Physician's Notebooks 9 - http://physiciansnotebook.blogspot.com - See Homepage
31. The Paranoias of Life (Update 17 Septr 2021).
"Paranoid?” The word evokes “He's out to get me.” It is a word for excessive worries about bad things happening to one; a vicious variety of anxiety. The "bad things" can be something like losing a check in the mail or excessive worry about catching a deadly illness; today Covid-19. A successful life needs a bit of those kinds of worries but, overdone, it may harm one's life. For example, my then age 90's cousin Dan had allowed me to live in his rent-controlled 5-room Bronx flat. He was just barely able to walk, and, as I am a physician, a loving, close relative and greatly enjoyed my regular several weekly stays at his flat, it seemed an ideal arrangement for him and for me. I arranged a downstairs neighbor to clean and watch Dan when I was not there and got him a wheelchair so he could be taken out to shop or just get the air in good weather. Things seemed OK except Dan had a strain of paranoia one point of which focused on his not allowing anyone to have a copy of his door key. Since I worried he might fall and not be able to get back up when I was not at the flat, I, without his knowledge, made a copy of his door key in 2010. And, one seemingly happy day, April 21, 2012, Dan's 91st birthday, I decided to tell him I had made a copy of the key. So I did, and at the immediate moment it seemed it was OK with him. Next day I flew to Tokyo and a week later, when I made my weekly call to the downstairs neighbor to check Dan's usual weekly condition, she told me that Dan had started talking angrily about how I dishonestly copied his door key for my own bad purpose and he was now constantly asking her to arrange a new lock for his door with a different key. And from that time, Dan cut relations with me.
Flash forward 2 years to April 2014. One early-AM night Dan got out of bed to pee, stumbled and fell, striking his forehead, and could not get up. But he was able to call emergency 911. However, as his door was locked and no one had a key copy to the new lock, they had to waste time removing the whole door from its hinges, and, furthermore, Dan ended up in hospital; and, because no one wanted to take responsibility for him, his niece had to fly in from Texas and, despite the fact that Dan actually had only suffered a concussion and no brain damage or stroke, he ended up in a nursing home in New Jersey and lost his apartment and after more than a year in the nursing home he begged me whenever I called him to put him back in his old Bronx flat that already had been renovated and rented to someone else at 4 times the rent. And finally in 2016, Dan died mainly because of his transfer from his comfortable flat to the uncaring nursing home. And this happened because of Dan's paranoid behavior in losing his cool over my loving, caring act of making a key copy to prevent what actually ended up happening from actually happening. Had Dan accepted my loving behavior, he could have called me that night, first, before he called 911, and even though I was in Tokyo at that moment (He had my direct-digit mobile number), I would have called the downstairs neighbor, whom I had given a key to previously, and she could have come up, opened the door, helped him back into bed, and if needed arranged for an emergency 911 that did not involve his ending up in a nursing home and losing his last independent hold on his life, because I would have flown in from Japan immediately and taken control of his case, and since it was only a mild head trauma would have gotten him back into his lovely rent-controlled flat.
Here is a good place to emphasize the importance of getting a good psychoanalysis. Had Dan been successfully psychoanalyzed, he would have said to himself after discovering about the key: "OK. My cousin copied the key against my wishes and it makes me feel angry, but that is because of my natural tendency to paranoia. However, when I look at the facts objectively, my cousin has always been honest with me, he is a physician and has no reason to be dishonest and what he did was done for my benefit. So I will discount my anger as the result of my own paranoia and forget about it or even say thank you to my cousin for such a good act."
A good practice is to replace paranoia with fact-based knowledge. (Principle of Cognitive Treatment (CBT) psychotherapy of Dr Aaron Beck.)
