suddenly

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deteriorated. The remaining six volunteers retained their normal level of hearing. Instead, they were given a compulsion to scratch a perpetually itchy ear. They weren’t told that it was the instructions they’d received while hypnotized that were causing them to scratch. Now, the six volunteers who didn’t know why they weren’t hearing properly rated themselves as much more confused, agitated, and irritated than the other participants. No surprise there, you might think. But what’s really interesting is that these six volunteers also had the highest scores for paranoid thinking. And these ﬁndings were echoed by the assessments of the concealed observers, who were also unaware of the instructions given to the hypnotized students. So we’re much more likely to respond in a distressed, agitated, and—crucially—a paranoid way if we don’t understand what’s happening to us. Paranoia rears its head when we try to make sense of the bewildering experience (for example, people exchanging apparently whispered comments). Maybe this strange stuff is happening, we think, because other people have it in for me. Maybe they’re whispering about me. Although the deafness experiment provides a striking illustration of this phenomenon, most paranoia is sparked not by hearing loss but by many other types of odd and unsettling feelings. The term psychologists use to describe these feelings is anomalous experiences, and in this chapter

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we’ll look in detail at what they are, how they’re caused, and how they can help trigger paranoia. ■

The most common type of anomalous experience is arousal—a feeling of being unusually tense and alert, of being on edge. We may have butterﬂies in our stomach. Our heart may pound and our mind race with thoughts. Lots of things can make us feel this way, and we’ll look at some of the major ones below. But the root of arousal, its evolutionary function if you like, is the desire to escape danger. We may not even be conscious of the threat, but our body is gearing up for action. And if arousal is all about our sense of danger, it’s not surprising that it is frequently the backdrop to feelings of paranoia. Paranoia is, after all, a response to the threat we perceive from other people. Arousal is often accompanied by perceptual anomalies. The world around us can appear brighter or more vivid; sounds can seem louder and more intrusive. In fact, any of our senses can be affected. We may become unusually sensitive to smells; objects can feel odd to the touch. The list of perceptual anomalies is a long one, encompassing not just these sensory experiences but the feeling that our thoughts are not our own, or that apparently unimportant events are actually highly signiﬁcant. We might have the impression that the world isn’t real, or that we

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don’t exist (this last one is known as depersonalization). The most notorious form of perceptual anomalies, though, is hallucinations—when we see or hear things that haven’t actually happened. The link between anomalous experiences and paranoia has been demonstrated by numerous research studies. Paranoia, we know, is a typical feature of psychosis. And so are ‘hearing voices’ and ‘seeing things’—hallucinations, in other words. But common too are more subtle perceptual changes. Take these comments from people with schizophrenia, surveyed for a study in 1999: Things are louder than normal; the TV is louder; other people’s conversations seem louder. Sometimes it seems like everything’s coming in, like my brain is a radar for sounds. Things in the corner of my eyes often catch my attention. I feel like I see everything all at once.

The study found that people with schizophrenia were much more likely to report perceptual anomalies, particularly relating to sounds and visual sensations, than folk without the illness. But, as we see time and time again with paranoia, people with serious mental illness aren’t freakish exceptions to everyday experience. Quite the contrary. Paranoid delusions are common in people with schizophrenia. But those of us with everyday, common-or-garden suspicious thoughts are also prone. (It’s another example of the continuum theory of paranoia.)

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When we surveyed over three hundred university students, for instance, we found that those with the highest rates of paranoia also reported the greatest number of perceptual anomalies. And we saw the same thing in the virtual reality experiment we discussed in Chapter 4—from which, remember, anyone with a history of serious mental illness was excluded. In fact, what distinguishes someone who responds to a challenging situation in a paranoid way from someone who simply becomes anxious is (at least in part) the frequency of their anomalous experiences. So whether you’re crippled by the most debilitating paranoid beliefs, or just a little over-suspicious from time to time, the chances are anomalous experiences will feature in the causal mix somewhere. ■

In 1983 the psychiatrist Stuart Grassian published a paper arising from conversations he’d had with fourteen prisoners held in solitary conﬁnement in a maximum security prison in Massachusetts. Each cell was approximately 1.8 by 2.7 metres in size and contained an open toilet and sink, a steel bed, and a small ﬁxed steel table and stool. (There are currently in excess of 25,000 prisoners in solitary conﬁnement in the US, and many thousands more scattered around the rest of the world.) Grassian found that eleven of the fourteen prisoners he spoke to had experienced heightened sensitivity to the (very limited) world around them:

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You get sensitive to noise—the plumbing system. Someone in the tier above me pushes the button on the faucet, the water rushes through the pipes—it’s too loud, it gets on your nerves. I can’t stand it; I start to holler. Are they doing it on purpose?

Five of the prisoners seemed to have experienced hallucinations: I overhear the guards talking. Did they say that? Yes? No? It gets confusing. I tried to check it out with [the prisoner in the adjoining cell]; sometimes he hears something and I don’t. I know one of us is crazy, but which one? Am I losing my mind?

Some of the accounts Grassian heard pointed to pretty complex delusions: They come by with four trays; the ﬁrst has big pancakes— I think I’m going to get them. Then someone comes up and gives me tiny ones—they get real small, like silver dollars. I seem to see movements—real fast motions in front of me. Then it seems like they’re doing things behind your back— I can’t quite see them. Did someone just hit me? I dwell on it for hours.

Stuart Grassian’s work provides compelling evidence of the link between solitary conﬁnement and anomalous experiences. (Solitary conﬁnement has also been associated with increased rates of prisoner suicide and serious mental illness, but that’s a topic for another book.) And even in the brief excerpts we’ve quoted, you can see how these experiences are coloured by paranoia (Are they doing it on purpose?... it

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seems like they’re doing things behind your back . . . Did someone just hit me?). It goes without saying that prisoners in solitary conﬁnement are under enormous psychological stress. And it’s the stress, together with the sensory deprivation, that seems to produce the anomalous experiences. Because we see the same thing when people are exposed to other serious, but much more common forms of stress. One of the certainties in life is that, at some point, we’re going to have to deal with upsetting events. It’s a fortunate (and probably ﬁctitious) person who can make it to the ﬁnishing line without having experienced bereavement, serious illness, the break-up of a long relationship, or redundancy. And these kinds of traumatic events have been shown to be instrumental in the onset of mental illness. Obviously, losing your job or ending your marriage isn’t inevitably going to propel you into psychosis. Almost all psychological phenomena have multiple causes and mental illness is no different. But severe stress is very often a contributory factor. A study in the early 1990s, for example, focused on the three months immediately preceding the development of symptoms in one hundred people with psychosis (of which anomalous experiences are a typical feature). It turned out that traumatic life events were ﬁve times more common in that three-month period than they are for the general population. And if those traumatic events involve danger at the hands of other people (an assault perhaps, or a mugging at

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knife-point) there’s a good chance that paranoia will feature prominently in our illness. One of the many unpleasant side-effects of stress is the havoc it can wreak on our sleep patterns. And, as we all know, sleeplessness doesn’t brighten anyone’s mood. On the contrary, it magniﬁes our problems and intensiﬁes our stress. Not only that, but sleep problems often seem to play a role both in the development of mental illness and in the occurrence of anomalous experiences. In fact, going without sleep for a prolonged period is a sure-ﬁre way of turning your view of the world upside down and inside out. One sleep deprivation study kept volunteers awake for up to 72 hours. By the 44-hour mark, eight of the ten participants reported hallucinations. Among the most imaginative were the comments that ‘the monitor screen is growing sprouts of grey and green hair’, ‘Helena [one of the research assistants] is camouﬂaged as a ﬁre hydrant’, and—somewhat gruesomely—‘the decaying corpse of Barbara [another assistant] is interfering with my vision’ (as it would). Clearly, this is a pretty extreme scenario. Even those of us with relatively serious sleep problems are going to be able to grab a few hours’ rest in a 72-hour period. But insomnia is widespread: on any given night, one in three of us will be struggling with it. That means that there are an awful lot of people who may be undergoing sleeplessness-related anomalous experiences. And, at the most severe end of the

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mental health spectrum, the onset of psychosis is usually accompanied by sleep problems. Sadly, the problems caused by insomnia don’t end when we ﬁnally get to sleep. Because there are a number of sleeprelated anomalous experiences, and if you have insomnia your chances of suffering from them are much greater than if you get your eight hours regularly. Given the prevalence of insomnia, it’s not surprising that these sleep-related problems are extremely widespread. For example, a survey of 5,000 adults in the UK found that 37 per cent reported hallucinations while falling asleep and 12.5 per cent when waking. Extrapolate those ﬁgures and that 37 per cent equates to around 15 million adults in the UK. Ten per cent of the 5,000 surveyed had experienced the sensation that someone or something was in the room with them as they fell asleep. And 4 per cent reported the vivid impression that someone had been about to attack them as they drifted off. One especially distressing type of sleep-related anomalous experience is sleep paralysis. For a very short period while we’re going to sleep or waking up (generally just a few seconds, though sometimes a couple of minutes), we ﬁnd that we’re unable to move. Sleep paralysis is often terrifying, though it’s actually the by-product of an eminently sensible strategy on the part of the brain. You may enjoy dreaming you’re scoring a penalty at Wembley, or playing a Beethoven cello sonata, but you

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probably don’t want to perform the actions too. Sleep is primarily designed for rest, after all. (A sentiment your pummelled bed-mate would no doubt vigorously endorse.) So sleep paralysis kicks in to prevent our bodies acting out our dreams. Unfortunately, sleep paralysis isn’t much fun to experience while we’re awake (or partially awake). Sufferers often report feelings of intense fear; they feel extremely tense and agitated; and they can endure frightening hallucinations. Sleep paralysis is particularly common when we’re very stressed. These hallucinations generally fall into one of three categories. People sometimes feel as though they’re ﬂoating, ﬂying, or—perhaps most disturbingly—falling. Out-of-body experiences are common: for example, observing oneself from afar (this is known as autoscopy). And sometimes we imagine we’re moving—anything from lifting our arm a fraction all the way to sitting up in bed or walking through the house. (This lot goes under the elegant title of vaestibularmotor hallucinations.) In the case of intruder hallucinations, we typically sense a threatening presence nearby. We might hear footsteps, gibbering voices, and other peculiar noises. We may actually see people in the room with us and feel that we’re being touched or grabbed. Unpleasant though intruder hallucinations are, incubus hallucinations can be even worse. Breathing difﬁculties; feelings of suffocation; the sensation of being crushed

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or weighed down; pain; and thoughts of impending death—all very unpleasant and all hallmarks of incubus hallucinations. These kinds of experiences are incredibly common. In one survey of 870 university students, 30 per cent reported at least one occurrence of sleep paralysis, and three-quarters of those episodes involved hallucinations. Yet most people have no idea how prevalent they are, and they don’t know what’s causing them. (When was the last time you read an article, or saw a TV programme, on sleep paralysis?) Which means that they’re ripe for misinterpretation. Ever imagined, for example, that you’ve been abducted by aliens? Perhaps not. But many apparently sane and stable individuals have reported being kidnapped by extraterrestrials. The ‘abductions’ tend to follow a similar pattern: the victim is transported to the aliens’ spaceship and given a physical examination; they communicate with the aliens (sometimes receiving Important Messages for Humanity) and are treated to a guided tour of the UFO, before being returned home. Theories abound regarding the explanation for these very weird feelings, though there is consensus on one aspect of the phenomenon: namely, and perhaps a shade disappointingly, that it has nothing to do with genuine aliens. But it seems likely that at least a proportion of these extraterrestrial adventures are in reality misinterpretations of sleep paralysis experiences. The apparent appearance of intruders; the feeling of ﬂying and other movement; hearing voices and

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other strange noises—all bear a striking similarity to many accounts of sleep paralysis. In a moment we’ll look at the other main cause of anomalous experiences: the familiar double-act of drugs and alcohol. But before we do it’s worth quickly noting that not all stress-related anomalous experiences are distressing. People who’ve lost a very long-term partner often describe how the deceased has ‘come back’ to them in some way, usually in the ﬁrst weeks after their death. One study focused on ﬁfty people in their early seventies who’d recently lost their spouse. One month after the spouse’s death, half of the bereaved had felt the presence of the deceased. A third reported hearing their spouse; a quarter had seen them; 6 per cent had felt their touch. And most people in the study found these experiences comforting. ■

In 1958 Frances Ames, a South African doctor, conducted a study into the effects of cannabis intoxication. (An eminent neurologist, Ames is perhaps best remembered for her challenge to the South African government and medical establishment over the death in custody of the black activist Steve Biko in 1977.) Ames was motivated in her research by the perceived similarities between the effects on the brain of hallucinogenic substances like cannabis, mescaline, and lysergic acid (or LSD) and the changes detected in people with serious

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mental illnesses such as schizophrenia. If you could ﬁgure out how the psychedelic plants worked, the theory went, you could gain unprecedented insight into the mechanisms and causes of psychosis. So Ames recruited ten volunteers from the medical staff of the teaching hospital at the University of Cape Town. She gave them each a large oral dose of cannabis (from four to seven grains, or 0.24 to 0.42 grams, depending on body weight). Ames herself also took a dose. The volunteers were then observed for the next day or so and later wrote their own accounts of the experience. If you’ve ever wondered what large amounts of cannabis can do to you, you need look no further than the experiences of Frances Ames and her volunteers: Waves of warmth . . . started in the centre of my abdomen and radiated up . . . This was associated with forceful, fast palpitations, dyspnea [shortness of breath], dry mouth and waves of throbbing frontal headache . . . it was like having the visceral effects of panic . . . Your eyes look like large oranges—as big as a beach umbrella. It [the reﬂection of the sun on the wall] looks like a hyena or a duck-billed platypus. I see [when closing his eyes] a fat man in military uniform costume running down the stairs. . . . [He] has a snow-white beard and is in a Roman tunic. My one eye feels bigger than the other—like a Picasso picture—my face is drawing out and when the corners of the mask go up I feel happy.

