In popular culture, the term paranoia is usually used to describe excessive concern about one's own well-being, sometimes suggesting a person holds persecutory beliefs concerning a threat to themselves or their property and is often linked to a belief in conspiracy theories.
The term is more typically used in a general sense to signify any delusion, or more specifically, to signify a delusion involving the fear of persecution. The exact use of the term has changed over time, and because of this, psychiatric usage may vary.
In psychiatry, the term paranoia was used by Emil Kraepelin to describe a mental illness in which a delusional belief is the sole, or most prominent feature. In his original attempt at classifying different forms of mental illness, Emil Kraepelin used the term pure paranoia to describe a condition where a delusion was present, but without any apparent deterioration in intellectual abilities and without any of the other features of dementia praecox, the condition later renamed schizophrenia.
In the original Greek, παράνοια (paranoia) means simply madness (para = outside; nous = mind). Kraepelin developed a definition from this root involving delusional beliefs. Notably, in his definition, the belief does not have to be persecutory to be classified as paranoid, so any number of delusional beliefs can be classified as paranoia. For example, a person who has the sole delusional belief that he is an important religious figure would be classified by Kraepelin as having 'pure paranoia'.
Although the diagnosis of pure paranoia is no longer used (having been superseded by the diagnosis of delusional disorder) the use of the term to signify the presence of delusions in general, rather than persecutory delusions specifically, lives on in the classification of paranoid schizophrenia, which denotes a form of schizophrenia where delusions are prominent.
More recently, the clinical use of the term has been used to describe delusions where the affected person believes they are being persecuted. Specifically, they have been defined as containing two central elements:
Paranoia is often associated with psychotic illnesses, particularly schizophrenia, although attenuated features may be present in other primarily non-psychotic diagnoses, such as paranoid personality disorder.
Other common paranoid delusions include the belief that the person has an imaginary disease or parasitic infection (delusional parasitosis); that the person is on a special quest or has been chosen by God; that the person has had thoughts inserted or removed from conscious thought; or that the person's actions are being controlled by an external force.
Many despotic rulers (for example Stalin) allegedly suffered from paranoia. This presents an interesting question because in Stalin's case, it is quite likely that many people really were out to get him (some theories concerning his death hypothesize that he was poisoned). The possibility exists that with enough enemies, it is impossible to be clinically paranoid. It still might be possible to identify a paranoid in that situation via his unrealistic assessment of the relative threat presented by various enemies, but it is not clear that non-paranoid persons are all that good at this. This raises interesting philosophical questions about the criteria by which we can diagnose a belief as paranoid or delusional, as well as prompting the joke that "Just because you're paranoid doesn't mean they're not out to get you".
The general suspiciousness of modern intellectuals also makes separating paranoid thinking from normal frequently a perplexing task. Freud once wrote to his friend Marie Bonaparte, “The moment a man asks about the meaning and value of life, from that moment he is sick, since neither has any objective existence.” This puts just about all of us in the asylum. The paranoid discovers more order and meaning in the world than is really there, but in doing so, he or she is just like everyone else. Freud frequently observed, with strategic humor, the likeness of his own thinking with paranoia: both the psychoanalyst and the paranoid look beneath the apparently peaceful surface of appearances to find the hidden hostile motives.
Freud’s own personal combination of grandiosity, suspicion, and hostility has been a frequent one among the most important modern intellectuals. It appears as well in Descartes, Bacon, Hobbes, Swift, Rousseau, Nietzsche, and Strindberg, the last three clearly suffering from Delusional Disorder. The greatest works of modern literature also abound with paranoid characters: Don Quixote (Cervantes), Gulliver (Swift), Julien Sorel (Stendhal), Captain Ahab (Melville), Masterbuilder Solness (Ibsen), Captain Alving (Strindberg), K. (in Kafka), Stephen Daedalus (Joyce) and just about all of Thomas Pynchon’s central characters all suffer from persecution and conspiracy to one degree or another, showing that power of paranoia and the problem of separating paranoid from normal are not just symptoms but major preoccupations among modern western intellectuals.
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