November 21, 2006

Paranoid Stance in Life?

I saw Dr O today and we talked about paranoia, which, she said, through no fault of my own but because of paranoid schizophrenia, colors my outlook on life, my approach to the world. She says I am prone to "see" and "hear" conspiracies and secret messages where none exist simply because my brain is disposed that way. Naturally I am certain I'm right about what I feel is going on, because that is human nature: to assume our perceptions correctly interpret the world. But, she said, in my case, I have to be more circumspect and not automatically assume that everything I perceive tells me the truth. So she made up a card for me to carry in my wallet with three steps on it for me to read whenever I feel that someone hates me or has it in for me or that They are "doing something to me" or "conspiring against" me. Step number one says: Notice when afraid or upset that someone else feels negatively towards you. It will feel certain. Step number two: Allow for the possibility that you might be wrong. Step number three: Check it out! Checking it out is not necessarily easy, even though it is a three word step. It means asking someone if it is going on, if they are thinking this way or doing this thing etc which cannot always be done comfortably or appropriately. So sometimes you have to ask someone else, like Joe or Dr O or Lynnie etc what they think is going on, or is happening...Or discreetly ask someone on the periphery, I dunno. Somehow you have to find out the truth, the facts, whether or not what you fear is actually happening.

Now these three steps, essentially a way to reality test for paranoia, seem simple, even simple-minded, but for me they are very difficult, most especially the first. How do I know when to notice? How do I even think to challenge my immediate "KNOWLEDGE" -- which is how it feels, not a suspicion that people are out to get me but full-blown certainty. Aha, there it is, that word, "certainty". She said, "It will feel certain...that someone feels negatively towards you..." So I could take that feeling of certainty as a benchmark for when to use the three steps. Whenever I feel convinced that people hate me or are doing things to me etc, whenever that feeling of absolute certainty that something negative is happening hits me, that is when I must NOTICE it, triggering the three steps of the reality test. I wonder if that would work. I know that Lynnie told me to assume absolutely without question that whenever I thought someone was SECRETLY doing something, communicating something to me secretly etc that it was paranoid. This helped me to question certain delusions, when I managed to catch myself speak or think the word "secretly." When I didn't actually use the word "secretly" it was harder, as I was literal enough to have the "delusion buster" triggered only by one word at first. But later, it became clearer to me that anything communicated sub rosa, so to speak, anything I thought was communicated in a manner that was not clear and aboveboard for the most part ie not verbally or written down, should trigger her paranoia reality test.

Now it doesn't work if I don't notice the "secretly" does it? And much of what I said about the cabal of DOs yesterday fits under that rubric (though I maintain that Dr F's RN really did do something to get Dr F to hate me...There was something weird going on there...). But I didn't notice it, so certain was I that Dr C hated me and was against me, along with his RN. So CERTAINTY and SECRECY are two words/concepts that have to start triggering reality testing or I'm going to continue to run into situations that I build up into huge paranoid constructions, rather than situations that I appraoch with paranoia but quickly defuse. And how will I defuse them? By: Noticing my fear and certainty that They are against me; allowing for the possibility that I might be wrong; and Checking it out (by asking them or getting help from Joe or Dr O or someone else in finding out if it is true). In point of fact, though, I've found that with any reality test, merely noticing and challenging the thinking, the delusion, asking yourself if you might be wrong, can be enough to get you to think a different way, to stop pushing the panic button and accept that you're merely paranoid. Actually checking it out ends up being less necessary than Dr O thinks, because once you suspect you are paranoid, well, that answers a lot of questions and allows for a lot more clear thinking.