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My body feels as though it is in continual motion, rocking and spinning around through space. My teeth feel strange, as though they were made of plastic. It is as though I am watching myself lying in a big transparent bubble with my face pressed close to the side.

One could hardly wish for a more comprehensive catalogue of anomalous experiences. But cannabis can stimulate other reactions too. Several of Ames’ participants showed signs of paranoia: H. refused on several occasions to close his eyes because he thought he was being hypnotised into seeing visual images. . . . [C.] asked uneasily several times, ‘Is there someone hidden behind that screen?’ . . . J. became convinced that cannabis had unmasked a latent schizophrenia and when several people came in to talk to him he refused to answer any questions because he believed they had been called in to certify him.

The wonders of sleep paralysis may have escaped the media, but the possible links between cannabis use and mental illness certainly haven’t. In fact, it’s a very hot topic, not least in the wake of the UK government’s downgrading in 2004 of the drug’s legal status from Class B to Class C (and the almost constant debate since then regarding the merits of upgrading it again). In itself cannabis probably won’t cause psychosis, but it does increase the chances of illness in young people who are already at risk. We’re more likely to have the very intense experiences described by Frances Ames’ volunteers if our

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mental health is a little shaky, or if we’re already prone to mild delusions or hallucinations. Not only that, but those weird and unsettling feelings can stay with us long after the drug is out of our physical system. Of course cannabis isn’t the only drug that can bring on anomalous experiences. Any of the so-called recreational drugs (cocaine, amphetamines, Ecstasy, LSD, and so on) can do it. Alcohol can do it. Even coffee—thanks to its caffeinecontent—can make us feel very peculiar if we drink enough of the stuff. But anomalous experiences aren’t a coincidental byproduct of these substances. They’re the reason we take them in the ﬁrst place! Drugs help us change the way we feel about ourselves and the world around us. And, if the data on drug use is anything to go by, boy do we want to change the way we feel. In a survey published by the UK government in 2005, for example, around 3.3 million people in England and Wales said they’d used cannabis in the previous year. Over the same period, three-quarters of a million people had taken cocaine; 600,000 Ecstasy; and 480,000 amphetamines. Twelve per cent of adults had used an illicit drug in the previous twelve months, and 7.5 per cent in the previous month. In the US, the 2006 National Survey on Drug Use and Health estimated that 20.4 million Americans, or 8.3 per cent of the population aged 12 or older, are current illegal drug users. Cannabis is the drug of choice

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for 14.8 million people. Almost 2.5 million Americans use cocaine; a million people take hallucinogens such as LSD or ‘magic mushrooms’; and 528,000 take Ecstasy. And that’s just the ﬁgures for illegal drugs. When it comes to the stuff we’re allowed—indeed encouraged—to consume, the numbers predictably skyrocket. Around 125 million Americans aged 12 or older drink alcohol—that’s 50 per cent of the population. Fifty-seven million people are ‘binge drinkers’, deﬁned as ﬁve or more drinks on at least one occasion in the thirty days prior to the survey. In England in 2004, 39 per cent of men and 22 per cent of women had drunk more than the recommended number of units on at least one day in the week leading up to the survey. Twenty-two per cent of children aged 11–15 had drunk alcohol in the week before they were interviewed. How alarming you ﬁnd these ﬁgures probably depends to some extent on where you stand in the drugs and alcohol debate. But even the most ardent opponent has to face the fact that millions of people regularly drink alcohol or take illegal drugs with a lot of pleasure and minimal negative side-effects. On the other hand, we know that drugs and alcohol can cause huge problems for people, including affecting their mental health. And the anomalous experiences drugs bring about often play a big part in this. For sure drugs alter the way we see ourselves and the world around us: that’s their big attraction. But, for some people, when we try to make sense of these changes, when

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we try to understand what’s happening to us, the world can start to seem a frightening and hostile place. Why are those lights suddenly so bright? Because someone’s trying to blind me. Why is that person following me? Because they want to mug me. Or, to take an example from Ames’ study, Why are those people coming to interview me? Because they suspect I have schizophrenia and they want to hospitalize me. And, as we saw with cannabis, the chances of us developing these kinds of problems through drug use are particularly high if we’re already feeling low or agitated, or have other mental health problems. ■

Whether they’re caused by stress, drugs and alcohol, or physical problems like hearing loss, anomalous experiences shake up our everyday sense of things. And when this happens, all sorts of stuff we’d previously ignored or were unaware of can start to seem very important indeed. Thanks to recent research, we’re beginning to get sight of some of the neurological ‘nuts and bolts’ behind these changes. The clinical psychologist David Hemsley, for example, has focused on the issue of memory. Think of what happens when you access a site on the Internet. If you’re visiting the site for the ﬁrst time, your computer must download the entire contents of the web page—which can be a relatively lengthy and memory-intensive job. But things get much easier next time you access the page, because your computer (or, more

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accurately, your web browser) has already stored in its memory the details from your previous visit. All it needs to do this time is download the bits of the page that have changed. Human memory works in a similar way, though with fewer advertisements. We’re currently writing these words in our ofﬁce. We know we’re in our ofﬁce (you’ll be relieved to hear), and we could describe its layout and contents if you asked us to. But all that stuff is stored in our memories. So instead of having to spend time and mental energy taking in our surroundings each time we enter the room, we can devote ourselves to the really important task—ﬁnishing this chapter. But say our memories stop functioning properly. Suddenly everything in the ofﬁce is new to us. The picture that we hung on the wall four years ago and have scarcely looked at since goes from being (literally and metaphorically) a part of the furniture to a strange and puzzling addition to our environment. Why is it there? Is it hiding a camera? Is someone spying on us? It may be that this kind of memory problem is involved behind the scenes in certain anomalous experiences—for example, the perceptual oddities that make parts of our environment seem more vivid or striking to us. Some people seem especially prone—possibly because of their genetic make-up, problems in the womb or at birth, or later incidents causing minor abnormalities in the brain—though it’s generally stress that provides the immediate trigger.

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On a similar tack, the psychiatrists Marc Laruelle and Shitji Kapur have each considered the role of dopamine in psychotic experiences. Dopamine is a neurotransmitter, a chemical used to relay messages from the nervous system (including the brain) to other cells in the body. One of the functions of dopamine is thought to be to highlight important elements in our environment. So when we see something that might help us or give us pleasure—or, conversely, that might harm us—dopamine is released in our brains. Now anti-psychotic drugs are known to block the release of dopamine. Which begs the question: is dopamine somehow involved in psychosis? For Laruelle and Kapur, the answer is a deﬁnite yes. They argue that the psychotic brain is one in which (among other things) dopamine is running riot, tagging all kinds of stuff as important when in reality they’re nothing of the sort. With this kind of dopamine dysfunction, our experiences can seem very anomalous indeed. And this way lie delusions, misinterpretations, and—very often—paranoia. ■

Making sense of the way we feel, and the events we witness, can be tough. But don’t ever underestimate the ingenuity of the human mind, and especially the reach of our imagination. Sometimes, indeed, you simply have to stand back and marvel. Take the September 11 attacks, for example. Conventional wisdom may put al-Qaeda squarely in the frame,

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but what does conventional wisdom know about the links between the Pentagon and the Freemasons? The folks at www.freemasonrywatch.org, on the other hand, have plenty to say on the matter. They argue that the prevalence of the number eleven (a number of special signiﬁcance in Masonic lore) in the circumstances surrounding the attacks points the ﬁnger clearly at the Pentagon. Construction of the Pentagon, the website notes, began on September 11, 1941—exactly sixty years before 9/11. When you add together 9 + 1 + 1, you get 11. September 11 is the 254th day of the year; 2 + 5 + 4 also equals 11. After September 11, the year has 111 days to run. Not convinced? Well, what if you realized that the words ‘The Pentagon’, ‘New York City’, and ‘Afghanistan’ all have 11 letters? Or that the towers of the World Trade Center resembled the ﬁgure 11? Or if you knew Flight 11 was the ﬁrst plane to hit the towers? When we try to get to the bottom of stuff we don’t understand, there’s no telling where we’ll end up. Previously unimportant details assume sudden and dramatic signiﬁcance. Unforeseen—and strictly non-load-bearing— connections are dextrously forged. Extravagant conclusions are reached. Anomalous experiences seem particularly effective at setting off this kind of wild speculation. Understandably so, because most people haven’t the ﬁrst idea about them. They don’t know how common they are. They haven’t a clue what causes them or what to expect if they should experience

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them. In these circumstances, naturally you might panic. And, as we all know, panic is not conducive to clear thinking or smart decision-making. It’s much more likely to lead us to entirely the wrong conclusion about what’s happening to us—and that conclusion may be a paranoid one. (We can think of paranoia, remember, as acts of interpretation gone awry.) And yet anomalous experiences don’t affect everyone in this way. So here’s where we have to acknowledge some caveats. The fact is, the relationship between anomalous experiences and paranoia is one that requires a lot more research. We still need answers to some pretty big questions. Why, for example, do most people have anomalous experiences without it affecting their mental health? How do we go about any properly scientiﬁc study of anomalous experiences given that they’re so frequently unrecognized— especially by those people who are prone to paranoia? And how do you begin to disentangle the feelings someone is experiencing from their interpretation of those feelings? Actually, we may already have part of the answer to the ﬁrst of these questions. What distinguishes those people who take anomalous experiences in their stride from those who are sent into a tailspin of fear and confusion is the way they reason. How we typically think through problems and experiences plays a big role in the development (or not) of paranoia, as we’ll see in the next chapter.

6

DOI NG TH E CAM B ERWELL WALK

Paranoia and Reasoning ................................................................................

Welcome to Camberwell, home of the Institute of Psychiatry at King’s College London. In many ways Camberwell is typical of inner-city London: built-up, busy, and ethnically very diverse. It’s also an area of considerable poverty. In the 2004 Index of Multiple Deprivation—a government-sponsored survey of

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living standards across England—Camberwell was ranked at 6,327 out of 32,482. This sounds alright until you know that the most deprived area is ranked number 1 and the least deprived number 32,482. (Parts of the Anﬁeld area of inner-city north Liverpool were ofﬁcially deemed the most deprived place in England in 2004; the village of Oakley in rural Hampshire took place number 32,482.) Pictured opposite is the area’s main shopping street. Follow it far enough and it’ll lead you to the Thames, but the wide expanse of the river seems a very long way from the run-down, trafﬁc-clogged, and people-thronged streets of Camberwell. What effect—if any—does an urban environment like this have on paranoia? To ﬁnd out, we asked ﬁfteen volunteers with strongly paranoid thoughts to walk down the Camberwell Road from the Institute, buy a newspaper, and come back. Afterwards they were given a range of psychological tests. Finally, their test scores were compared to those of ﬁfteen other people, again all with pronounced paranoia, who’d simply stayed at the Institute listening to a relaxation tape. Did making the trip down the Camberwell Road increase the volunteers’ level of paranoia? Absolutely. And given the stressful nature of the environment that didn’t come as a surprise. (As we saw in Chapter 3, there’s a well-established link between stress, particularly in urban environments, and mental illness.) More intriguing though were the results of one particular psychological test: the beads task.

