The paranoid dynamic and mindfulness

Paranoia consists of individuals projecting on to other objects their unconscious desires or motives. There is a certain amount of a paranoia existent in every individual and there are a good number of people who have more of this trait than other people. According to the DSM-IV-TR, between 0.5% and 2.5% of the general population of the United States may have PPD, while 2%–10% of outpatients receiving psychiatric care may be affected. A significant percentage of institutionalized psychiatric patients, between 10% and 30%, might have symptoms that qualify for PPD.

Paranoia is sometimes used to cope with intra-psychic conflicts. When used like that it is called a defence in classical pshychoanalytical literature. For example lets consider a person who does not like a certain sweater and wants to destroy it while it is hanging on display in the shop. For the sake of appropriateness he will inhibit that impulse and by inhibition will give rise to an intrapsychic conflict. This conflict will become more and more strong as the impulses to destroy this sweater increase because of the opposite tendency which is in harmony with not doing anything inappropriate while looking at sweaters in the shop. Now let us consider the shop manager who to help out this person looking at sweaters in the shop comes over and starts hovering around. This person who has been thinking of destroying the sweater will project on to the manager. Now he will feel persecuted by the manager and feel that the manager is expecting him to destroy the sweater and that is why he is hovering around him. This will lead to paranoia on the part of the person who is browsing the sweater line up in the sweater shop.
If people use this defence exclusively it results in a certain type of a personality called the paranoid personality disorder. People described as having a Paranoid personality employ other defences also but we are foucsing on the paranoid dynamic.

In clinical situations it is proscribed that dealings with these individuals should be follow certain rules.

-It is important to hide as little as possible from these individuals. This transparency should include note taking; details of administrative tasks concerning the individual; correspondence; and medications.

-Individuals with paranoid tendencies often don't have a well-developed sense of humor; those who must interact with people with PPD probably should not make jokes in their presence. Attempts at humor may seem like ridicule to people who feel so easily threatened.

-Asking about an individual's past can undermine the treatment of PPD people. Concentrating on the specific issues that are troubling the patient with PPD is usually the wisest course.

-The paranoid thought should not be challenged too directly.

The basic proscription is because of the following dynamic. The paranoid dynamic vascillates in between two extremes. The model of the two extremes is useful for a number of dynamics and the etiology of defences (from Level I to Level IV), Gustafson has called these extremes the near-far dilemma. On one hand is the threat to be engulfed in the closeness which is too uncomfortable and on the other hand is the distance which threatens total isolation and loss of touch from reality.

So with a health care provider there is a dance which the paranoid person engages in. If the clinician is not quick on his/her toes they can soon find themselves out of rhythm with the interview. The above general rules serve well but it is to be kept in mind that rules are made for people and not vice versa.

"The unfettered mind" which is taught in everyday mindfulness is needed in many things including dealing with this trait/defense/jinn described above.