As time went on [at my first job after law school, at the federal courthouse in Kansas City, Mo.], I met all manner of people who had business for the court. We met several people who complained that some government department or other was beaming invisible rays at their heads. One of these poor souls came in on a quiet Friday afternoon, so another clerk and I took him over to the Lexis terminal, at that point an imposing stand-alone console about the size of a small desk. We turned it on, typed in "Stop beaming rays at John Doe's head," hit "enter" and turned it off. Doe left happily, the voices in his head now silent, and we returned to our duties, knowing that we had helped one American citizen obtain justice in an imperfect world.
If only it were that easy! It's a lovely story, but let me tell you what likely happened a bit later, unbeknownst to our legal professional.
A week or two goes by. The poor soul in the story above begins to notice that, although "they" are not beaming rays at his head anymore, his thoughts seem fuzzy and people look at him strangely--as if he were emitting some strange ray. Being an intelligent person, he deduces that "they" have done something--what could it be? A little more thought, then he realizes that they don't have to beam rays at him anymore because they must have implanted a computer chip in his brain and can now monitor and control his very thoughts!
In other words, sadly, Mr. John Doe has substitued another delusion in place of the one so cleverly dealt with!
I have had similar experiences as Overlawyered's friend. For example, on a surgical ward once, an older gentleman who had dementia had had a hip replacement and the staff were unable to keep him lying in bed because he was so agitated, yelling that God had spoken to him and not want him to stay in bed! Finally, after a particularly irritating bout of trying to get him back into bed, my resident was so annoyed at him, that he went back to the nurses' station and placed a call to the old gentleman's room. "This is God," the resident told him in a stentorian voice, "you must lie still and do what your doctors want you to!"
We all laughed because it seemed to work. The old gentleman became gentle as a lamb and things went well for a week or so. Then one day, when we went into his room, we found him whimpering in fear and anguish. He haltingly told us that --because God had chosen him, the devil and his minions were now tormenting him for his righteousness.
Or the time when I was a psychiatric resident and saw a man who believed that he had microscopic germs on his skin that jumped from him to others, causing others to stay away from him and not be his friend. I helpfully made a slide of his skin and showed him that the little bugs did not really exist. "Why didn't I think of that!" he exclaimed happily. But then, several weeks later, he was back--because now he believed that the bugs were so tiny that they couldn't be seen--even by an electron microscope! How else, he asked, could he explain that no women would go out with him--a successful scientist?
Or the woman convinced she had Hodgkin's Lymphoma and when extensive tests were done to eliminate her fear once and for all; returned the next day convinced she had colon cancer.
You see, the problem is that the paranoid delusion serves a psychological need that doesn't go away if the delusion is exposed. How comforting it must be to the non-existent self-esteem of someone to think that the powerful government --or FBI; or CIA; etc. etc.--is focusing all their attention on them! That God and the agents of evil find him important enough to fight over him! Or that the reason he is not able to make friends or interest women is because of microscopic bugs--not because of anything else!
In all of the cases mentioned, and in all cases of clear-cut psychotic paranoia, it is obvious to all observers that something is wrong with the thinking of the person involved. In the last case I mentioned (the woman convinced she had cancer), the delusional conviction was not sufficiently bizarre to permit doctors to be comfortable ignoring her--so they did many tests to convince her all was well. But it didn't work for her either.
Paranoia is really only the distorted expression of a psychological defense mechanism that is available to all humans--not just psychotic humans. At the non-psychotic end of the spectrum you have what is called projection-- a primitive defense mechanism that children use routinely, and which is abandoned with maturity because its use distorts reality and will cause more trouble than it is worth usually to utilize it.
In adults that use projection, it is usually when the thought or feeling they are trying to cope with is so threatening, their unconscious mind can find no other option. For example, to realize that you have angry--even murderous impulses at times--can be so frightening, the psyche fears the disintigration of the self if acknowledged. It is so much easier to believe that others have that feeling you can't acknowledge in yourself; and that you are the helpless victim or object of their anger and violent rage.
But at some point, projection--which has some minimum level of surface acceptability (at least it doesn't involve little green men putting computer chips in the brain) crosses over into delusional projection, or a full-blown paranoid delusion. In order to cross that threshold, there must be some physiological abnormality in the brain (e.g., schizophrenia; or a toxic or degnerative insult) that completely distorts normal perception. While both projection and paranoia are psychological distortions, the latter form takes the psychological distortion completely out of the realms of reality. Medication can sometimes bring the physiologically abnormal brain back into some degree of balance. But in either case, the exposure of the defense only paves the way for the real work that needs to be done on the underlying needs or fears that led to its use in the first place.
I only wish it were that easy to convince people using projection in either its psychotic or non-psychotic forms that their fears are unjustified by simply exposing the delusion as false. If you don't address the underlying need that stimulated the defense, then eventually you will simply be right back where you started.
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