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In the beads task, participants are presented with two glass jars. One contains 85 orange beads and 15 black beads; the other contains 85 black and 15 orange. The beads have been mixed up in the jars. The researcher conducting the test chooses one of the jars (without telling the participant), and moves them both out of view. They then remove beads from the jar they’ve selected, one at a time, showing them to the participant and then putting them back. The participant is asked to decide which of the jars the beads are coming from. After they’ve been shown a bead, they can ask for another one or they can tell the tester whether they think it’s come from the mainly orange or the mainly black jar. There’s no hurry: the participant can ask for as many beads as they like—85 if they feel like it—before they make a decision. Thanks to pioneering work by the British clinical psychologist Philippa Garety, the beads task is now regularly used with people suffering from severe delusions. What these tests show is that people with delusions ask for fewer beads than people without. In fact, about 50 per cent decide which jar the beads are coming from after having seen just one or two. Moreover, they carry on making very rapid decisions even when the task is made more difﬁcult by changing the bead ratios from 85:15 to 60:40. People with delusions, in other words, jump to conclusions based on minimal evidence. The Camberwell shopping experiment was the ﬁrst to feature the beads task after the participants had been

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outside. And the trip certainly made a difference, because the volunteers who’d ventured down the Camberwell Road generally asked for fewer beads than those who’d stayed behind at the Institute. Which is no mean feat given that pretty much everyone with serious paranoia is prone to snap judgements. Our environment, then, makes a signiﬁcant difference to the way we make sense of the world—to the way, in short, that we reason. Choosing the wrong jar in a psychological test isn’t a big deal. But when this kind of decision-making is carried over into everyday life the consequences are much more far-reaching. For one thing, it feeds and sustains paranoia. Because paranoid thoughts—like all delusions—can be tenacious so-and-sos, constantly elbowing their way into our mind and then clinging on for dear life. They have a weak spot, and a signiﬁcant one at that: they aren’t true. But to ﬁnd that weak spot you’ve got to take the time to challenge them, to ﬁnd the evidence that will unmask them as the misjudgements they surely are. And you can’t do that by jumping to conclusions. You can see this reasoning style at work in a study carried out by Carolyn John and Guy Dodgson. They played Twenty Questions six times with 36 volunteers (which is probably enough of the game to last you a lifetime). Of those 36 participants, 12 suffered from delusions; 12 had depression; and the other 12 had no serious mental health problems. Here’s a typical example, quoted from start to ﬁnish, of someone with delusions:

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       

Which famous person am I thinking of ? Is the person alive? No. Have they been dead for over ﬁve years? Yes. Have they been dead for over ten years? Yes. Was it John Lennon?

The study showed that the people with delusions guessed much quicker than the other participants. And because they were guessing quicker, their answers were based on much ﬂimsier evidence. All of which meant that they got far fewer answers right. (In case you were wondering, the mystery person in the example above was Elvis Presley.) The insight that people with paranoia have distinctive ways of thinking isn’t a new one. After all, believing stuff that clearly isn’t true is, almost by deﬁnition, a sign that our reasoning is awry. The real question is how is it awry? As far back as 1944, the German psychiatrist Eilhard von Domarus argued that delusions were the result of a failure of syllogistic reasoning. The world of the syllogism contains recesses of bewildering philosophical complexity, none of which—thankfully—we need delve into here. Sufﬁce it to say that syllogistic reasoning is a type of logical thinking in which a conclusion is drawn from two other statements (or premises). For example: All humans are mortal; I am human; therefore I am mortal. Von Domarus argued that people with delusions are particularly bad at this sort of logical thought. Here’s an example he gives: Certain Indians are swift; stags are swift;

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therefore some Indians are stags. It’s the repetition of the adjective ‘swift’ that causes the confusion, von Domarus suggests. And this kind of logical error often underpins paranoid thinking, for example: People who publicize sensitive ofﬁcial secrets are watched and hounded by the government; I’ve seen people watching me on the street; therefore I’m being watched and hounded by the government. But there’s a ﬂaw in von Domarus’s theory. Try this little poser: Premise 1 Premise 2 Therefore

Some of my wishes are fulﬁlled. Some of my wishes are small. a. All small wishes are fulﬁlled. b. Some fulﬁlled wishes are not small. c. No valid conclusion is possible. d. Some small wishes are fulﬁlled. e. Some fulﬁlled wishes are small.

Not easy, is it? And indeed when this puzzle is given to all kinds of people, plenty of them get it wrong, paranoia or no paranoia. Because it’s not just those of us with delusions who aren’t terribly good at syllogistic reasoning; it’s almost everyone. As we saw in Chapter 3, logical thinking is not humanity’s forte. (The answer is c, by the way. We think.) The syllogistic theory turned out to be something of a dead end. And something similar looks to have happened with a more recent account, which emerged out of research on autism. Humans are intensely social creatures (though doubtless we can all think of individuals who consistently refute this observation). But you can’t form social ties unless you’re

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aware of two crucial phenomena. First, you have thoughts and feelings; and second, other people do too. This is known in psychological circles as having a Theory of Mind. And without it, self-expression and interaction with other people become fraught with difﬁculty. Children with autism typically struggle with communication and social engagement. And it’s been suggested, for example by the eminent psychologist Uta Frith, that this is because of an absence of Theory of Mind. But what about people with paranoia? How robust is their Theory of Mind? Well, according to Uta Frith’s husband, the equally eminent Chris Frith, paranoia is produced by a misﬁring of our Theory of Mind. We know people have thoughts, feelings, and intentions; but we lose the ability to judge what they are. My workmates seem to look at me blankly: are they keeping something from me? Why did those women on the bus laugh like that? Were they laughing at me? It’s an appealing theory. Paranoia is, after all, a misinterpretation of other people’s intentions. But unfortunately it’s a theory that’s not conclusively backed up by the research evidence. Problems with Theory of Mind are quite common in people with schizophrenia when they’re tested in a clinical setting. But those problems tend to be associated less with paranoia than with other symptoms of schizophrenia, such as incoherent speech and a lack of interest in normal activities. Despite these twists and turns, our picture of the kind of reasoning styles that are typical of people with paranoia (and

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other delusions) is now clearer than ever. As we’ve seen, they tend to jump to conclusions, making judgements on the basis of minimal data. And they’re also given to noticing the things that seem to conﬁrm their suspicions and disregarding anything that doesn’t. Psychologists call this the belief conﬁrmation bias. Everyone is prone to this kind of thinking. We’re all more comfortable with the things we know and understand, and that ﬁt our sense of the world, than we are with the stuff that challenges our preconceptions. Francis Bacon noted the prevalence of this trait in his New Organon of 1620: The human understanding when it has once adopted an opinion . . . draws all things else to support and agree with it. And though there be a greater number and weight of instances to be found on the other side, yet these it either neglects and despises, or else by some distinction sets aside and rejects, in order that by this great and pernicious predetermination the authority of its former conclusions may remain inviolate.

In 1960 the British cognitive psychologist Peter Wason devised a strikingly effective means to test this belief conﬁrmation bias. He called it the 2–4–6 task. The researcher tells the participant that they have in mind a rule linking a set of three numbers. The researcher explains that the numbers 2–4–6 conform to the mystery rule. The participant’s job is to discover that rule by formulating their own sets of three numbers. Each time the participant suggests a set, the researcher will let them know whether or not it ﬁts the rule.

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The participant is encouraged to take all the time they need to be really conﬁdent that they’ve worked out the solution. But most people instantly assume that the rule is ‘numbers increasing by two’ and spend their time suggesting similar sets (6–8–10 or 20–22–24). What they don’t do is try out examples that don’t conform to what they imagine to be the rule. Which is unfortunate, because this way they only discover they’re mistaken when they announce their conclusion to the researcher. (The rule isn’t ‘numbers increasing by two’; it’s ‘any increasing numbers’.) If we analyse the performance of those people who are most successful at the 2–4–6 task, we ﬁnd that they use three really valuable strategies. For one thing, they’re much more likely to suggest sets of numbers that don’t ﬁt their hypothesis, thereby giving themselves the chance to see whether it really holds water. Second, they’re prepared to consider alternative solutions. And ﬁnally, they tend to suggest a lot more sets of numbers before coming to a decision. Even scientists, when they take the Wason test, tend to display the belief conﬁrmation bias. Which is ironic, because it’s a seriously unscientiﬁc way of reasoning. You can’t prove a hypothesis simply by producing evidence that supports it. You have to demonstrate that your hypothesis will stand up in the face of all possible objections and alternative explanations. Here’s another example of the belief conﬁrmation bias in action. Suppose you were introduced to someone for the

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ﬁrst time at a party. You’re a curious person and you’re keen to know whether or not your new acquaintance is an extrovert. What questions would you ask your fellow partygoer—who, by the way, has had recent dental surgery and can only answer with a jaw-clenched ‘Yes’ or ‘No’? Okay: this may not be an especially plausible scenario, but as an experiment it does throw up some interesting results. Because most people asked to imagine this situation suggest questions like ‘Do you like going out?’ or ‘Do you enjoy seeing friends?’ To which even a conﬁrmed introvert might answer ‘yes’. After all, introverts frequently enjoy socializing, though they may not feel the need to do as much of it as extroverts. If we only ask questions about extrovert behaviour, we’re skewing the terms of the enquiry, giving our new friend lots of opportunities to conﬁrm any extrovert tendencies. Sure, they may answer with an unambiguous ‘no’, but chances are that’ll only be occasionally. Much more effective would be to also ask them about introvert behaviour: Would you say that you’re shy? Do you ever feel uncomfortable in social situations? Questions, in other words, that are designed to disprove the idea that someone is an extrovert. All of which is not to say that the belief conﬁrmation bias is yet another indictment of the human mind’s laziness and unreliability. For a start, it doesn’t mean we’re completely blind to alternative viewpoints (though they may need to be particularly compelling to grab our attention). And imagine

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life without preconceptions! Consider how you’d feel if you had to test out every little thought! The world would rapidly seem a very confusing—and exhausting—place. Unfortunately this style of reasoning isn’t great if you suffer from paranoia, or in fact from other delusions. Because, as we’ve mentioned above, delusions need to be challenged—and challenging beliefs is one thing conﬁrmatory thinking is hopeless for. We gave Wason’s 2–4–6 task to thirty students, together with a number of other psychological tests. And we discovered that the students who displayed the strongest belief conﬁrmation bias had the highest levels of both delusional thoughts and depression. Bear in mind that, unlike the Camberwell shopping experiment, these participants weren’t drawn from patients at our clinic. They had no particular mental health problems (or at least none that aren’t typical of the general population). This suggests that, even at the mildest end of the paranoid spectrum, there’s a clear link between a conﬁrmatory style of reasoning and suspicious thoughts (and, indeed, other distressing feelings such as anxiety and depression). And, although we’re all prone to the belief conﬁrmation bias, it seems to be most dominant in people with delusions. But how do paranoid delusions survive the almost inevitable avalanche of contradictory evidence? How can I persist in believing I’m going to be mugged the moment I set foot outside my door, for example, when no one has ever made the slightest aggressive move towards me? How

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can I be so sure that my colleagues dislike me when they’re always inviting me to join them for lunch or a drink after work? Dogged and deeply entrenched though the belief conﬁrmation bias is, surely even it must eventually concede defeat? Not a bit of it. For one thing, remember safety behaviours, the little precautionary routines we develop to stop us coming to harm? (Chapter 4 is the place to go if you want to refresh your memory on these.) Most people with serious paranoia use safety behaviours and they’re a remarkably effective means of drawing a veil over events that seem to undermine delusions. So I’ve never been mugged, not because the risk is very small, but rather because I won’t walk down certain streets on my own after dark. Thus are years of experience-based evidence instantly erased . . . Then we have our imagination, which appears to relish the opportunity to dream up specious explanations for facts we’d prefer not to acknowledge. If disaster hasn’t befallen us, it’s because our enemies want it that way. (My workmates might appear to be friendly, but that’s only because they don’t want other people to see how they really feel about me.) Or I just got lucky. (I’m sure that guy would’ve mugged me if that police car hadn’t happened to drive by.) Finally, imagine you’re on a night out with your friends. Suddenly you feel extremely odd—anxious and agitated and as if the ﬂoor is about to be pulled out from under your feet. You’re not sure how much you’ve drunk, and you know you should have eaten before you came out. But surely having

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a few drinks on an empty stomach wouldn’t make you feel this terrible? And then it hits you: someone must have spiked your drink (though you can’t recall having left your glass unattended). Why else, you reason, would you feel this way? Sometimes a paranoid explanation is simply all we can come up with, whatever the evidence to the contrary. ■

I came from very stable parents, married for 43 years until mom died in 1991. . . . Mom worked part-time taking care of an elderly lady in her home. My father was a school custodian. . . . I had four brothers and two sisters. I was the youngest. I heard my mom had a fever while delivering me. There was a real sense of family, which I cherish tremendously to this day. There were no traumas in the family and we did not receive any verbal, emotional, physical, or sexual abuse or physical punishment. I don’t remember my mother or father ever shouting.