A paranoid mindset is excessive fear of the future and too many suspicions, and is a trait and also a neurosis or, in the extreme, a psychosis, which under stress and unmasked by brain deterioration due to drug or old age, may be part of a mental disease. One old-age common paranoia is worrying that one will become poor and homeless. Its prevention starts with reading this here, getting insight into one's own reaction, and making a distinction between the reality of one's financial situation and what is causing one's excess anxiety. The point is that when a paranoid idea hits, react to it, before losing sleep and worrying, by checking to see if it is justified. And become self-aware of the tendency to paranoia.
31. The Paranoias of Life (Update 17 Septr 2021).
"Paranoid?”
A common paranoia
Psychotic paranoia
Paranoid behavior is universal
In my life experience
An example of rooting out a source of paranoia
An example of rooting out a source of paranoia
End Note - Kindling and Paranoia; a Personal Experience
Flash forward 2 years to April 2014. One early-AM night Dan got out of bed to pee, stumbled and fell, striking his forehead, and could not get up. But he was able to call emergency 911. However, as his door was locked and no one had a key copy to the new lock, they had to waste time removing the whole door from its hinges, and, furthermore, Dan ended up in hospital; and, because no one wanted to take responsibility for him, his niece had to fly in from Texas and, despite the fact that Dan actually had only suffered a concussion and no brain damage or stroke, he ended up in a nursing home in New Jersey and lost his apartment and after more than a year in the nursing home he begged me whenever I called him to put him back in his old Bronx flat that already had been renovated and rented to someone else at 4 times the rent. And finally in 2016, Dan died mainly because of his transfer from his comfortable flat to the uncaring nursing home. And this happened because of Dan's paranoid behavior in losing his cool over my loving, caring act of making a key copy to prevent what actually ended up happening from actually happening. Had Dan accepted my loving behavior, he could have called me that night, first, before he called 911, and even though I was in Tokyo at that moment (He had my direct-digit mobile number), I would have called the downstairs neighbor, whom I had given a key to previously, and she could have come up, opened the door, helped him back into bed, and if needed arranged for an emergency 911 that did not involve his ending up in a nursing home and losing his last independent hold on his life, because I would have flown in from Japan immediately and taken control of his case, and since it was only a mild head trauma would have gotten him back into his lovely rent-controlled flat.
Here is a good place to emphasize the importance of getting a good psychoanalysis. Had Dan been successfully psychoanalyzed, he would have said to himself after discovering about the key: "OK. My cousin copied the key against my wishes and it makes me feel angry, but that is because of my natural tendency to paranoia. However, when I look at the facts objectively, my cousin has always been honest with me, he is a physician and has no reason to be dishonest and what he did was done for my benefit. So I will discount my anger as the result of my own paranoia and forget about it or even say thank you to my cousin for such a good act."
A good practice is to replace paranoia with fact-based knowledge. (Principle of Cognitive Treatment (CBT) psychotherapy of Dr Aaron Beck.)
A paranoid mindset is excessive fear of the future and too many suspicions, and is a trait and also a neurosis or, in the extreme, a psychosis, which under stress and unmasked by brain deterioration due to drug or old age, may be part of a mental disease. One old-age common paranoia is worrying that one will become poor and homeless. Its prevention starts with reading this here, getting insight into one's own reaction, and making a distinction between the reality of one's financial situation and what is causing one's excess anxiety. The point is that when a paranoid idea hits, react to it, before losing sleep and worrying, by checking to see if it is justified. And become self-aware of the tendency to paranoia.
A common paranoia is that you have a deadly disease like cancer. This is stimulated by some sign or symptom misinterpreted or over-interpreted; like the ache in my left hip I thought was due to a cancer to my bone, or the burn of my lower lip I thought was the start of a cancer of the lip. It is a cause of excessive, harmful, wasteful medical visits and tests. Occasionally the anxiety is justified, but the usual anxiety ought to be considered paranoia and relaxed on, or, if still worried over, simply tested for once. It almost never turns out true.
