perm filename CHAP1[4,KMC]16 blob sn#067177 filedate 1973-10-17 generic text, type T, neo UTF8
00100			 THE PARANOID MODE
00200	 The Concept of Paranoia
00300		Like  ourselves,  the  ancient  Greeks  called  one   another
00400	paranoid.  The  term  `paranoia'  (Gr.:  para=beside;  nous  =  mind)
00500	referred to states of craziness and mental deterioration. For roughly
00600	the next two thousand years the term disappeared from classifications
00700	of mental disorders.  Historians have not seemed curious  about  what
00800	persons  with persecutory delusions were called all that time. (It is
00900	doubtful that there weren't  any.)  In  the  18th  century  the  term
01000	reappears  in  German  classifications  to refer to delusional states
01100	categorized as disorders of intellect rather  than  emotion.  (Lewis,
01200	1970 ).
01300		Little agreement about the term's usuage  was  reached  until
01400	this  half of the present century when it achieved a solid adjectival
01500	status, as in "paranoid  personality"  and  "paranoid  state".     At
01600	present   the   category  `paranoid'  has  high  reliability  (85-95%
01700	interjudge agreement). The term is generally used  to  refer  to  the
01800	presence  of  persecutory  delusions.   Somatic, erotic, grandeur and
01900	jealousy  delusions   are   simply   identified   as   such   without
02000	characterizing them as paranoid.
02100		To  introduce  what  being  paranoid  is  like,  let us first
02200	consider two sorts of human activity, one termed "ordinary"  and  the
02300	other termed "paranoid".
02400		In the ordinary mode of human action a person goes about  his
02500	business  of everyday living in a matter-of-fact way.   He deals with
02600	recurrent and routine situations in his environment  as  they  arise,
02700	taking things at their face value.  Events proceed in accordance with
02800	his beliefs and expectations and thus can be managed routinely.  Only
02900	a  small  amount  of  attention  need  be  devoted  to monitoring the
03000	environment , simply checking that everthing is as expected.     This
03100	placid ongoing flow of events can be interrupted by the the detection
03200	of signs of alarm or opportunity at any  time.  But  the  predominant
03300	condition  is one of a steady progression of events so ordinary as to
03400	be uneventful.
03500		In  contrast  to this routine ordinariness are arousal states
03600	of emergency .   The particular aroused emergency  to  be  considered
03700	herein  considering  is termed the "paranoid mode" characterized by a
03800	continous wary suspiciousness. To appreciate the nature and  problems
03900	of  this  state, imagine the situation of a spy in a hostile country.
04000	To him, everyone he meets is a potential enemy, a threat to existence
04100	who  must  be  evaluated  for  malevolence.  To  survive  he  must be
04200	hypervigilant and fully mobilized to attack, to flee, to stalk.    In
04300	this  situation  appearances  are  not  to  be taken at face value as
04400	ordinary events or routine background but each must  be  attended  to
04500	and  interpreted  in  order  to  detect  malevolence.   Events in the
04600	environment, which in the ordinary mode would not be connected to the
04700	self,  become  referred  to  the  self  as potentially menacing.  The
04800	unintended effects of others may be misinterpreted  as  intended  and
04900	the  undesigned  tends to become confused with the designed.  Nothing
05000	can be allowed to be unattendible.  The  dominant  intention  of  the
05100	agent is to detect malevolence from others.
05200	(INCLUDE SOME DESCRIPTIONS OF NATURAL PARANOIA BY BIOGRAPHERS
05300	HISTORIANS, POLITICAL SCIENTISTS, NOVELISTS ?)
05400	
05500	 Characteristics of Clinical Paranoias
05600		When dividing the world of experience into conceptual classes
05700	,  we  sort  and  group  together  objects  and  events  according to
05800	properties they have in common. The members of a class  resemble  one
05900	another  in  sharing  certain  properties.    The resemblance between
06000	members of a  class  is  neither  exact  nor  total.   Members  of  a
06100	conceptual  class  are  considered more or less alike and there exist
06200	degrees of resemblance.  Humans are neither subjective nor objective;
06300	they  are  projective.     In forming classifications, we project our
06400	intentions onto the world.  Thus the world of experience consists  of
06500	our  interactive relations, not simply of objects isolated from human
06600	interests.