Thus begins Robert Chapman’s account of his battle with schizophrenia. The illness ﬁrst began to show itself in 1979 when Chapman was 19, while he was living away from home for the ﬁrst time and working as a machinist. He became convinced that he was a genius whose numerous ideas for inventions and art works were as singularly remarkable as he was himself. Even at this early stage of his illness, Chapman was having paranoid thoughts, suspecting that company executives might be trying to steal his ingenious product ideas. The paranoia grew worse:

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I began to be preoccupied with thoughts that others could somehow know what I was thinking, that my entire thoughtlife was made available to others, who were thereby stealing my ideas. Every day I thought I was going to die from whoever was monitoring my thoughts. Some thoughts didn’t seem to be my own. They seemed foreign, as though someone was putting them there.

By 1982 Chapman had reached a very low ebb. His paranoid schizophrenia so dominated his life that he’d had to abandon his college degree and was unable to hold down a job. He’d received psychiatric treatment, and was taking medication, but these had brought about little or no improvement— as you can see from the assessment of Chapman’s mental health counsellor at that time: The prognosis for Rob is not very good. . . . [He] is quite out of touch with reality. He has very poor insight. His present goals are totally unrealistic . . . He experiences delusional thinking and has had visual hallucinations. He is a risky client.

Despite this, one thing his counsellor said struck home: delusions and hallucinations are the product of your own mind, not something externally real. And Chapman eventually made this insight the cornerstone of his self-devised recovery programme. Because, if he could prove that his paranoid thoughts were delusions, their hold over him would weaken: The degree of paranoia stiﬂed my ability to live and think freely. False suspicions impeded my progress in going forward. Once I began to question, my suspicions could not be veriﬁed. Once I acknowledged that there were holes of

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uncertainty, I began to think that some of my thoughts might be delusional even though they had the appearance of truth and believability. As each day passed and I wasn’t killed, I dug deeper at my own scared pace.

Chapman’s ﬁrst step was to doubt every paranoid thought— for example, ‘How is it that I have been feeling very paranoid about being persecuted for so long, yet I haven’t been killed, assassinated, kidnapped, or imprisoned?’ And once he’d identiﬁed a delusion, he set about disproving it. The belief stayed ﬁxed until I researched and found sceptical debunking counterarguments and disconﬁrming evidence. I put on my detective cap. I would test out arguments. I tried to develop the strongest arguments possible against the falsehoods. I made a list of all the rational alternatives that I could think of. I looked for evidence for what really was happening and what really wasn’t happening. Since I realized I had a bias toward thinking meagre evidence conﬁrmed my false beliefs, I looked particularly hard for disconﬁrming evidence. I compared the way things really are with what my delusions claimed. Over time, I repeatedly found nothing that would substantiate the convictions of my delusions.

Over the course of the next three years, Robert Chapman’s delusions gradually stopped, and by 1985 they had vanished completely. He was able to stop taking medication and, in time, to return to college. He now works as a writer and artist, and as a research assistant in the mental health ﬁeld. His schizophrenia has gone. Chapman’s paranoid delusions were ﬁrmly at the most serious end of the mental health spectrum. But there’s

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nothing marginal about the techniques he used to overcome his illness. They’re relevant to everyone affected by paranoia: mild, severe, and all points in between. Because beating paranoia means changing the way we think, shaking off those negative patterns of reasoning that, almost without our noticing, have become second nature. As Chapman’s account so compellingly demonstrates, paranoid thoughts have to be challenged, tested, and ultimately unmasked. But this will only take us part of the way. To really get the better of paranoia, we need to tackle its roots in culture and society. And how, you might well ask, do we do that? It’s a fair question, and one to which the next chapter represents our—admittedly provisional—answer.

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Combating Paranoia ................................................................................

We’re witnessing the downward spiral of Britain. Decent members of the public are being murdered by feral youths on our streets. MPs just give us sad eyes and soundbites. This is the 2008 equivalent of Nero ﬁddling while Rome burns.

This cri de cœur appeared on the front page of the Sun, Britain’s top-selling newspaper, on 21 January 2008. The previous week had seen the conviction of the killers of 47-year-old Garry Newlove. Late on the night of 10 August 2007, Newlove had heard noises outside his home in Warrington, a Lancashire town previously best-remembered for being the unlikely target of two IRA bombs in 1993. He confronted a gang of drunken teenagers, who promptly punched and kicked him to death. The outraged lament on the Sun’s front page was in fact quoted from a letter to the paper from one Dr Stuart Newton, a former head teacher. And forming a melancholy

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border around his words were the faces of ﬁfteen highproﬁle murder victims. The message was unmistakable, conveyed with the newspaper’s usual clarity: the country is going to the dogs; the streets are not safe for respectable folk to walk; our youth is out of control. ‘In parts of our country there is social breakdown. Society stops at the front door of our house and the streets have been lost and we’ve got to reclaim them’, agreed Conservative Party leader David Cameron. And the Home Secretary, Jacqui Smith, confessed that she felt uncomfortable walking in London after dark (her words, explained an ofﬁcial, ‘hadn’t come out as she had intended’ and, by way of proof, Ms Smith had recently gone so far as to purchase a kebab on the inner-city streets of Peckham). But where, you might wonder, is the news in all this? The reference to ‘feral youths’ is distinctively contemporary (rampaging teenagers being, as it were, one of the foul ﬂavours of our day). But has there ever been a time when newspapers—and perhaps indeed the rest of us too—haven’t been decrying the ‘downward spiral of Britain’? The fact that one of the faces staring out from the Sun’s front page is that of Stephen Lawrence, stabbed to death in a racist attack in south London in April 1993—ﬁfteen years ago—can be read as a discreet allusion to the timelessness of this nostalgia for a better, safer world. Which isn’t to say, of course, that we shouldn’t be shocked by Garry Newlove’s horriﬁc murder, nor that there are no lessons to be learned from it. But the fact remains that

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crime rates have actually fallen over the past ten years, even in London, where the Home Secretary apparently fears to tread. In the year up to March 2007, for example, crime in the capital fell to its lowest level for eight years, with gun and knife crimes and sex attacks all substantially down. And national ﬁgures show violent crime falling by 8 per cent in the twelve months to September 2007. Gun crime was up marginally (by 4 per cent), but the rise largely comprised incidents in which no one was injured; the number of gunrelated deaths actually fell (from 55 to 49; too many for sure, but still a much smaller number than you might guess from media coverage of the issue). And yet, we don’t seem to believe the (relatively) good news. As we saw in Chapter 3, despite all the data to the contrary most people believe that crime is increasing. An opinion poll carried out in the wake of Garry Newlove’s death, for instance, showed that 50 per cent of people felt less safe on the streets than a decade ago and 65 per cent thought under-16s shouldn’t be allowed out unsupervised after dark. (In truth, if anyone is at increased risk of a violent assault it’s not middle-aged parents, but socially disadvantaged black kids embroiled in gang-related conﬂicts.) Our estimate of the dangers facing us from crime is way out of proportion to the reality of the risk—which primes us all nicely for paranoid thoughts. And media over-reporting of these kinds of stories seems to play a signiﬁcant role in stoking our fears. (This isn’t, incidentally, an attack on the

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Sun in particular. It’s not just the tabloids that love a scare story: the so-called ‘quality’ papers and indeed the other media are just as smitten.) So when we’re looking for ways in which the levels of paranoia in society might be lowered, the role of the media might make a reasonable starting place. In fact, the issue is explicitly recognized in the BBC’s editorial guidelines: What exactly is the risk, how big is it, and who does it affect? If you are reporting a change in the level of risk, have you clearly stated the baseline ﬁgure? A 100% increase or doubling of a problem that affects one person in two million will still only affect one in a million. . . . We should consider the impact on public perceptions of risk if we feature emotional pictures and personal testimony. . . . Would information about comparative risks help the audience to put the risk in context and make properly informed choices? Consider for example, causing undue worry about safety of the railways could lead audiences to migrate to the roads unaware that the safety risk is many times greater.

There are speciﬁc BBC guidelines for the reporting of crime: Our output may add to people’s fear of becoming crime victims even when, statistically, they are very unlikely to be so. . . . This does not mean we should ‘explain crime away’, but we do need to keep our crime coverage in proportion. We must ensure that over time, all our principal news and factual programme outlets—network, regional and local— report the whole crime picture: the relevant trends as well as the individual events that lie behind, and sometimes contradict, them. Violent crime is a small percentage of total crime

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but it occupies a greater proportion of our crime coverage and we should be sensitive to the fears this may create.

This all seems eminently sensible stuff. Unfortunately, much of the media appears to take an alternative view (how successfully the BBC’s own output conforms to these guidelines is a question for another book). Of course, and lest we lose ourselves in a paroxysm of media-bashing, we need to remember that the newspapers and TV are often used by politicians and other public ﬁgures and organizations as a kind of mass consciousness-raiser, emphasizing particular threats in order to stimulate public awareness and/or win support for particular policies. Thus in the wake of two attempted car bombings in June 2007, the then-mayor of London, Ken Livingstone, was given wide coverage as he urged Londoners to remain vigilant in the face of ‘a very real threat’. Livingstone’s warning was understandable. The capital was clearly under threat and in such circumstances it’s obviously right to encourage people to report their suspicions. But there have been many hundreds of emotive pleas from ofﬁcials regarding the dangers of terrorism, not all of them as temperately expressed. Here, by way of one small example, is Jonathan Evans, the head of MI5, in November 2007 describing al-Qaeda-inspired terrorism as the ‘most immediate and acute peacetime threat’ the security service had faced in its 98-year history: ‘Terrorists are methodically and intentionally targeting young people and children in this

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country . . . They are radicalising, indoctrinating and grooming young, vulnerable people to carry out acts of terrorism.’ Evans’ dire warning, with its highly charged language evoking the evils of paedophilia, and its timing shortly before the government presented new anti-terrorism legislation, sparked a minor and short-lived furore, which we don’t intend to revive here. But it shows how the terms of debate are not always set by the media that carries it—and how journalists can ﬁnd themselves, merely by virtue of reporting speeches by major ﬁgures, feeding public fears. And it’s not just politicians, of course. As the media would no doubt argue, the public—at least to some extent— sets the journalistic agenda. Take the exit polls for the 2004 US presidential election, which showed that 19 per cent of voters saw terrorism as the most important issue (only the economy and ‘moral values’ scored higher). And a whopping 72 per cent of the US electorate saw terrorism as a major issue in the mid-term elections of 2006. Whether the public is inﬂuenced by a media preoccupation, or whether it’s the other way around, is a moot point (doubtless it’s a combination of both). So, though one might argue that the media over-reports the dangers of terrorism, any paper or TV station that didn’t reﬂect this public interest would probably soon ﬁnd that its audience had gone elsewhere. And remember that hoary newspaper axiom ‘If it bleeds, it leads’? Well, it points the ﬁnger right at us, the mediaconsumer. Because we seem to possess an unquenchable