So, how'm I doing? I still feel afraid that Dr C and the DOs are in something against me and I still feel upset by the smile that I read as a smirk when he talked about meds taking away my appetite (I didn't write about this yesterday but it was one of the things that bothered me) but I can at least tell myself I'm probably wrong about it, that it is a paranoid way of thinking, that there is in fact NO REASON for a cabal of DOs to be thinking or talking about me, just as one of you said, they have more important-to-them things on their minds! And sometimes a smile is just a smile...How can I tell it was a smirk? Do I know the guy? I've seen him twice, for god's sake! Can I read his mind? I barely look at people! And now I'm looking at him so closely I say I can tell a smirk from a smile on someone I don't even know??? C'mon! (I feel certain that I can, but I could be wrong...) So I've got to assume that it's mostly paranoia, despite the feelings that make me afraid and upset (still) and on that basis have to talk to myself more about how other people worry about their own lives much more than mine, they have their own paranoias and fears and upsets, and don't spend their time trying to torment me...WHY would they? Who am I that they would care that much to spend hours tormenting me? AM I that important? If not, why would they bother? All good questions, and I can't answer them, except mostly to say either I dunno or No. Which means, Okay, I guess it is paranoia. So now I have to act as if it is, and ignore how I feel, hard as that is, hard as that is.

Posted by pamwagg at November 21, 2006 07:12 PM


I remember when I was paranoid I thought every time I went for a drive that the people who passed me in other cars were following me and could listen to me speaking aloud in my car. I had to train myself to not look at the people in the cars. The more you feed the paranoia, the more it takes hold of you. But I know, it is so hard to do this. I think Dr. O was quite right to give you that 3 step card. Anything to break the cyclic pattern of paranoid thoughts is worth trying. I do think the concept of secrecy is key to understanding paranoia. If you think it's a plot specifically against you (as I thought too though I didn't understand it) then there's a high probability that it is paranoia. The exceptions to the rule are not as common as you or I tend to think. Most people are not the target of any kind of plot. Most of us are somewhere in the middle, neither so good, nor so bad with only friends and family involved in our lives and no virtual strangers (as some doctors really are) involved in anything but their business. Still, you can load yourself up with the sense of it but be emotionally tied to illusions. Logic does not always succeed in arresting emotional problems, but I have found that it helps, when in doubt, to think it over first and struggle with your heart afterwards. I guess we all want to trust our perceptions and to have to distrust them is, of course, unsettling. But that is the nature of mental illness. We're not quite balanced enough to see the big picture or we see a big picture that is full of distortions. You're smart Pam and you have a good heart and I think you'll be able to navigate through your paranoia one step at a time. Reality check all over the place, here, with Dr. O, with Joe and Lynnie and you'll find your way, I'm sure of it.

Posted by: Kate K. at November 24, 2006 11:58 AM

Your explanation here is so well done, it really helps me understand paranoia, and I think writing it must help you understand paranoia as well. Please keep asking everybody for a reality check: most people desire the opportunity to be of service in this fashion to someone who is suffering. I guess it's kind of like being hard of hearing: sometimes you have to ask the guy next to you what that sound was.

Posted by: Debbie at November 22, 2006 12:26 PM

Hi Pam,

I'm so glad you went to see to Dr. O to get a reality check. It must be wonderful to have someone like Dr. O to guide you through what is troubling you. I just want you to know you have nothing to be ashamed of when you have these feelings. As you said, it's all part of your illness. I like the card idea. This too shall pass and please keep us up to date how you are doing.

Warmest regards,

Posted by: yaya at November 22, 2006 07:26 AM

I am so thankful that you have Dr. O. as the guiding light in your life. She speaks everything that I believe. The difference, however, is that she is a specialist in her field, you have chosen her above all others to be your physician,you trust her knowledge and intelligence,and she is able to penetrate your shield in order to help you. I care for you deeply, and you know this, but my opinions cannnot possibly carry the weight of Dr. O's. I understand this completely. You are disturbed about something, or ask for advice, and I rush in where angels fear to tread. It doesn't matter how often you hear from friends that people do not hate you.It requires the skill and compassion of an excellent psychiatrist to make you at least attempt to believe that your perceptions may be incorrect. You are in good hands,Pammy. For this, I am grateful beyond words.
With loving support, Paula

Posted by: Paula Kirkpatrick at November 21, 2006 10:52 PM

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