Paranoia and delusions of persecution. Intervention through brief strategic psychotherapy

"There is no such thing as paranoia. His worst fears come true at any moment"
(Hunter S. Thompson)

To classify this type of mental pathology for the first time was Emil Kraeplin, a German psychiatrist of the late 1800s. With the term "pure paranoia" he identified all those disorders that are based on illusory beliefs, not necessarily connected to ideas of persecution. In the DSM classification, to date, paranoid ideations are mentioned in Paranoid Personality Disorder, Delusional Persecutory Disorder and Paranoid Type Schizophrenia.

The structure and distinctive features of the problem
Those who suffer from paranoia live in the constant belief that they have "an enemy to fight".
He feels constantly attacked and, to defend himself, he often attacks first; he appears polemical, always on the alert, "blaming", cold and detached, at times even hostile.

The paranoid's ability to read the surrounding reality undergoes a real deformation: irony is perceived as a deliberate blow against oneself; the offer of help as an elegant way to point out one's own inability; a compliment as a way to disqualify. Actions and communications are perceived as confirmation of one's beliefs.

The tendency to attribute the blame to others, or at least to something outside oneself, is the defining characteristic of the paranoid.
This way of thinking and behaving, even if apparently it may seem voluntary, in truth it is not, as it implies a great difficulty: the inability to cultivate the most intimate interpersonal relationships and a profound lability regarding one's love life in general.

The delusions of persecution
A further aggravation occurs when paranoia is also accompanied by delusions of persecution, or the belief of being spied on, persecuted, of being the object of plots, of running into danger, poisoning or ambushing, of being victims of some action aimed at damaging them.

The paranoid with persecution mania differs from the paranoid by the presence of the idea that others have evil, that they plot, plot and deliberately do something against his person. The irrational fear that someone will follow him, the fear of being discovered at any moment.

The battle of the paranoid: the attempted solutions
The research-intervention activity conducted over the years at the Strategic Therapy Center of Arezzo directed by Professor Giorgio Nardone and his collaborators has allowed us to identify what are the dysfunctional Tentative Solutions * implemented by those suffering from paranoia - and by people around him - which, instead of resolving, amplify the disturbance.

The suspicion that becomes certainty: the attempt to control external reality.
To defend himself from the constant attack he feels against himself, the paranoid person tries to control everything and everyone. This attempt at control causes others to perceive his being wary. The latter, as a reaction, begin to feel discomfort in his presence and, in turn, mistrust. The dynamic that feeds the belief that others are angry with him is confirmed at this point. The attempt at control is transformed into what actually triggers that vicious circle that feeds the disorder: I suspect others and control them, but this makes others suspect me. In the end, what I will find in their looks and attitudes will be the confirmation of my doubts and this will lead me to behave more and more suspiciously.
He who seeks finds: the search for confirmation of his suspicions.
Doubting everything and everyone leads the paranoid person to constantly live in doubt. On the one hand there are others who try to make him think, to rationally explain the strangeness of his behavior, on the other there are thoughts based on suspicion - "if you don't understand me, it means you are plotting against me". To get out of such a duality, the paranoid begins to interpret in a rigid way all the information that surrounds him: in every situation, he is concentrated on scrupulously searching for all those elements that can confirm his idea of a threat: "if you want me to do in a certain way it is not because you want my good but because you want to spite me, or even harm me ”.
The sand fortresses: the involvement of family members
The person suffering from paranoia, in order to defend himself from a possible attack from the outside, in some cases can get to actively involve family members. In a more or less veiled way, he can ask them to take particular actions. If these adhere, the belief underlying the disorder is strengthened; if they are hesitant, they may receive outbursts of anger from the paranoid who, by doing so, causes the disturbance to keep everyone in check. Everyone joins in trying to find a solution but they end up joining in the problem!

Strategic intervention
The main modes of strategic intervention for paranoia and paranoia with persecution delusions differ according to how the problem works in the individual case. Each case is unique and the choice and use of the different techniques, maneuvers and indications, requires that these are perfectly suited to the problem and to the person who carries it.

The goal of therapy is to crack and then dismantle the person's belief. As always for us strategists, we proceed through an accurate study of the structure of the problem, which will determine the structure of the solution.

When we say structure of the problem we mean how it was formed, how it persists and how it is maintained. The structure of the solution, on the other hand, is given by how the problem is interrupted with the targeted use of prescriptions and maneuvers. Only at the end of the therapy will we know the true functioning of the disorder, thanks to what solved it.

To conclude, it is good to remember that between health and pathology, the difference is above all in the "quantity". Similar mechanisms but in different doses create different realities; if suspecting is something that happens to each of us and that often also has its own usefulness, living constantly on the alert until you cross over into full-blown delusions is something that heavily borders on the pathological and that makes the person's life a real hell.

We could say that "paranoia is just a more active calculation of probabilities"(Richard Krause).

* By Attempted Solution we mean everything that the person, and the context in which he moves, puts in place to try to solve a difficulty and which, repeated over time, not only does not solve, but also maintains and feeds the difficulty itself, contributing to the structuring and persistence of a real disorder. It is a key construct of the strategic intervention model, the starting point of any therapeutic intervention because it is configured as a "complexity reducer" that allows us to know how the problem works and, at the same time, take concrete action towards resolution.

Dr. Daniela Birello (Psychotherapist and Official Researcher of the Strategic Therapy Center)
Dr. Lindita Prend (Psychotherapist and Official Researcher of the Strategic Therapy Center)

(For further information on the subject, we suggest reading the book "If you are paranoid you are never alone. From distrust to paranoid delirium", Written by Emanuela Muriana and Tiziana Verbitz and published by Alpes in 2017)

BIBLIOGRAPHY
Cagnoni F., Milanese R. (2009), Change the past. Overcoming trauma with strategic therapy, Ponte alle Grazie, Milan.
Muriana, E., Verbitz, T. (2017), If you are paranoid you are never alone! From distrust to paranoid delirium, Alpes, Rome.
Nardone G. (2013), Psychotrap, or the sufferings we build for ourselves: learn to recognize and fight them, Ponte alle Grazie, Milan.
Nardone G., (2007). Change eyes touch the heart. Milan: Ponte alle Grazie.
Nardone, G., Balbi, E. (2008). Sail the sea without the knowledge of the sky. Florence: Ponte alle Grazie.
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Nardone, G., De Santis, G. (2011), Cogito ergo suffer: When thinking too much hurts, Ponte alle Grazie, Milan.