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appetite for dramatic stories of danger, death, and destruction. Scaring ourselves silly proves to be a rather feebler disincentive than one might have predicted—as the enduring popularity of horror movies amply demonstrates. All of which suggests that changing the way our media covers certain stories is, to say the least, an ambitious proposition. Pie-eyed optimism it may be, but that shouldn’t blind us to the potential beneﬁts of such a shift. What we need is a recalibration of the relationship between risk and the reporting of that risk. If we get it right, the unrealistic fears that provide such a fertile breeding-ground for paranoia will ﬁnd it much harder to thrive. ■

Throughout this book we’ve made a big deal of the fact that paranoia is much more prevalent in society than most of us, including the scientiﬁc and medical establishment, had suspected. It may even be more prevalent than ever before. This may well seem a somewhat disheartening message. Are we condemned to a world of increasing suspiciousness and fear, or is there anything we can do to reverse the trend? Yes and no. Paranoia is so widespread that eradicating it completely is a pipe dream—as plausible as the elimination of sadness or stress. Moreover, there are occasions when it’s sensible to be wary of other people; blithely trusting everyone we meet is admirably open-minded but, sadly, likely to end in tears. That said, there are steps we can take to reduce the level of suspiciousness and fear in society (being alert

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to the media’s role in all this is one example), and to help us deal with paranoia when we experience these feelings as individuals. Before we explore these ‘anti-paranoia’ strategies in detail, a word of caution. Research into paranoia is at an early stage. This isn’t to say that it was ignored by doctors in the past, but rather to acknowledge that it was always seen as a symptom of something else (schizophrenia, for instance). As such, paranoia was of purely secondary interest, of signiﬁcance only in so far as it could help in the business of making a diagnosis. We believe, on the other hand, that paranoia is an experience of such centrality that it merits study in its own right. Happily, this is a view that’s becoming more accepted within the scientiﬁc and medical community, having been pioneered by the psychologist Richard Bentall. But, while much research has been done, and lots more is in progress, we have a long way to go. Exactly how far, you can judge from this little list of so far unresolved questions: r How common is paranoia among the general public? We have data indicating that it’s extremely frequent, but we need to put more ﬂesh on the bones, tracking rates of paranoia across time and in larger population groups. r What determines the content of paranoid thoughts? Why do we believe them and why is it they’re so difﬁcult to shake off ? Why are they sometimes so distressing?

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r How does everyday, low-level suspiciousness turn into clinical paranoia? r What impact does our social and physical environment have on the development of paranoia? r What’s going on in our brains when we have paranoid thoughts? And what role does our genetic makeup play? Most research into paranoia has looked at it as a psychological phenomenon, but the biological aspects need study too. r And, at the risk of you concluding that the rest of this chapter is going to comprise a series of blank pages, what can be done to reduce paranoia? All of which might seem to amount to a dismayingly full to-do list. Fortunately, however, the situation isn’t quite that hopeless. We have partial answers to most of these questions (as we hope the previous hundred or so pages have demonstrated). But the more completely we’re able to ﬁll in the gaps in our knowledge, the more effectively we’ll be able to combat paranoia, both on an individual and a wider social level. ■

We began this chapter with a reminder of the inﬂuence of the media on levels of paranoia, and a tentative suggestion as to how that inﬂuence could be more productively deployed. Fair enough, you may think, but can anything else be done?

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Well, one relatively straightforward strategy—certainly much easier than persuading the media not to go overboard on the latest apparent threat to the survival of humanity—is simply to make people aware of the prevalence and causes of paranoia. It turns out that the less people are willing to talk about their suspicious thoughts, the more troublesome those thoughts are. And the reason we don’t tend to discuss these feelings, even with trusted friends and family, is that we assume we’re the only ones with the problem. How could anyone else understand? And besides, what exactly is the problem? Am I, perhaps, going mad? Just knowing that suspicious thoughts are perfectly normal, that they aren’t a sign of impending insanity, and that there are tried-and-tested techniques to overcome them makes a huge difference to people. It’s one of the reasons we wrote this book. But more needs to be done to reach the unfortunate few who don’t happen to have read our work. What’s required is an educational campaign—targeted at health professionals as well as the general public—to raise awareness of paranoia, much as has been done successfully in the UK for problems like depression. Paranoia, after all, is just as common as depression, and often just as distressing. ■

Are you stuck in a rut? Thinking of upping sticks and starting afresh somewhere—perhaps in an entirely different country? If you are, you might prefer to opt for Sweden rather than,

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say, Russia. Because, although the two countries are near neighbours (separated only by the svelte form of Finland), life expectancy is twenty years greater in Sweden than in Russia. Of course what this really amounts to is the observation that living standards are much higher in Sweden, a fact you were probably already well aware of. But what may surprise you is the sheer extent of the effect on longevity of these living standards. The link between poverty and ill health, however, has been well established, and we have a mass of data to prove it. People in the poorest parts of Glasgow, for example, live on average twelve years fewer than those in the most afﬂuent districts. Men in relatively low-paid, low-skilled jobs are nearly three times more likely to die between the ages of 25 and 64 than men in senior managerial positions. And remember Oakley, the least deprived place in England we mentioned in Chapter 6? According to the 2001 census, 73 per cent of Oakley’s citizens aged 16–74 rated themselves as in good health; 5.5 per cent in poor health; and 1.3 per cent as permanently sick or disabled. Compare and contrast this with the neighbourhood in innercity north Liverpool ranked the most deprived. There just 55 per cent of people aged 16–74 felt that they were in good health; 16.6 per cent were in poor health; and almost 15 per cent described themselves as permanently sick or disabled.

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Paranoia, as we saw in Chapter 3, is associated with a whole series of social factors: urban living, isolation, migration, and victimization. But the thread running through them all, intensifying their effects and magnifying distress, is poverty and deprivation. (‘Deprivation’ and ‘poverty’, incidentally, are used here as relative terms. The very poorest people in Western societies today have many more material comforts than their equivalents a hundred years ago. But colour television, central heating, and proper sanitation don’t prevent them suffering the disadvantages associated with deprivation. This suggests that it’s not ‘poverty’ per se that’s responsible. It’s primarily a question of wealth inequality—the size of the gap between the richest and the poorest in society.) Now clearly these kinds of statistics—of which there are many, many more than the tiny sample we’ve given above— can stand a lot closer interrogation than the rather cursory glance we’ve given them here. Exactly how poverty and health are interrelated is the subject of a substantial body of scholarly research. But there is a bottom line, and it’s this: the poorer you are, the worse your health and the shorter your life expectancy are likely to be. One theory for the link between deprivation and health centres on the role of stress. Now stress is a curious beast. Rather like a good (or indeed average) wine, a little of it can make life more enjoyable and interesting. Too much, on the other hand, can have considerably less attractive

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consequences, including damaging our cardiovascular and immune systems. Living with deprivation is known to be extremely stressful. But it’s not only our physical health that is compromised by poverty: our psychological well-being is also adversely affected. Because when stress gets out of hand, it can trigger and exacerbate mental illness. Fascinating light on this intertwining of the physical and psychological effects of deprivation has been cast by some recent work in neuroscience. One of the many unhappy side-effects of poverty is a feeling of social exclusion. We can feel rejected, marginalized, or even abandoned by the rest of society. When the psychologists Naomi Eisenberger and Matthew Lieberman looked at the language we use to describe our experience of social exclusion, they found that it’s full of references to physical pain (people often talk, for example, of having a ‘broken heart’ or of being ‘hurt’). But there’s much more going on here than a mildly interesting linguistic coincidence. Because neuroimaging scans show that, whether the ‘pain’ is psychological or physical, the same part of the brain—the anterior cingulate cortex—is activated. This makes evolutionary sense: being abandoned by society is just as dangerous to our chances of survival as any physical illness. When it comes to paranoia, deprivation seems to be implicated here too. Research by Ichiro Kawachi and colleagues, for example, looked at income inequalities across

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thirty-nine US states. What they found was that the states with the biggest inequalities also had the lowest levels of voluntary group membership, which the researchers used as an index of community cohesion and ‘civic engagement’. And to reinforce the point, people in these states also displayed the lowest levels of trust in one another. Much the same conclusion has been reached by Eric Uslaner, a professor of government and politics at the University of Maryland, who argues that the rise of distrust in the US is directly related to growing inequalities of wealth. ‘The more equitable the distribution of wealth in a country,’ Uslaner comments, ‘the more trusting its people will be.’ A society in which people are divided by huge differences in income—and all that this brings in its wake—is a fractured society, breeding conﬂict, unhappiness, and distrust. We perceive our fellow citizens as strangers, competitors, and even persecutors. When community cohesion dissolves, levels of suspicion rise (as we saw in Chapter 3 when we looked at the role played by urbanization and migration in the development of paranoia). And as so often with mental illness, it’s the people at the bottom of the social heap who are most adversely affected. The poorer you are, the less trusting you’re likely to be—and, as a consequence, the more prone to paranoia. (More research is needed, but at least part of the explanation may lie in the feelings of powerlessness, and the experience of victimization, that poverty often brings with it. For the poorest in society, the world can often seem a very hostile place.)

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As if all this weren’t enough, societies with the highest levels of distrust also seem to have higher rates of mortality. Exactly why this should be the case is a matter for speculation. It may be related to the increased stress that living in this cold emotional climate is likely to entail; or perhaps societies that allow income inequalities to ﬂourish are also unlikely to provide the kind of infrastructure (such as a top-class public health system) required to keep the population in good shape. Although we don’t yet have a clear sense of the causes, the ﬁgures are startling. Kawachi et al. found that, as levels of trust rise by 10 per cent, the death rate declines by 8 per cent. Or, to put it another way, for every 1 per cent increase in the number of individuals believing that other people want to take advantage of them, there are 6.7 more deaths per 100,000 of the population. The effects of inequality have been eloquently summarized by the leading epidemiologist Richard Wilkinson, in his inﬂuential book Social Determinants of Health: with large socio-economic inequalities, societies will have bigger problems of low social status, feelings of inferiority, and subordination; with larger inequalities, the quality of social relations will deteriorate, leading to increases in violence and reductions in both trust and involvement in community life.

Which hardly makes for cheering reading in a world where inequalities of wealth show few signs of reducing. In the UK, for example, the top 1 per cent of the population increased their share of national wealth from 20 to 23 per cent in the

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period 1997–2002; the wealth of the poorest 50 per cent of the population, on the other hand, steadily dwindled from 10 per cent in 1986 to 7 per cent in 1996 and 5 per cent in 2002. The story is much the same in the US, which has the greatest inequalities of wealth of any nation. Between 1973 and 2000, for instance, the average income of the bottom 90 per cent of US taxpayers fell by 7 per cent, while the income of the top 1 per cent grew by a massive 148 per cent. The top 20 per cent of US households now enjoys almost 50 per cent of the country’s total income, while the bottom 20 per cent owns just 3.4 per cent of it. All of which means that the next item on our antiparanoia wish list is governmental policies to reduce inequalities of wealth. The beneﬁts of such an initiative are likely to be many and varied. But among them would be lower levels of social exclusion, stress, insecurity—and paranoia. However, rather like our suggestions regarding the media, it might be unwise to hold one’s breath in eager anticipation. Many governments have committed themselves to the eradication of inequality—indeed, a list of governments that hadn’t declared such an aspiration would make interesting, although probably momentary, reading. To date at least, few of these pledges have been honoured—though that only makes them more pressing. ■

Back in 1992, a team of researchers led by the psychiatrist Scott Weich investigated the relationship between our

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mental health and our environment. What they found from their survey of 2,000 Londoners was that, if you knew what kind of accommodation an individual lived in, you could predict with some accuracy whether or not that person suffered from depression, and how severely they were affected. (This was true even allowing for socio-economic status; in other words, the rates of depression apply across the board rather than being simply a sign of poverty.) So if you want to stay happy, try to avoid the following: r Houses with structural problems, such as damp, a leaking roof, rot in the woodwork, and infestation r Accommodation with mostly deck access (the sort of shared walkways typical of many 1960s housing projects) r Houses built after 1969 r Accommodation with fewer private gardens or less shared recreational space This raises a key question: if certain types of accommodation seem to exacerbate psychological problems, what kind of houses could we build instead to improve people’s wellbeing? But it’s not merely a matter of the home we happen to live in. As the World Health Organization (WHO) has argued: In every city, people’s relationships with each other and with their environment fundamentally determine their well-being. . . . [European] city residents . . . experience stress caused by social pressure, rapid change in lifestyles, job

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insecurity, unemployment, more single-person households and patterns of urban development in recent decades. These patterns include urban sprawl and isolated suburbs, inappropriate transport systems established to serve a sprawling city and large, anonymous shopping centres.