06700		Observations and classifications made by clinicians regarding
06800	naturally-occurring paranoid disorders have been thoroughly described
06900	in the psychiatric literature.   Extensive accounts can be  found  in
07000	Swanson,  Bohnert  and Smith (1970) and in Cameron (1967).    I shall
07100	attempt to give a condensed description of paranoid phenomena as they
07200	appear  in, or are described by, patients in a psychiatric interview.
07300	It is many of these phenomena which  the  proposed  simulation  model
07400	attempts to explain.
07500	
07600		The main phenomena of paranoid disorders  can  be  summarized
07700	under  concepts  of suspiciousness, self-reference, hypersensitivity,
07800	fearfulness , hostility and rigidity.  These class-concepts represent
07900	common empirical indicators of the paranoid mode.
08000	
08100	 Suspiciousness
08200		The chief  characteristic  of  clinical  paranoid   disorders
08300	consists  of  suspiciousness,  a  mistrust  of  others  based  on the
08400	patient's malevolence  beliefs.       The  patient  believes  others,
08500	known and unknown, have evil intentions towards him. In his relations
08600	with  others  he  is  continously  on  the  look-out  for  signs   of
08700	malevolence  which  he  often  reads  from  the  results  of  his own
08800	probings.  He is hypervigilant; people must be watched, their schemes
08900	unmasked  and  foiled.   He  is  convinced  others try to bring about
09000	undesirable states in himself such as humiliation, harassment, mental
09100	subjugation,  physical  injury  and even death.    In an interview he
09200	may report such beliefs directly or ,if he is well-guarded, he offers
09300	only  hints.   He does not confide easily. Disclosure may depend upon
09400	how the interviewer responds in the dialogue to the patient's reports
09500	of fluctuating suspicions and/or absolute convictions.
09600		He is greatly concerned with "evidence". No room  is  allowed
09700	for  mistakes,  ambiguities  or chance happenings.  "Paranoids have a
09800	greater passion for the truth than other madmen."  -(Saul  Bellow  in
09900	Sammler's  Planet). Using  trivial evidential details, his inferences
10000	leap from the undeniable to the unbelievable.
10100		The patient may vary in his own estimate of the  strength  of
10200	his  malevolence  beliefs. If they consist of weakly-held suspicions,
10300	he may have moments of reasoning with himself in which  he  tries  to
10400	reject  them as ill-founded.  But when the beliefs represent absolute
10500	convictions, he does not struggle  to  dismiss  them.    They  become
10600	pre-conditions for countering actions against tormentors who wish and
10700	try to do him evil.  He seeks affirmation of  his  beliefs.  ("It  is
10800	certain  that  my  conviction  increases the moment another soul will
10900	believe in it." Joseph Conrad in Lord Jim.). He  wants  sympathy  and
11000	allies  in  positions  of power such as clinicians or lawyers who can
11100	help him take action against his oppressors.
11200		The  malevolence  beliefs may involve a specific other person
11300	or a conspiracy of others such as the  Mafia,  the  FBI,  Communists,
11400	Hell's Angels.  The patient sees himself as a victim ,one who suffers
11500	at the hands of others  rather  than  as  an  agent  who  brings  the
11600	suffering  on himself.  Other agents subject him to, and make him the
11700	object of, their evil intentions. He dwells on  and  rehearses  these
11800	outrages  in  his  imagination.  He  schemes  to defeat or escape his
11900	adversaries.
12000		The  misdeeds  of others are denounced, disparaged, condemned
12100	and belittled. He feels interfered with  and  discriminated  against.
12200	The  specific content of the beliefs may not be directly expressed in
12300	a first interview.     The patient may be so mistrustful of how their
12400	disclosure might be used against him that he cautiously feels his way
12500	through an interview offering only hints which an interviewer can use
12600	to infer the presence of persecutory delusions.
