Paranoia, a feeling that someone is trying to harm you, get you, follow you, or send messages to you via TV, radio, cell phone, or some other unearthly means is a common psychiatric symptom. It is an example of delusional thinking and occurs in patients who have lost touch with reality.
One characteristic of being paranoid is that you suspect everyone of potential mayhem — the paranoid’s “danger antennae” is always on full alert. No one is immune to being a suspect.
Since the psychiatrist is always a major suspect, it makes treating patients with paranoid disorders extremely difficult — not impossible, but as you can imagine, very time intensive, sometimes dangerous, and often frustrating. Here’s an example from Skin Dance, a mystery. Jake Robb, a psychiatrist, is called to the Emergency Room to treat Sean Murphy, a paranoid sixteen-year-old boy.
Lying face-up on a gurney, wrists and ankles in leather restraints, was a huge man-beast — untrimmed beard, greasy-hair down to his shoulders, a look in his eyes somewhere between murder and Mars. Paranoia crossed all boundaries — age, religion, sex, social position. It was truly an egalitarian disorder.
“Sean?” Jake said softly, closing the door. “I’m Doctor Robb, a psychiatrist. Your dad is very worried about you. He wants–”
“Get me the fuck out of here!” Sean yelled, pulling on the restraints and arching his back. “You’re one of them!” He glared at Jake, nostrils dilated, eyes wide, teeth clenched.
“How am I one of them?” Jake asked, voice calm and gentle.
Sean pulled harder on the leather straps, the whole gurney shaking.
“Sean, your blood studies show you’ve been drinking and using speed and pot.”
“Get away from me or I’ll rip you a new asshole!” Sean jerked hard on the straps, fixing Jake with another hate-filled look.
“Who’s trying to hurt you?”
Sean glared, continuing to pull hard, straining, sweat glistening on his forehead.
“Sean, do you know where you are?”
Sean strained even harder, the desperation building.
“I’m not going to hurt you, I’m a doctor, a psychiatrist. I just want to help you feel better.” Jake reached down and put his hand on Sean’s shoulder.
“You fucker!” Sean wrenched his face around, his teeth bared and his jaw snapping together hard. Jake jerked his hand back.
“Sean, no one’s going to hurt you.” Jake’s voice sounded calm even though his heart was pounding. The crazy kid was less than an inch away from chomping off his finger.
After fifteen fruitless minutes, Jake left the examining room and walked quickly to the nursing station. “Mary, please give Sean twenty milligrams of Geodon IM. Let’s get him upstairs to the eighth floor, back on the closed unit. Be very careful. The Grizzly bites.”
Paranoia can also be viewed positively. It is a powerful tool for our fictional heroes and heroines to possess. Jack Reacher, Lee Child’s hero, always seems to know when the bad guys are ready to pounce. Without “healthy paranoia” Jack wouldn’t have survived his first novel.
Even “normal” people who are placed in difficult and life threatening situations can use this magical trait. If psychotic people can be paranoid, why can’t a healthy person develop the trait and use it to his own advantage? When our characters are battling vicious sociopaths they need all the psychological help they can get.
Dr. Art Smukler is the award-winning writer of Chasing Backwards, a psychological murder mystery, Skin Dance, a mystery, and The Man with a Microphone in his Ear. All are available as paperbacks and eBooks.