One of our patients who has been paranoid for many years at a low level even when well, and severely so when his medications go out of whack picked up a copy of 1984 at the library, having heard that reasonably-educated people should read it and be familiar with it. He is an intelligent but rather isolated person. We asked him what he thought after.

“It was a sad story.  The guy had a girlfriend, but he lost her.”

The entire paranoid point of the story seems to have been mere unimportant background to him, which I suppose makes some sense.

5 thoughts on “Paranoia”

  1. Does “Big Brother is watching you” have any emotional impact on anyone under 30 or so? Does it scare them at all? I doubt it.

  2. That is an example of the concrete thinking of most schizophrenics. The patient is probably psychotic but well compensated. I taught students to use parables and aphorisms to test for psychosis. One student who was planning to go into Psychiatry, came to me one day and asked about the patient he was interviewing. We were on a Psych ward and the patient seemed to be perfectly rational. I suggested he ask the patient about the expression “A bird in the hand is worth two in the bush.” He did and the patient was still going on about birds a half hour later.

    Of course, parables are cultural so they may not work on all.

  3. The other standard expression is “What does the phrase “The grass is always greener on the other side of the street” mean to you?” Mike K is right that schizophrenics often have difficulty with those. If they do even moderately well on that, the next, more abstract question is “People who live in glass houses shouldn’t throw stones.” It is more difficult for two reasons: First, glass has two properties that might be in play. It is fragile, and it is transparent. Either one, or both, could be the reason a person living in one could be vulnerable. (The former reason is considered the slightly better reason for the old saying, but both are considered acceptably abstract.) Second, even when one knows the meaning in a flash, or has known the sense of it for years, it isn’t easy to quickly put into words, especially under pressure. Try it yourself for fun. Imagine a psychiatrist is asking you this question in an emergency room, with a nice policeman standing in the doorway making sure you don’t leave.

    People with psychotic disorders have a hard time with this. They get stuck on the breaking glass picture in their head.

  4. “I mean—hell, I been surprised how sane you guys all are. As near as I can tell you’re not any crazier than the average asshole on the street.”

    R.P. McMurphy

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