12700	
12800		Using  his  own  credibility  judgements,   the   interviewer
12900	attempts  to  determine whether the patient's malevolence beliefs are
13000	delusions (false beliefs) or not. Experienced clinicians realize that
13100	some  malevolence  beliefs  can  turn  out  to  be  true.  Others may
13200	represent correct  estimations  on  the  part  of  the  patient  who,
13300	however,  fails  to see that the malevolence of others is a secondary
13400	consequence of his tendency to accuse and provoke others to the point
13500	where they in fact become hostile towards him.
13600	
13700	
13800	 Self-Reference and Hypersensitivity
13900	
14000	
14100		The patient may believe many  events  in  the  world  pertain
14200	directly  to  himself.  Other  observers  of  his  situation find his
14300	conviction hard to accept. For example,  he  may  be  convinced  that
14400	newspaper headlines refer to him personally or that the statements of
14500	radio announcers contain special messages for him. Hypervigilant,  he
14600	hypersensitively reads himself into situations which are not actually
14700	intended to pertain to him and his particular concerns.
14800	
14900		References to the self  are  misconstrued  as  slurs,  snubs,
15000	slights  or  unfair  judgements.  He may feel he is being watched and
15100	stared at.  He is excessively concerned about eyes  (which  can  both
15200	watch  and  punish). Cameras, telescopes ,etc.  which may be directed
15300	his way unnerve him.   He may feel  mysteriously  influenced  through
15400	electricity,  radio  waves, or (more contemporaneously) by emanations
15500	from computers.  He is hypersensitive to criticism.     In crowds  he
15600	believes  he is intentionally bumped. Driving on the highway he feels
15700	repeatedly followed too-closely by  the  car  behind.   Badgered  and
15800	bombarded  without  relief  by  this  stream  of  wrongs , he becomes
15900	hyper-irritable, querulous and quarrelsome.
16000		He is touchy about certain topics, flaring up when references
16100	to  particular conceptual domains appear in the conversation.     For
16200	example, any remarks about his age, religion, family, or sexlife  may
16300	set  him  off.    Even  when  these  domains are touched upon without
16400	reference  to  him,  e.g.   religion  in  general,  he  may  take  it
16500	personally.   When  a delusional complex is present, linguistic terms
16600	far removed from, but still conceptually connectable to, the  complex
16700	stir  him up. Thus, to a man holding beliefs that the Mafia intend to
16800	harm him, any remark about  Italy  might  lead  him  to  react  in  a
16900	suspicious or fearful manner.
17000	
17100	 Affect-States   
17200	
17300		The  major  affects expressed, both verbally and nonverbally,
17400	are those of fear, anger and mistrust. The patient fears that  others
17500	wish  to  subjugate  and  control  him. He may be fearful of physical
17600	attack and injury even to the point of death. His fear  is  justified
17700	in  his  mind by the many threats he detects in the conduct of others
17800	towards him.   He is hostile to what are interpreted as  insinuations
17900	or  demeaning  allusions. His chronic irritability becomes punctuated
18000	with outbursts of raging tirades and diatribes.  When he feels he  is
18100	being  overwhelmed, he may erupt and in desperation physically attack
18200	others.
18300		The affects of fear, anger and mistrust he experiences  blend
18400	with  one  another  in  varying  proportions  to  yield an unpleasant
18500	negative affect state made continuous  by  fantasied  rehearsals  and
18600	retellings  of  past  wrongs.      Depending on his interpretation of
18700	input from other people, the patient may move away  from  others  and
18800	become  guarded,  secretive  and  evasive. Or he may suddenly jump at
18900	others with  sarcastic  accusations  and  arguments.    His  negative
19000	affect-states  become locked into self-perpetuating cycles with other
19100	people in his life space who may take censoring  action  towards  him
19200	because of his uncommunicativeness or outbursts.
19300	
19400	
19500	 Rigidity
19600	
19700		Another  salient  characteristic  of  the  paranoid  mode  is
19800	excessive  rigidity.   The  patient's  beliefs in his sensitive areas
19900	remain fixed, difficult  to  influence  by  evidence  or  persuasion.