Our mental and physical health—including, as we saw in Chapter 3, our tendency towards paranoia—is hugely inﬂuenced by the entire urban environment. And when you remember the rapid rate at which humanity is migrating from the country to the city, and the ballooning number of megacities with populations in excess of ten million, these questions begin to seem very urgent indeed. Questions are all very well, of course, but what about answers? As ever, we urgently need more research on the issues, but here’s how the epidemiologist Tony McMichael has described the task facing us: Urbanisation has recently become both socially and ecologically somewhat dysfunctional. This situation poses risks to the sustainability of good health. . . . In the globalised world of the twenty-ﬁrst century, we will need to modulate our design of cities. This will entail bringing back nature, via urban greenery, gardens and horticulture. It will require intraurban community facilities on a human scale, for high density ‘urban village’ nodes, separated by parklands, recreation facilities and garden plots, and connected by light-rail transport. Energy generation and transport will depend increasingly on environmentally benign technologies.

The WHO has set out a number of criteria for a truly ‘healthy’ city. Among them are:

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r a strong, mutually supportive and non-exploitative community

r a high degree of participation in and control by the citizens over the decisions affecting their lives, health and well-being

r access by the people to a wide variety of experiences and

resources, with the chance for a wide variety of contact, interaction and communication r a diverse, vital and innovative economy r the encouragement of connectedness with the past, with the cultural and biological heritage of city dwellers and with other groups and individuals

Cities must meet our basic needs for food, water, shelter, employment, health care and so on. But they must also be places where cohesive communities can thrive, and where the inequality, isolation, and exclusion that breeds paranoia can’t get a foothold. Easier said than done, naturally. But one thing is certain: we won’t stumble upon healthy cities by chance. As the WHO has pointed out: cities and towns need to be more consciously planned if they are to address sustainability properly; this cannot be left to spontaneous mechanisms or to market forces. Planning practices need to be changed to reﬂect a new awareness and to integrate environmental, health, economic and social concerns in the twenty-ﬁrst century.

Regrettably, the WHO is neither property developer nor urban planner. To what extent its laudable suggestions will

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be adopted by those that are, remains to be seen. But we won’t be making a down-payment on any property just yet. ■

An end to inequality. The transformation of our cities. A disciplined and temperate media. In sum, a range of measures in all areas of our society (from education to town planning, employment to immigration policies) designed to build social cohesion. To which we might add—while we’re aiming for the stars—the restoration of public trust in authority, from the government to the police to doctors and teachers. When we survey our list of recommended measures for tackling paranoia, the spring soon leaves our step. It’s difﬁcult to hold out much hope that the problem is going to be tackled successfully any time soon, though these issues are certainly taken seriously by many in government. But, if progress at this macro-socio-economic level is going to be slow, thankfully we do at least have an armoury of triedand-tested techniques to combat paranoia on an individual basis. People with persecutory delusions, which is what psychologists call the most severe form of paranoia, are generally treated with anti-psychotic drugs. But because these drugs are strong tranquillizers they can have some very unpleasant side-effects, including feeling disconnected from

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the world around you, impotence, weight gain, constipation, drowsiness, diabetes, heart problems and, in extremely rare cases, death. These are not drugs you want to be taking unless there’s absolutely no alternative. Antidepressants are often prescribed for people whose paranoia is less serious, but who still ﬁnd it interferes with their lives. The idea is that the antidepressant will help tackle whatever emotional problem—and it might not be depression—is triggering the paranoid thoughts. The sideeffects are usually much less troublesome than those of anti-psychotics, and the drugs can be moderately effective for a while. For most people, however, they’re not a longterm cure-all. But there’s a bigger issue at stake here than simply the efﬁcacy or otherwise of these drugs. Do we really want medication to be the standard treatment for paranoia? Given the prevalence of paranoid thoughts, that’s going to mean a very large number of people taking antidepressants (or rather, an even larger number, since the ﬁgures are already astronomical). And remember that, for most of us at least, paranoia isn’t an illness. It’s a style of thinking, a way of looking at the world—and one that everyone ﬁnds themselves in the grip of from time to time. We don’t need medication to change the way we think or, more speciﬁcally, to stop unhelpful thoughts dominating our lives. Much more effective over the long term are psychological therapies (the so-called ‘talking therapies’ or ‘psychotherapies’). And best of this particular bunch is cognitive behaviour therapy (usually,

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and quite understandably given that life is short, referred to by its acronym of CBT). CBT was developed in the 1960s by the eminent American psychiatrist Aaron T. Beck as a treatment for depression, and it’s now used to treat a range of problems—including paranoia. CBT, explains the psychologist Gillian Butler, is ‘based on the recognition that thoughts and feelings are closely related. If you think something is going to go wrong, you will feel anxious; if you think everything will go ﬁne, you feel more conﬁdent.’ There’s an appealingly elegant insight at the core of CBT: change the way you think, and you’ll change the way you feel. Elegant insights are all very well, but how do they translate into practical therapy? We crystallized CBT into six key steps in Overcoming Paranoid and Suspicious Thoughts, a selfhelp book for people with paranoia (indeed, the only selfhelp book on the topic, which tells you something about the proﬁle of paranoia in medical circles until very recently). So stand by for CBT for paranoia, the nutshell version: 1. Become a detached observer of your fears. We can’t hope to tackle our paranoia unless we get some perspective on it. So we show readers how to monitor their paranoid thoughts using diaries and other writing exercises. 2. Understand what causes paranoia. Like all fears, paranoia loses much of its power if we know what’s causing it. As part of that process of understanding, we ask readers to focus in detail on one or two recent episodes of paranoia. We show

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them how to analyse the roots of their paranoid thoughts and, in particular, the role played by such key factors as difﬁcult life events, emotions (particularly stress and anxiety), confusing social encounters, anomalous experiences, and reasoning habits. 3. Don’t just accept your suspicious thoughts: question them. Paranoid thoughts often seem really compelling and plausible—which is ironic since, by deﬁnition, they won’t stand up to careful scrutiny. Instead of taking them at face value, we need to challenge these thoughts, weighing up the evidence for and against, and seeking out alternative explanations for the way we’re feeling. Here are some of the questions we suggest people ask themselves: r Is there anything that might suggest the paranoid thought could be wrong? r What would I say to a friend who came to me with a similar problem? r Are there any alternative explanations for what seems to have happened? r If I was feeling happier, would I still think of things in the same way? r Are my past experiences getting in the way of me seeing the present situation clearly? 4. Put your paranoia to the test. Nothing disarms a paranoid thought so effectively as actually testing it out. We set out a

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range of techniques to help readers confront their fears for real. These strategies were put to good use by Rosie, a 51-year-old woman from London, who was convinced that local children were out to get her. Rosie’s family had seen no evidence to back up her fears, but she never went out unless it was early in the morning or late at night when there were no children around. (This safety behaviour, of course, meant she didn’t get to see whether her fears were really justiﬁed.) Rosie began testing her anxieties by going to the local park during the day. Once she felt comfortable doing that, she moved on to standing outside the nearby school as the kids streamed home at the end of the day. Much to her amazement, she found that the children didn’t give her so much as a glance, let alone attack her. 5. Let go of your suspicious thoughts. Everyone has these kind of thoughts. And they can sometimes play a crucial role in keeping us safe. But though it’s unrealistic to think we can put a complete stop to them, we can improve the way we deal with these thoughts when they do occur. The trick is not to focus on them, to develop what’s known as a mindful attitude. Don’t ﬁght your thoughts and don’t spend time thinking about them. Try to be detached. Watch the thought come to you, remind yourself that it doesn’t matter, and let it go off into the distance. Concentrate on what you’re doing, rather than what you’re thinking.

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6. Reduce the time you spend worrying about paranoid thoughts. Worrying makes everything worse, including paranoia. We put the spotlight on catastrophizing (the ‘what if ?’ thinking that always foresees the worst possible outcome for any situation); show how to conﬁne your fretting to well-deﬁned worry periods; and, most importantly, how to stop worrying and start problem-solving. ■

At the risk of sounding as if we’re peddling snake oil, this stuff really works. CBT has been subjected to lengthy and rigorous scientiﬁc testing (using the ‘gold standard’ of randomized controlled trials) with the result that in the UK and other countries it is now an ofﬁcially recommended treatment for paranoia. Which is not to say that all in the therapeutic garden is unequivocally rosy. CBT doesn’t help everyone with paranoia (in particular, people with very serious delusions often need other types of help). CBT for paranoia is still developing and improving, based on the kind of scientiﬁc research we describe in this book. And then there’s the small matter of ﬁnding a therapist trained in both CBT and paranoia. At the moment, not only are such people thin on the ground, but the opportunities for therapists to train in this area are even thinner. This is one of the reasons we wrote Overcoming Paranoid and Suspicious Thoughts: so people could learn to help themselves.

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CBT doesn’t come without its caveats then, at least in the short term. But because it’s based on hard scientiﬁc evidence, it’s a therapy of both outstanding potential and proven efﬁcacy. It certainly represents our best bet for overcoming paranoia. Sadly, until the social changes we’ve sketched out in this chapter are put in place, these CBT techniques are likely to get an awful lot of use.

8

CONCLUSION

Or, Enjoy the Fruit ................................................................................

October 1, 2007 and London is in the grip of another terrorism alert. Shoppers in Soho are sparked into panic by a strange noxious-smelling cloud. Suspecting the capital is under chemical attack, the emergency services cordon off roads and evacuate the area. Meanwhile, ﬁreﬁghters wearing breathing apparatus begin a three-hour search for the source of the stench. This eventually turns out to be the Thai Cottage restaurant where, until he’d been asked to leave his kitchen, chef Chalemchai Tangjariyapoon had been midway through preparing a batch of nam prik pao. ‘We only cook it once a year—it’s a spicy dip with extra hot chillies that are deliberately burned’, he said later. ‘To us it smells like burned chilli and it is slightly unusual. I can understand why people who weren’t Thai would not know what it was but it doesn’t smell like chemicals. I’m a bit confused. . . . When we came

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back at 7.30 p.m. we saw the door had been smashed and there were ﬁre brigade and police waiting outside. I was a bit scared but they were very nice about it.’ Should you wish to have a go at making the abovementioned Thai dip, you will need charred chillies, garlic ﬂakes, dried shrimps, palm sugar, shrimp paste, tamarind, and vegetable oil. But then again, given Mr Tangjariyapoon’s experience, you might prefer to let the experts handle it. Provided they still dare. Because, as the staff of the Thai Cottage know only too well, right now we’re more than a little jumpy. Threats seem to loom at us from all quarters. And of course sometimes it’s right to be cautious. Lurking within the kitchen of the Thai Cottage was nothing more sinister than a superspicy savoury dip, but Londoners are well aware of the havoc terrorists can wreak. Muggers, vandals, delinquent teenagers, paedophiles, rapists, corrupt ofﬁcials, malicious colleagues, gossips, spies, and blackmailers—none of these are entirely the ﬁgment of our fevered imaginations. The trick, of course, is to keep a sense of perspective, recognizing that these kinds of dangers are rare and taking that on into a calm and measured assessment of risk. When we look at the data on rates of paranoia, however, it appears that many of us are ﬁnding that trick increasingly difﬁcult to pull off. At any one time, around a quarter of the population are having regular paranoid thoughts, with lots more people probably experiencing them occasionally.