Psychotic paranoia is extreme and it is worst in the schizophrenic who sometimes murders others under its influence. It usually targets a harmless acquaintance who, it is madly believed, is out to kill the paranoid person; but it may be an opposite, one's idea that a famous person, usually of the opposite gender, loves one and therefore ought to return one's advances. With the help of anti-psychotic drug that may give a period of clarity, helped by directive cognitive behavioral treatment psychotherapy, the irrationality and impossibility of psychotic delusion may be made clear. (See in the 2001 A Beautiful Mind, John Nash's acceptance of seeing his hallucinatory companions as part of a delusion.)
Paranoid behavior is universal. Having a mental edge against it is like the contrarian edge that says "Exactly because I feel or believe something is true, I make a point to disbelieve it until factual proof." It means always to start by taking a contrary approach to what you believe. So if you believe someone is speaking bad about you or is out to get you, you should say “Exactly because I believe it so strongly, probably he is not saying that, probably he is not out to get me; probably it is just my paranoid fear.” And then take time, look at the facts, and you may come to a null hypothesis conclusion and get happy. And if it turns out that he actually is out to get you, you'll find out quickly enough and nothing lost. But 99.9% of common worry paranoia will turn out to be untrue - merely a paranoia of your imagination.
In my life experience, almost all of my strong negative feelings not based on facts turned out incorrect. Paranoid thought and feeling is an important reason for a life's unhappiness. If you wish to achieve or approach happy life, note each paranoia and then root each out by getting the facts. But keep in mind that new paranoia is constantly regenerating. It is free-floating and will attach to a potential problem. It is useful to be aware of this so you may discount it instead of allowing it to act out in your behavior.
An example of rooting out a source of paranoia. I have been in the habit of putting my cash money in an easily accessible drawer at my desk. Recently I started training an assistant and I got the possibly paranoid idea she was stealing the cash. Realizing it was more likely a paranoid obsession I wanted to delete from my life I changed my habit of putting the cash in the desk drawer and secured it on my own body and that paranoia was extinguished. A good paradigm for anti-paranoia techniques.
End Note - Kindling and Paranoia; a Personal Experience: Kindling is a metaphor from the experience of feeding a fire to get it going. In epilepsy, kindling literally means a seizure begets more seizures. In animal experiments it is shown by the fact that causing a seizure in a normal brain by electric shock then starts a train of seizures over the life of the animal even though the brain remains normal on examination. I experienced something like this with my period of free floating paranoia. I did not have paranoid ideas until the last day of January 1974, when at age 41, I had a near sudden death episode where I became briefly unconscious and blue about the lips. (according to an observer). Following this episode I was mentally unstable (Situational psychosis, or ICU syndrome) for about 1 month with the main symptom a paranoid idea that my employer was "out to get me". Reacting to that idea caused me to lose my job. (Not because of my employer's malice but because of my paranoid behavior.)
From that point in 1974 to the start of year 2001, I suffered a free-floating paranoid tendency. Mostly this centered on excessive fears that the IRS (U.S. tax authority) was out to get me or that narcotic agents were bugging my phone and shadowing me. This was paranoia because my reactions to them were excessive. (Spending large amounts of money and energy and time trying to protect myself against the authorities that I wrongly believed were out to get me.) Since 2001, a period that includes a very positive development in my life plus my own successful self psychoanalysis, the free floating paranoia has left me; gradually at first, but now completely, and, in fact I am now if anything, anti-paranoid. (I.e., I tend to make excuses that no one is out to get me when events might suggest the contrary.).
I think my experience suggests that the episode of brain anoxia I must have suffered with the near sudden death episode in 1974 created an irritable focus in my cerebral cortex that produced a continuous streaming of anxiety which gets easily converted into paranoia when events suggest the paranoid ideas. That it eventually has gotten cured suggests that even organic paranoia may be cured by psychotherapy and positive life style change.
END OF CHAPTER. To read next click 9.32 Feelings, Nothing More Than Feelings
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