20000	The  patient  himself  makes  few  verification  attempts which might
20100	falsify his convictions.     To change a belief  is  to  admit  being
20200	wrong.     To  forgive  others  also  opens  a  crack  in the wall of
20300	righteousness.    He does  not  apologize  nor  accept  apology.   He
20400	stubbornly   follows   rules   to   the   letter   and   his  literal
20500	interpretations of an organization's  regulations  can  drive  others
20600	wild.    It is this insistent posture of rigidity  and  inflexibility
20700	which  makes the treatment of paranoid processes by symbolic-semantic
20800	methods so difficult. The patient clings to his convictions in  spite
20900	of all the "rational" counter-evidence offered.
21000	
21100	 Theories of Paranoia
21200	
21300		Attempts to explain, to make intelligible, paranoid disorders
21400	have been offered since antiquity.     None of these  verbally-stated
21500	formulations has won the consensus which typifies scientific theories
21600	since they were neither systematic nor testable.
21700		Science   represents   a   search  for  consensus  knowledge,
21800	judgements about which agreement can be obtained. (See Ziman,  1968).
21900	For  a theory to gain scientific consensus, it must meet requirements
22000	of systemicity and testability.
22100		For a theory to be systematic, its hypotheses must cohere and
22200	not be isolated. They must connect with one another  and  collaborate
22300	in  a consistent way. Each hypothesis stands as an initial assumption
22400	or as  a  consequence  of  one  or  more  initial  assumptions.   The
22500	consequence  relation  can  be one of logical or empirical entailment
22600	but the system of hypotheses, to be consistent,  should  not  contain
22700	contradictions.
22800		For a  theory  to  be  testable,  it  must  be  sensitive  to
22900	empirical  data  which  can strenghten or weaken its acceptability as
23000	true or authentic. Each hypothesis in the theory need not be directly
23100	or  independently  testable.     But  the  theory as a conjunction of
23200	hypotheses must be brought into contact with data of observation,  if
23300	not directly, then indirectly, through a translation process in which
23400	a consequence of  the  theory  can  be  compared  with  observational
23500	evidence.
23600		Previous theories of  paranoia  can  be  criticized  for  not
23700	satisfying  these  requirements of systemicity and testability.   The
23800	model to be presented fulfills these requirements. When theories  are
23900	presented  in  literary  form  it  is  difficult  to  know  what such
24000	formulations imply or whether the implications are consistent.  Being
24100	vague,  they  do  not  tell us what we are supposed to do in order to
24200	believe the world behaves as their authors have conceived  it.  If  a
24300	formulation  is  untestable, the issues it raises are undecidable and
24400	unsettleable; thus the necessary consensus cannot be reached.
24500	
24600		Theories stem from two sources: (1) from hypotheses suggested
24700	by  new  descriptions or revisualizations of the phenomena themselves
24800	and (2) from modifications of a legacy of previous  theories  serving
24900	as  the  bequeathed  myths of the field.  Each generation attempts to
25000	formulate new explanatory theories by discovering new phenomena or by
25100	modifying  predecessor theories.  The old theories are unsatisfactory
25200	or only partially satisfactory because  they  are  found  to  contain
25300	anomalies or contradictions which must be removed. Sometimes previous
25400	theories  are  viewed  as  lacking  evidential  support  by   current
25500	standards.  Theories are mainly superseded rather than disproved. The
25600	new  versions  try  to  remove  the   contradictions   and   increase
25700	comprehensiveness by explaining more phenomena.
25800		Theories  have  many  functions.   They  can be summarized as
25900	follows ( Bunge, 1967):
26000		(1)To systematize knowledge.
26100		(2)To explain facts by showing how they are the entailed
26200			consequences of the systematizing hypotheses.
26300		(3)To increase knowledge by deriving new facts.
26400		(4)To enhance the testability of hypotheses by connecting
26500			them to observations.
26600		(5)To guide research by:
26700			(a) posing fruitful problems
26800			(b) suggesting new data to gather
26900			(c) opening new lines of investigation.
27000		(6)To map a portion of reality. 
27100		It  would be excessive to demand that a single theory fulfill
27200	all these functions.  In  the  pre-consensus  states  of  undeveloped
27300	fields  we  should be happy in achieving even one of them. Models, as
27400	well as theories, can be  assigned  these  functions  when  they  are
27500	theoretical  in  type.   Our model was constructed primarily to serve
27600	functions (2) and (4), offering a testable explanation.