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Our fears have gotten the better of us, and the twenty-ﬁrst century begins to look like a new age of paranoia. ■

How did we get to this point? Why is paranoia so prevalent in society? And how does it work on an individual level? We hope this book has gone some way to providing answers to these key questions. And now that we’ve reached the ﬁnal chapter, let’s take a quick look back at where we’ve been. We should start with the sober scientiﬁc acknowledgement that any historical view of the development of paranoia is necessarily speculative. There’s enough evidence to suggest that it’s long been a feature of human behaviour. But sadly we simply don’t have the data to say for certain whether paranoia is increasing. That’s partly because, until very recently, no one was much interested in paranoia, except as a symptom of serious mental illness. This also meant that the scale of paranoia was vastly underrated. Nineteenth-century psychiatrists didn’t realize that what they were observing in their clinics was merely the tip of a very large iceberg. (They didn’t know because it never occurred to them to put their heads below the metaphorical water.) What we understand now, however, is not only that paranoia is widespread, but that there is a connection between experiences as apparently diverse as mild suspiciousness and really severe delusions. These are not unrelated psychological phenomena; they are in fact the opposite ends of a

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spectrum of paranoia, with their similarities far outweighing their more obvious differences. Trying to clinch the argument without hard statistical evidence is a futile exercise, but there are a number of social and economic trends that point to a likely rise in paranoia. Urbanization; migration; social isolation; income inequalities; the tendency of the media to highlight the sensational and scary: all these factors can raise our levels of fear and anxiety, thereby preparing the ground for paranoia to thrive. Indeed, it may be that the kind of consumer capitalism we see in countries like the UK, US, and Australia predisposes us to suspicious thoughts (though it goes without saying that paranoia has also often led a full and extremely active life in Communist countries). An emphasis on individual economic success can encourage us to see other people as competitors and potential threats. (For many people, this view of the world is epitomized by Margaret Thatcher’s assertion in 1987 that ‘there is no such thing as society. There are individual men and women, and there are families. . . . and people must look to themselves ﬁrst.’) And what would the world of business be without competitiveness? When it comes to business, I believe in the value of paranoia. Business success contains the seeds of its own destruction. The more successful you are, the more people want a chunk of your business and then another chunk and then another until there is nothing left.

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This might seem a rather extreme statement. (It was made, incidentally, by Andrew S. Grove, former president and CEO at the computing giant Intel.) Business isn’t inherently paranoid (unless, like Mr Grove, you choose to see it that way). Believing that competitors want to take your business isn’t fantasy: it’s the nature of the game. And yet this kind of aggressive, candidly hostile capitalism nonetheless seems to play to our paranoid tendencies, fostering a sense of other people as enemies who need to be defeated. Finally, and as if all this weren’t enough, trust in authority seems largely to have broken down. We now positively expect our leaders to lie to us. Barely a week goes by, it seems, without another cover-up or scandal being dragged kicking and screaming into the light. Conspiracy theories multiply. Picture Hunter S. Thompson taking a drag on his cigarette, draining his tumbler of whisky, and drawling: ‘This is the Nineties, Bubba, and there is no such thing as Paranoia. It’s all true.’ ■

These kinds of issues play a big role in paranoia, but they’re only one element in a much more complex picture. In fact, we believe paranoia is caused by the subtle interaction of four factors: r Anomalous experiences and ambiguous events r Our emotions

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r Our previous experiences r The way we reason When you put them all together, you get something we like to call the threat-anticipation model of paranoia. Paranoia is essentially a failure of interpretation. Or, in the words of American comedian Emo Phillips: ‘I was walking home one night and a guy hammering on a roof called me a paranoid little weirdo. In Morse code.’ Understanding what’s going on around us can sometimes be tricky. And it’s not made any easier by the fact that we can never know for sure what someone else is thinking. That leaves plenty of leeway for our imagination to get to work on, say, a glance in our direction, or an overheard snatch of conversation. Then there are the odd feelings—known to psychologists as anomalous experiences—we discussed in Chapter 5 and that are generally caused by extreme stress, drugs, or alcohol. These ambiguous events and anomalous experiences (factor number one in our threat-anticipation model of paranoia) can leave us ﬂoundering to make sense of the world. But, just as nature abhors a vacuum, human beings abhor ambiguity. Ignorance isn’t an option. We want an explanation for the strange way we’re feeling, or the smile on our boss’s face when we passed her in the corridor. For some of us, that explanation may be a paranoid one. So our boss is really feigning friendliness, trying to mask what she

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really thinks of us. Our peculiar feeling of being on edge is because our colleagues have been getting at us all morning, and not because we’re exhausted after several sleepless nights. But why should some people be more prone to this kind of misinterpretation than others? After all, everyone experiences stuff they can’t explain, but most of us don’t view it as evidence that other people are hostile towards us. The explanation lies somewhere deep in the mix of our previous experiences, social and economic inﬂuences, our emotional state, our memories, personality, and reasoning style. And of all these inﬂuences, it’s our emotions (factor number two) that are key. Anxiety, in particular, is intimately connected to paranoia. In fact, if you know how anxious someone is, you’ll be able to hazard a fairly accurate guess at their level of suspiciousness—an association that seems less of a surprise when you realize that paranoia is in essence a form of anxiety. Both are concerned with the anticipation of danger. In the case of paranoia, that danger is seen (albeit mistakenly) as coming from other people. And just as anxiety feeds off worry, so too does paranoia. Worry makes us dwell on our fears, magnifying and entrenching them. This is especially true for people whose previous experiences have led them to feel negatively about themselves, other people, and the world in general (factor number three). After all, if you see yourself as weak and vulnerable, and other people as cruel and dangerous, it doesn’t require

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too much of a leap of imagination to start thinking that people might want to harm you. Our suspicious thoughts are simply an extension of our anxieties. And here’s where we slot in the fourth piece of the paranoid puzzle: the way we reason. Remember the belief conﬁrmation bias—the tendency to only notice things that conﬁrm our preconceptions and to dismiss whatever challenges them—we discussed in Chapter 6? And how some of us are prone to jump to conclusions on the ﬂimsiest of evidence? The more we’re given to these types of reasoning, the more severely we’re likely to be troubled (and troubled on a long-term basis) by paranoid thoughts. Which, when you think about it, is no surprise. This kind of thinking shrinks our universe, jettisoning any element that seems to contradict our paranoia, and reinforcing our anxieties. As if this weren’t bad enough, we can ﬁnd ourselves locked into the dreaded vicious circle. We dwell on our fears, which makes us anxious and depressed, which can trigger anomalous experiences, which provides us with even more ‘evidence’ that our suspicions are justiﬁed—and round we go again. For some people, there’s a further unhappy circuit to be endured. Their fears make them behave suspiciously or even aggressively towards other people. Naturally, it’s hard to make (or keep) friends acting this way; the paranoid person can ﬁnd themselves increasingly isolated, or at least treated differently by those around them. All of which can feel precisely like the persecution they’ve been fearing all along.

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At this point, we have an admission to make. Clearly, the premise of this book is that paranoia is—how can we put it?—not a good thing. Broadly speaking, that’s true. But paranoia isn’t always a problem for people. Not everyone ﬁnds their suspicious thoughts upsetting. So what makes paranoia distressing for some people and not others? As you could doubtless have predicted, the answer lies in a combination of factors. First, and not entirely surprising, the more we believe our paranoid thoughts to be true, the more upsetting they’ll seem. (The kind of reasoning biases we describe in Chapter 6 are heavily implicated here.) Once we start thinking there’s some truth to our suspicions, we start behaving differently too. We might adopt safety behaviours or change the way we act with other people, becoming nervous or upset, secretive, or even hostile. And this kind of behaviour only serves to reinforce our paranoia. And then there’s the effect on our emotions. For a start, paranoid thoughts can make us extremely anxious, as we worry about the danger we may be in. And just knowing that they’re in the grip of paranoid thoughts can be profoundly depressing for some people. They may feel as if they’ve failed, or as though there’s something wrong with them. Their paranoia may seem uncontrollable and permanent. And it may seriously interfere with their everyday lives. All of which is likely to make them depressed and anxious, again leaving them even more vulnerable to paranoia, and

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increasing their levels of distress. And thus another vicious circle is formed. ■

Life, as we’ve seen, is nothing if not ambiguous. Consider a simple gift basket of fruit. Generally speaking, it is what it looks like: an attractively presented collection of exotic delicacies. But not always, or at least not always in Hollywood. Witness the sitcom writer Rob Long, waiting anxiously for news of his latest project: A messenger appears at our door, burdened by three large fruit baskets from our network. We panic. I call my agent.  We’re dead! They sent us fruit baskets!   What?  We’re dead!   I’ll call you right back. . . . Moments pass. The phone rings.   I just spoke with the VP over at the network. He assures me that the network is truly happy with the pilot, and that the fruit baskets are actual fruit baskets.  They’re really happy? Are you sure?   I’m sure. Enjoy the fruit.

Paranoia can turn any gift basket into a death sentence. It’s amazingly widespread, resilient, and creative—and it may well be on the rise. But it can also be beaten. To do so requires measures targeted at society as a whole, and at individuals. Governments must play the major role with the former. We need a range of policies to raise public

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awareness of paranoia; train therapists; and tackle the effects of potentially damaging social and economic trends. The problem, fortunately, is simpler to deal with at an individual level. Cognitive behaviour therapy has a proven track record of helping people overcome paranoia. And though trained therapists aren’t as plentiful as they might be, you can make real progress by using the techniques yourself. Enjoy the fruit.

SOU RCES

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GENERAL

Bentall, R. (2004). Madness Explained. London: Penguin. Corcoran, R., Howard, R., Blackwood, N., & Kinderman, P. (2001). ‘Persecutory delusions’. Clinical Psychology Review, 21, 1143–92. Freeman, D., Bentall, R., & Garety, P. (Eds.) (2008). Persecutory Delusions. Oxford: Oxford University Press. Freeman, J., & Garety, P. (2006). Overcoming Paranoid and Suspicious Thoughts: A Self-Help Guide Using Cognitive Behavioural Techniques. London: Constable & Robinson. Garety, P. (2004). Paranoia: The Psychology of Persecutory Delusions. Hove: Psychology Press. (2007). ‘Suspicious minds: the psychology of persecutory delusions’. Clinical Psychology Review, 27, 425–57.

CHAPTER 1

‘Be a “Bad” Parent and Let Your Children Out’, Daily Telegraph, 6 June 2007. Berrios, G. (1991). ‘Delusions as “wrong beliefs”: a conceptual history’. British Journal of Psychiatry, 159 (s14), s6–s13. Bogart, L. M. & Thorburn, S. (2006). ‘Relationship of African Americans’ sociodemographic characteristics to belief in conspiracies about HIV/AIDS and birth control’. Journal of the National Medical Association, 98, 1144–50.

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Brown, K. M., Keppel, R. D., Weis, J. G., & Skeen, M. E. (2006). Case Management for Missing Children Homicide Investigation. US Department of Justice. Butler, R. W., Mueser, K. T., Sprock, J., & Braff, D. L. (1996). ‘Positive symptoms of psychosis in posttraumatic stress disorder’. Biological Psychiatry, 39, 839–44. Cohen, C. I., Magai, C., Yaffee, R., & Walcott-Brown, L. (2004). ‘Racial differences in paranoid ideation and psychoses in an older urban population’. American Journal of Psychiatry, 161, 864–71. Coleman, K., Jansson, K., Kaiza, P., & Reed, E. (2007). Homicides, Firearm Offences and Intimate Violence 2005/2006. Home Ofﬁce Statistical Bulletin. Cruickshank, A. (2006). ‘Diary of a paranoid schizophrenic’. Schizophrenia Bulletin, 32, 614–15. Department for Transport. (2007). Road Casualties Great Britain 2006. London: The Stationery Ofﬁce. Freeman, D., Garety, P. A., Bebbington, P. E., et al. (2005). ‘Psychological investigation of the structure of paranoia in a non-clinical population’. British Journal of Psychiatry, 186, 427–35. GfK NOP Social Research. (2006). Attitudes to Living in Britain— A Survey of Muslim Opinion. Poll carried out April 2006, available at www.imaginate.uk.com. Ipsos Reid. (2006). Canadians Reﬂect on the Fifth Anniversary of 9/11/01. Poll carried out September 2006, available at www.ipsosna.com. Jaspers, K. (1913/1963). General Psychopathology (trans. J. Hoenig & M. Hamilton). Manchester: Manchester University Press. Johns, L. C., Cannon, M., Singleton, et al. (2004). ‘The prevalence and correlates of self-reported psychotic symptoms in the British population’. British Journal of Psychiatry, 185, 298–305. Johnson, J., Horwath, E., & Weissman, M. M. (1991). ‘The validity of major depression with psychotic features based on a community sample’. Archives of General Psychiatry, 48, 1075–81.

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INDEX

.................

