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Brain, Mental Health, Psychiatry, Schizophrenia

Delusions and Paranoia: past experiences

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During the second part of what I call my Y2K Meltdown, when I was hospitalized for 3 months, first in central and then in southern Connecticut, I was extremely — but what I call serially– paranoid. What I mean by this is that plots occurred to me one after another seemingly without end. A new conspiracy would “appear” out of nowhere, as of course paranoid plots tend to, generated as they are by that two step process, described in the “Paranoia and Hallucination” entry. It would “do its thing” as they say, run its course, wreak its own havoc, then having done so, pop or be defused, and disappear. But almost immediately and, without my having any sense that this was happening or had any pattern, in its place another conspiracy would arise to take its place.

 

An example: at one point during that same hospital stay, having smelled what I was certain was marijuana coming from the art supplies room, I became convinced that the staff had been infiltrated by drug dealers selling weed and stronger drugs to patients. I’d mentioned the smell — no doubt some innocuous meaningless odor, if it existed at all — to a male nurse, and the look he gave me convinced me that he was involved. As a result, I realized that my knowledge of the presence of drugs on the unit made me dangerous to him and the other dealers. I felt frightened that he might retaliate, threaten me, or worse, hurt me when no one was around or could help me or know he was responsible.

Terrified enough to start talking, I told the doctor, and I called my sister and begged her to come in and sign me out. Please take me anywhere else, I begged. I would agree to any other hospital only get me out of there where I was in mortal danger. It was, I knew, after visiting hours, indeed it was after bedtime, but she had to come in and get me, now, or I might not survive the night.

 

Incredibly, she actually came in, if only to make sure that the staff was aware of my extreme distress. I knew only that she came to check out the drug situation and was devastated when she left without taking me home with her, though by then she had managed to “talk me down” some, convince me that I was in less danger than I believed, and that at least some of the staff were on my side and would be watching out for me all night.

 

Somehow, her words got through to me, and by the next day, the matter of the drug  conspiracy was resolved, though I cannot recall exactly how.

 

All I know is that as the urgency of that situation ebbed, I became aware that a new patient had arrived on the unit. Cally wore a raglan-sleeved sweater made of what I immediately apprehended was a washable wool yarn called “Candide.” Now, I knew only one other person aside from myself who knitted sweaters like that made of Candide yarn and she was the woman who had taught me to do so. “Lisa” not only knitted many such a sweater but did so for her long lost daughter, “Cally,” who had been given away for adoption many years before. The fact that “Cally” lived in North Dakota, last I knew, was of no importance to me. What seemed of paramount, vital and decisive importance was 1) the Candide wool and raglan sleeves, and 2) the fact that Cally appeared to have Lisa’s ballet-slender body type. These two coincidences in fact absolutely clinched the matter. Cally was “Cally,” wasn’t she?

 

These equivalences might not have been so critical to me, except that, it suddenly seemed that Lisa had died. She had committed suicide, so the message was communicated to me, and I had now to inform Cally of the fact that I’d known her mother way back when. I felt it was incumbent upon me to tell her what she had been like, that was the mission I’d been given. But  first I needed to ascertain beyond a shadow of a doubt that this Cally was indeed Lisa-my-former-friend’s daughter “Cally”…

 

If this was not a true paranoia that instantly arose following the death of the drug dealing plot, it was a delusion coupled with the felt urgency to act on what I was certain I knew (not so different from the marijuana delusion after all). And it was only one of a long string of plots and serial delusions that followed one upon another almost without a break that winter and spring. Just as I described in my entry of the other day, not once in the midst of any of these conspiracies or delusions was I cognizant of what was going on or able to step back and analyze the situation with any objectivity. At that time, I did not even have the tools I have now to dissect an incident after the fact: I was at the utter mercy of my brain illness, without any insight whatsoever. Now, at least, I can step back after the experience and say, Wow, I must have been really paranoid to think such a thing, or That was a hallucination after all…My goal, and a real triumph would be to recognize these things in medias res, that is, right while they are happening, but so far that does not seem to be possible.

 

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Paranoia and Hallucination

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Argh… An incident of paranoia and, hallucination unrecognized by any of us, including me, caused certain people close to me unnecessary distress this week.  I won’t go into the details of that particular incident, except to say that I had absolutely no appreciation for the fact that I was both paranoid and under the influence of false perceptions and so took what I hallucinated as solid reality, with predictable consequences. Since I felt attacked and “heard” corroborating evidence, when I accused the responsible parties, as I felt certain they were, you can imagine how people reacted…Anyhow, I don’t really know how to make things right now, since the accusations themselves seems to reveal a fundamental lack of trust, however paranoid and generated out of the whole cloth that is my imagination going full tilt…I don’t imagine it would  help anyone much to say that this has happened many many times before, and that I have accused so many people of so many outlandish things that it embarrasses me even in the remembering…Nor that some, no, most of the accusations have had utterly NO basis in fact other than the predisposition of my brain at that precise instant in time. They didn’t even reflect any longstanding attitude, so much as a temporary, very fleeting feeling that burst out as full-blown paranoia-of-the-moment.