27700		Again, theories offered as scientific explanations should  be
27800	(a) systematic	(i.e.          coherent   and   consistent)  and  (b)
27900	empirically testable.  Prior formulations  about  the  paranoid  mode
28000	have  not  met these criteria and thus are deservedly bygone notions.
28100	For example, to account for paranoid processes  by  hypothesizing  an
28200	imbalance   of  intellect  and  affect  is  so  vague  and  global  a
28300	formulation as not to merit explanatory status. For an explanation to
28400	achieve  consensus,  it  must  be  of  the right type, syatematic and
28500	testable. To meet  these  criteria,  I  shall  propose  a  postulated
28600	structure  of symbol-manipulating processes, strategies, functions or
28700	procedures which is capable of producing the observable  regularities
28800	of the paranoid mode.
28900		In  psychiatry  it  is still useful to view some things which
29000	happen to a man in causal mechanical terms. But a man is not  only  a
29100	passive  recipient,  subject  to Newtons's laws. He is also an active
29200	agent, a language user  who  thereby  can  monitor  himself,  control
29300	himself, direct himself, and emancipate himself while commenting upon
29400	and criticizing these performances. Modern psychiatric  theory  based
29500	on  information-processing  principles, views man as an agent as well
29600	as recipient.  It must also come to grips with those enigmatic  cases
29700	in  which  what causally happens to a man can be a consequence of his
29800	unrecognized reasons.
29900		Let  us  consider  some  explanations  for  the paranoid mode
30000	beginning with Freud  in  the  late  19th  century.  (Historians  can
30100	certainly  find  concepts  of  intentions, affects and beliefs as far
30200	back as Aristotle, who seldom quoted his sources. "It's all been said
30300	before  but  you have to say it again because nobody listens"- Gide).
30400	To explain persecutory paranoia, Freud postulated defense  mechanisms
30500	of repression and projection (Freud, 1896).  He assumed the patient's
30600	believed persecution by others represented intolerable  (  and  hence
30700	repressed   and   projected)  self-reproaches  for  childhood  sexual
30800	experiences.   Today hardly anyone finds this explanation acceptable.
30900	Although  the  formulation has withered , the concepts of defense and
31000	projection have weathered.
31100		Sometime during Freud's friendship with  Fliess  (1897-1902),
31200	the  latter  proposed  to  Freud that paranoia arose from unconscious
31300	homosexual conflict (Jones,1955).  For years Freud was  silent  about
31400	this  notion  in  his  discussions  of paranoia. Then in 1911, in his
31500	notes on the Schreber case, he developed the  Fliess  formulation  in
31600	terms of transformations being applied to the basic proposition `I (a
31700	man) love him.' He postulated this proposition to be  so  intolerable
31800	as  not  to  be  admitted to consciousness and therefore subjected to
31900	unconscious transformations, first into `I do not love  him,  I  hate
32000	him'  which  in  turn  was  transformed into the conscious belief `He
32100	hates me' with the accompanying conclusion `Therefore I am  justified
32200	in hating him'.(Freud,1911).  
32300		Great  difficulty  has  been  encountered  in   testing   the
32400	formulation since  there is  no  agreed-upon method for detecting the
32500	presence of unconscious homosexual conflict.     The  explanation  is
32600	also  inconsistent  with  another  psychoanalytic tenet that everyone
32700	harbors unconscious homosexual conflicts.  But not  everyone  becomes
32800	paranoid.  To reconcile the inconsistency one would have to postulate
32900	some  additional,  possibly  quantitative  factors,  to  explain  the
33000	intensity  and  extent  of  the  paranoid  mode in certain people.  A
33100	further difficulty with  the  formulation  has  been  the  fact  that
33200	overtly  homosexual people can be paranoid, requiring in such cases a
33300	postulate of some other type of underlying conflict.