African Americans 6, 33–4 Aids, and inaccurate beliefs about 5–6 air travel, and exaggeration of dangers 48–9 alcohol 104 alien abductions 99–100 Allen, Woody 29–30, 74–5 ambiguity 34, 35, 88, 157, 161 Ames, Frances 100–2, 105 Anatomy of Melancholy 19–21 Andersen, Susan 89 anomalous experiences: and dopamine 107 and drugs 100–4 and ignorance of 108–9 and memory 105–6 and paranoia 86, 90–1, 92–3, 157 arousal 91 perceptual anomalies 91–2, 93 and sleep problems 96–7 sleep paralysis 97–100 and solitary conﬁnement 93–5

and stress 95 anthrax scares 42 antidepressants 146 anti-psychotic drugs 145–6 Antley, Angus 69 anxiety: and media coverage of events 42 and paranoia 73, 75–8, 158 and safety behaviours 77–8 and threat anticipation 76 appeasement 77 arousal, and paranoia 91 autism 115–16 autoscopy 98 availability heuristic 44 avoidance 77 Bacon, Francis 117 BBC 129–30 beads task 111–13 Beck, Aaron T. 147 belief conﬁrmation bias 117–20, 159 Bentall, Richard 133

182

I N DEX

Bleuler, Eugen 23, 25 Brief Core Schema Scales 78 Bryson, Bill 84 Burton, Robert 19–21 Butler, Gillian 147 Camberwell 110–11 Cameron, David 127 cannabis: and anomalous experiences 100–2 and mental illness 102–3 capitalism 155–6 catastrophizing 74–5, 150 CCTV 5 Chapman, Robert 122–5 children: and increasing supervision of 2–3 and murders of 3–4 and obesity 1–2 and sedentary lifestyle 2, 4 and worries about 3 cities: and growth of 52–3 and healthy cities 143–4 and mental illness 53–4 Clinical Psychiatry 13–14 Clinton, Bill 33 coffee 103 cognitive behaviour therapy (CBT) 146–51, 162

community cohesion 139 and cities 144 competitiveness 155–6 conspiracy theories 5–8, 39 consumer capitalism 155–6 crime: and BBC guidelines for reporting 129–30 and media coverage 126–8 and perceptions of 61, 128 and rates of 60–1, 127–8 Cruickshank, Andrew 12 culture, and types of harm feared 29 deafness, and paranoia 88–90 death: and causes of 49 and estimates of causes of 45 decision-making: and beads task 112 and jumping to conclusions 112–14 delusion-as-defence theory 83 depersonalization 92 depression: and belief conﬁrmation bias 120 and housing 142 and paranoia 20–1 and persecutory delusions 11

I N DEX

deprivation: and health 136–41 and paranoia 137, 138–9 and stress 138 desensitization 69 Diana, Princess of Wales 7 Dodgson, Guy 113 Domarus, Eilhard von 114–15 dopamine 107 drugs: and anomalous experiences 100–3 and treatment of paranoia 145–6 and use of 103–4 Dunham, H. Warren 55 education 135 Eisenberger, Naomi 138 emotional stickiness 44 emotions, and paranoia 73, 83–4, 158–9 anxiety 73, 75–8, 158 feelings about ourselves and others 78–81, 158–9 worry 73–5, 150, 158 employment market, and changes in 56–7 environment: and health 141–3 and healthy cities 143–4 and reasoning 112–13

183

Evans, Jonathan 130–1 experience, and interpretation of 72, 157–8 extraterrestrials 7 and alien abductions 99–100 extroversion/introversion 118–19 Faris, Robert 55 fear: and paranoia 5, 20, 21 and range of sources of 24–7 ﬁnancial harm 28 Freud, Sigmund 82–3 Frith, Chris 116 Frith, Uta 116 Garety, Philippa 112 genes: and paranoia 84 and schizophrenia 84–5 ghosts 26 Gladwell, Malcolm 44 Glasgow 136 Grassian, Stuart 93–4 Grove, Andrew S. 155–6 hallucinations 92 and sleep deprivation 96 and sleep paralysis 98–100 harm, and types of harm feared 27–9

184

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heightened sensitivity 91, 93–4 Heinroth, Johann 22–3 Hemsley, David 105 heuristics 43–4 Hippocrates 21–2 homosexuality 82–3 housing, and mental health 142 incubus hallucinations 98–9 Index of Multiple Deprivation 110–11 inequality: and health 136–41 and reduction of 141 insomnia 96–7 intruder hallucinations 98 James I 16 Jaspers, Karl 13 John, Carolyn 113 Kabat, Loren 89 Kahneman, Daniel 43 Kapur, Shitji 107 Kawachi, Ichiro 138–9 Kraepelin, Emil 23 Laruelle, Marc 107 Lawrence, Stephen 127 Lieberman, Matthew 138 life expectancy, and living standards 136

Livingstone, Ken 130 Long, Rob 161 McMichael, Tony 53, 56, 143 madness, and paranoia 11, 13, 22–3 mass panics 41–3 and media 47 media: and BBC editorial guidelines 129–30 and crime reporting 126–8 and role in increase in paranoia 47–52, 128–9, 132 megacities 52, 53, 143 Memoirs of My Nervous Illness (Paul Schreber) 81–2 memory 105–6 mental illness: and cannabis 102–3 and migration/migrants 57–9 and paranoia understood as symptom of 11–14 and psychosis/neurosis distinction 12–13 and rural/urban divide 53–4 and social isolation 55–6 and stress 95–6, 138 and traumatic events 59–60, 95–6

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migration/migrants 57–9, 62–3, 81 Mitchell, Jerry 24 mortality rates, and distrust 140 murder, and children 3–4 negative feelings about ourselves and others 78–81, 158–9 negative-thinking 74 neurosis, and psychosis 12–13 neurotransmitters 107 Newlove, Garry 126, 127 newspapers, see media Newton, Stuart 126 Nijinsky, Vaslav 25 Oakley 111, 136 obesity 1–2 out of body experiences 98 Overcoming Paranoid and Suspicious Thoughts 147, 150 paranoia: and anomalous experiences 86, 90–1, 92–3, 157 arousal 91 dopamine 107 drugs 100–4 ignorance of 108–9 memory 105–6

185

perceptual anomalies 91–2, 93 sleep paralysis 97–100 sleep problems 96–7 solitary conﬁnement 93–5 and anti-paranoia strategies 161–2 improving urban environment 142–5 inequality reduction 141 raising awareness of 135 and causes of 66, 156–7 anxiety 75–8, 158 delusion-as-defence theory 83 emotions 158–9 feelings about ourselves and others 78–81, 158–9 genes 84–5 interpretation of experience 72, 157–8 negative emotions 83–4 worry 73–5, 150, 158 and changes in meaning of 21–3, 39–40 and conspiracy theories 5–8, 39 and current evidence of threat 34–5 and deﬁnition of 8, 23–4 and depression 20–1

186

I N DEX

paranoia: (cont.) and difﬁculty in observing paranoid thinking 66–7 and effects of paranoid thoughts 30–3 as explanation of ambiguous experiences 88 as failure of interpretation 157–8 and hierarchy of 79 and impact of 160–1 and increase in 43, 63, 155 breakdown of trust 64–5, 156 capitalism 155–6 changing employment market 56–7 migration/migrants 57–9, 62–3 perceptions of crime 60–1 role of media 47–52, 128–9, 132 social isolation 54–6, 159 traumatic events 59–60 urbanization 52–4 and nature of harm feared 27–9 and overcoming 123–5 and prevalence of 8–11, 14, 73, 86, 132, 153–4 and questionnaire on 35, 36–7 and range of fears 24–7

and reality of threats 33–4 and reasoning 109, 159 beads task 111–13 belief conﬁrmation bias 117–20, 159 challenging paranoid thinking 123–5 evidence contradicting beliefs 120–1 impact of environment 112–13 jumping to conclusions 112–14 safety behaviours 121 style of 116–17 syllogistic reasoning 114–15 Theory of Mind 115–16 and reasons for feeling threatened 29–30 and reducing level of 132–3 and research into 133 and similarity to other psychological experiences 35–9 and sliding scale of 30–3, 75 and spectrum of 32, 75, 154–5 and threat-anticipation model of 157 and treatment of: antidepressants 146 anti-psychotic drugs 145–6

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cognitive behaviour therapy (CBT) 146–51, 162 Robert Chapman’s experience 123–5 and understood as symptom of psychosis 11–14, 23 and unsolved questions about 133–4 and virtual reality experiment 67–73 perceptual anomalies 91–2, 93 persecutory delusions 10–11, 81–3 and genes 85 and psychosis 11–12 and safety behaviours 77 and worry 74 Phillips, Emo 157 physical harm 28 post-traumatic stress disorder (PTSD) 38–9 poverty 110–11 and health 136–41 and paranoia 137, 139 and stress 138 psychiatry, and establishment of discipline 22 psychological harm 28 psychosis: and neurosis 12–13 and paranoia understood as symptom of 11–14, 23

187

reasoning, and paranoia 109, 159 availability heuristic 44 beads task 111–13 belief conﬁrmation bias 117–20, 159 challenging paranoid thinking 123–5 evidence contradicting beliefs 120–1 impact of environment 112–13 jumping to conclusions 112–14 nature of 42–3 reasoning heuristics 43–4 safety behaviours 121 style of 116–17 syllogistic reasoning 114–15 Theory of Mind 115–16 risk assessment: and BBC editorial guidelines 129 and problems with 4–5, 43, 44–7 and reasoning heuristics 43–4 Rusk State hospital 24 safety behaviours 77–8, 121 Sauvages de Lacroix, François Boissier de 22 schizophrenia 11–12 and anxiety 76 and genes 84–5

188

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schizophrenia (cont.) and migration/migrants 57 and perceptual anomalies 92 and recovering from 123–5 and Robert Chapman 122–5 Schreber, Paul 81–2 Sea Empress 41–3 Seinfeld 87–8 self-esteem: and paranoia 73, 79, 158–9 and social networks 79 sensory deprivation, and anomalous experiences 95 September 11 terrorist attacks: and inaccurate beliefs about 6–7, 107–8 and inﬂuence of media coverage 47 Shakespeare, William, and The Winter’s Tale 16–19 shyness 35–8 Slater, Mel 69 sleep problems: and anomalous experiences 96–7 and sleep deprivation 96 and sleep paralysis 97–100 and stress 96 Slovic, Paul 43 Smith, Jacqui 127 social anxiety 35–8, 76 social cohesion 145

social exclusion 138, 159 social harm 27–8 social interaction, and Theory of Mind 115–16 social isolation 54–6, 159 social networks 79 solitary conﬁnement, and anomalous experiences 93–5 statistics, and inability to use 45 stress: and anomalous experiences 95 and deprivation 138 and health 137–8 and mental illness 95–6, 138 and sleep 96 Sweden 135–6 syllogistic reasoning 114–15 syphilis, and Tuskegee research study 33–4 Tangjariyapoon, Chalemchai 152–3 terrorism 130–1 and false alarms 152–3 Thatcher, Margaret 155 Theory of Mind 116 Thompson, Hunter S 156 Thoreau, Henry David 54 threats: and anxiety 76 and arousal 91

I N DEX

and current evidence of 34–5 and reality of 33–4 and threat anticipation 76, 157 trafﬁc accidents: and children 3, 4 and fatalities from 46 traumatic events: and feelings about ourselves and others 81 and mental illness 59–60, 95–6 treatment of paranoia: and antidepressants 146 and anti-psychotic drugs 145–6 and cognitive behaviour therapy 146–51, 162 and Robert Chapman’s experience 123–5 trust: and breakdown of 64–5, 156 and inequality 139 and mortality rates 140 Tversky, Amos 43 Twenty Questions 113–14 2–4–6 task 117–18 United Nations Global Commission on International Migration 58

189

urbanization 52–3 and health 142–3 and healthy cities 143–4 and increase in paranoia 53–4 and social isolation 54–6 and social networks 79 Uslaner, Eric 139 vaestibular-motor hallucinations 98 victimization 59–62 and feelings about ourselves and others 81 Vierkant, Arlyn 24 virtual reality, and observing paranoid thinking 67–73 Watson, Peter 117 Weich, Scott 141–2 Wilkinson, Richard 140 The Winter’s Tale (Shakespeare) 16–19 witches 25–6 World Health Organization 142–3, 143–4 worry, and paranoia 73–5, 150, 158 Zimbardo, Philip 89