 

Be that as it may, instead of dissecting this particular incident, I want to discuss paranoia of the rather prosaic sort that afflicts me these days, rather than the grandiose and global kind — involving the usual suspects like the CIA plus certain shadowy figures known as The Five People — which used to. These days, paranoia — which I’ve been taught to recognize and deal with by my psychiatrist, though success at either task remains elusive as best — reveals itself most often at the grocery store or the post office or the lobby of my “elderly-disabled” apartment complex. Or it might pop up in my suddenly suspecting  theft by someone near and dear, or accusations of malfeasance or betrayal by someone who would have no possible reason or motive for such an act, if an act of that sort were even in the realm of being contemplated. But usually the accusation is so outrageous as to be laughable if it weren’t so insulting or potentially dangerous to reputation or livelihood.

 

What happens in general is something like this: (and Dr O has broken it down for me, knowing the neurology of paranoia) my brain generates a feeling, that is the amygdala spontaneously, chemically, spurts out neurotransmitters of some sort that spell “fear” or “threat” coupled with a sense of absolute certainty. I don’t know if there has to be a trigger for this amygdala burst or not, but it seems to me that stress does induce it more often than calm does, and that certain stresses bring it on more often than others. But that is not to say that I can ever predict when or if my amygdala will produce an outburst at any given time; it is definitely unpredictable to the max! So imagine that I am, say, visiting someone in the hospital with another friend, and in that stressful situation — crowded hospital, stress of strange place and sick friend and not knowing what to do — my amygdala pours out the fear neurotransmitter. I’m suddenly on alert and feeling threatened. Someone is attacking me, my brain decides, and he or she is right there in the room with me! In fact, I just heard them both conspire against me, the sick friend and the well friend visiting him…They are both in on it and against me! I hate them both, they got me here on false pretenses and now are plotting against me, they want to hurt me, to do something to me, they…And so it goes.

 

Anyhow, after the primary flood of “threat” feeling (“the feeling is primary” and that feeling is almost always fear in some form or another) the brain’s longer pathway — as I understand it — kicks in and generates an explanation, a storyline to go along with the “threat feeling.” The important thing to know is that the storyline need not make any sense whatsoever. The brain doesn’t give a damn whether there is any evidence outside of it to explain the threat feeling, because the threat feeling is already inside and felt…So anything can explain it, literally anything can seem or feel reasonable, and does. So wherever the mind goes, or tends to go at that moment, will be the form of the storyline that explains the threat-feeling. If one’s brain travels along the line of (I should only be so reasonable) “why do I feel so threatened?  Did they just say something bad about me? Maybe I’d better ASK them! then one is in good shape, because at least then one can check out what is going on, and short circuit any tendency to mistake false perception for reality. But for me, while I do not, often, these days go so far as to opine that cosmic forces are behind my threat-feeling, I do find other less than reasonable sources than reality to explain it: voila paranoia. 

 

One example, when I am in the grocery store, particularly when alone, I almost always hear and as a result know that I am being followed, and instructed as to what I can and cannot buy. I generally race through the store in an effort to get out, and get away from my pursuers,  or if I do not, suffer from dreadful fear of imminent assault or at least dire consequences. At a minimum, in the best of times, I know that someone is following me and keeping track of what I put in my cart, and will be transmitting the “evidence” to a central authority, which will lead to later consequences that I will regret (which my mind spins into longer more detailed scenarios that change each time I am in the store but which vanish as soon as I am safely back in the car or walking down the hill a distance away…)

 

So that is both an explanation of how paranoia arises — from Dr O’s mantra, “the feeling is primary” , meaning the fear that is initially and instantly generated from that burst of neurotransmitters or neuroelectricity to the brain’s subsequent confabulation of a narrative, an explanation for that all-compassing feeling of threat and the certainty that the threat is real. And I hope I have given some examples of paranoia, specific examples, where the situation stimulates the content without the two being necessarily significant or significantly related. For example, in the instance of the two friends at the hospital, it is the fear and the feeling of threat and certainty that provides the stimulus for the paranoia, rather than any underlying distrust of the friends. The friends are simply the carriers of the fear and the certainty of the reality of the threat, which would have been borne by almost anyone stepping into the picture at that time…