33400		Because  of  inconsistencies  and  difficulty in testing, the
33500	homosexual-conflict explanation has not achieved consensus.   But  as
33600	will  be discussed, it may represent a special case in a more general
33700	theory  which  postulates  self-censuring  and  humiliation  to  have
33800	central functions in the paranoid mode. Freud's later attempts at the
33900	explanation of paranoia assumed simply that love was transformed into
34000	hate  (Freud,1923).    This notion is too incomplete and unspecific a
34100	formulation to  qualify  as  an  acceptable  scientific  explanation.
34200	Contemporary requirements demand a more complex and precisely defined
34300	organization of functions to account for such a transformation.
34400		Likewise Cameron's explanation of  paranoia  as  representing
34500	"projected  hostilty"  (Cameron,1967)  represents  a single, isolated
34600	hypothesis.  An isolated tendency  statement  says  little.  What  is
34700	needed  is  a  system  of tendency statements sufficiently complex to
34800	account for a variety of paranoid phenomena.
34900		Tomkins      (Tomkins,1963)      offered     an     arresting
35000	information-processing  theory  of  the   paranoid   posture.It   was
35100	articulated  in  terms  of defensive strategies, transformations ,and
35200	maximizing-minimizing principles. He viewed the paranoid `posture' or
35300	mode  as  an  attempt  to  cope with humiliation.  He proposed that a
35400	person whose information processing is monopolized  by  the  paranoid
35500	mode  is  in a permanent state of vigilance, in order to maximize the
35600	detection of insult and to minimize humiliation. To quote Tomkins:
35800		"The major source of distortion in his interpretation is
35900		 in his insistence on processing all information as though 
36000		 it were relevant only to the possibility of humiliation."
36200		Swanson, Bohnert and Smith  (1970),  in  their  monograph  on
36300	paranoia,  proposed  how  a "homeostatic" individual might attempt to
36400	deal with "bewildering  perceptions".       They  postulated  that  a
36500	person  in  homeostatic  equilibrium  perceives a pronounced inner or
36600	outer change which is inexplicable or unacceptable.    The  resultant
36700	disequilibrium   is   so   bewildering   that  in  order  to  restore
36800	equilibrium, the  person  constructs  a  paranoid  explanation  which
36900	attributes  the  cause  of  the change, not to an internal, but to an
37000	external  source.   With  the  cause  of  the  change  identified   ,
37100	bewilderment is abolished and uncertainty reduced.
37200		Aspects  of  this   formulation   suggest   symbol-processing
37300	strategies  typical of cases of paranoid thinking associated with the
37400	experienced  changes  resulting  from      organic  brain  damage  or
37500	amphetamine psychosis. These are conditions which mechanically happen
37600	to a man.  In paranoid states, reactions or  personalities  where  no
37700	pronounced  physical  change  can  be  identified ,the formulation is
37800	insufficient and must be filled out with more  complex  and  specific
37900	processes.
38000		In sum, the formulations of paranoia reviewed have not gained
38100	widespread acceptance because of various weaknesses and  limitations.
38200	Currently  there  exists  no  reigning  theory of paranoia. In such a
38300	pre-consensus state, the field is open for contending theories.
38400		Previous  theories  have  contributed useful hypotheses.    I
38500	have incorporated some of them (e.g.  Tomkin's  hypothesis  regarding
38600	humiliation)  in  an  attempt  to  explain  paranoid  phenomena  in a
38700	different way, using an  interactive  simulation  model.     I  shall
38800	attempt   to   explain   sequences   of  paranoid  symbolic  behavior
38900	(conversational  interactions)  by  describing  in  some   detail   a
39000	simulation  of  paranoid  interview  behavior  ,  having  in  mind an
39100	audience of  clinicians,  behavioral  scientists  and  colleagues  in
39200	fields  of computer science, artificial intelligence, and philosophy.
39300	The simulation model proposed (first described in  Colby,  Weber  and
39400	Hilf,1971)  stands  as  a  putative  explanation having the merits of
39500	being more explicit, systematic, consistent  and  testable  than  the
39600	theories  described  above.        The  model  combines hypotheses of
39700	previous formulations with additional hypotheses and assumptions , in
39800	an attempt to present a coherent, unified explanation.
39900		Before  we embark on a description of the model, let us first
40000	consider what it means to offer an explanation.