What is paranoia? What makes us mistrustful? How can this be overcome?
Daniel Freeman, Professor of Psychology at Oxford, has spent thirty years at the vanguard of paranoia research and treatment. This remarkable and moving book tells the story of that journey.
For decades, conventional wisdom held that paranoia was only experienced by people with severe mental health problems and little could be done to rectify its disastrous effects. Paranoia gives us a front row seat as Freeman turns the traditional view on its head.
He develops life-changing treatments for clinical paranoia – often using state-of-the-art technology like virtual reality. He reveals that suspicion is rife in society, with paranoia widespread, conspiracy theories rampant and emotion all too often trumping evidence. He discovers the causes of mistrust, including the role of genes, trauma, lack of sleep, worry, low self-confidence, cannabis use and hearing voices, and delves into the murky world of Covid-19 conspiracy theories. Lighting up the narrative throughout are the rarely heard voices of people whose lives have been almost wrecked by paranoia – and then in many cases transformed by Freeman’s groundbreaking treatments.
This is also a practical book. Freeman shows how we can measure our own levels of mistrust. He explains how we can remedy things if those levels are higher than we’d like, because although mistrust can seem engrained, things can change for the better. Ultimately, it can be overcome. Compelling and compassionate, this is a gripping tale from the front line of suspicion – an impassioned plea for the urgent rebuilding of trust between us all.
Daniel Freeman is Professor of Clinical Psychology and Medical Research Council (MRC) Senior Clinical Fellow in the Department of Psychiatry, Oxford University. One of the United Kingdom's leading clinical psychologists, he is a Fellow of University College, Oxford and a Fellow of the British Psychological Society.
Buku ini menghimpunkan kajian-kajian dan rawatan psikologikal yang terkini tentang paranoia, ditulis oleh Daniel Freeman, profesor psikologi di Universiti Oxford. Freeman merupakan antara pengkaji yang pertama menyelidiki simptom paranoia dengan dalam sejak tahun 90’an lagi; dan telah mengembangkan pelbagai aplikasi dan teknologi untuk mengkaji dan merawat paranoia seperti: Feeling Safer, gameChange dan London Virtual Tube (untuk mengkaji fenomena paranoia secara maya).
Paranoia, atau kecurigaan yang melampau, merupakan salah satu tema kepada simptom delusi dalam skizofrenia. Tetapi simptom paranoia itu sendiri tidak tertakluk semata-mata kepada skizofrenia. Ia juga merupakan sebuah gejala yang boleh muncul dalam:
1. Populasi berisiko ultra-tinggi (ultra-high risk population) di mana paranoia boleh menjadi salah satu simptom. Kriteria populasi ini adalah: berlakunya episod psikosis halus (halusinasi, delusi tetapi masih dapat membezakan realiti dan psikosis), simptom-simptom psikosis yang reda dalam lingkungan tujuh hari tanpa rawatan, sejarah keluarga terdekat dengan gejala psikosis dan penurunan daya fungsi sosial, pekerjaan atau aspek kehidupak yang lain. Sebanyak 15-35 peratus daripada populasi ini akan bertukar kepada gejala psikosis klinikal dalam 2-3 tahun. (Fusar-Poli et al, 2013). 2. Kecelaruan personaliti paranoid. 3. Kecelaruan delusi, jenis paranoid. 4. Paranoia yang dicetuskan oleh punca organik, seperti kanabis dan alkohol.
Freeman mengambil pendirian unik, apabila beliau memahami paranoia bukan setakat sebuah simptom yang disebabkan punca biologikal, tetapi juga sebagai sebuah mekanisme helah bela diri (defense mechanism); di mana seseorang memprojeksikan kegelisahan dalaman kepada orang lain.
Beliau juga berpendapat bahawa paranoia berkongsi asal-usul psikologikal dengan gejala kecelaruan kegelisahan, terutamanya dalam corak kognitif, seperti kecenderungan untuk gopoh dalam membuat keputusan (jumping to conclusions) dan sentiasa berfikiran yang membencanakan (catastrophising). Tetapi tidak konklusif perbincangannya sama ada kegelisahan mencetuskan paranoia atau sekadar salah satu fenomena yang mendampinginya.
Freeman optimis dengan kepercayaannya bahawa dengan menumpukan perhatian kepada faktor yang menyumbang kepada kegelisahan pesakit, paranoia boleh dikawal. Beliau membentangkan beberapa dapatan kajian beliau yang menggunakan teknologi terkini seperti realiti buatan yang menunjukkan hasil yang memberangsangkan.
Buku ini lebih fokus dalam menyenaraikan kajian-kajian dan pencapaian Freeman dalam kerjayanya menyelidiki paranoia. Beliau dengan jayanya dapat membuktikan bahawa paranoia sub-klinikal (yakni sebagai mekanisme helah bela diri, dan bukan sebahagian daripada gejala biologikal seperti skizofrenia) adalah sebenarnya lebih lazim daripada yang disangka dalam masyarakat awam; bahawa pengalaman traumatik, pengalaman dibuli, kekurangan tidur dan penggunaan bahan-bahan seperti kanabis menyumbang kepada paranoia.
Secara peribadi, saya berharap perbincangan yang lebih erat tentang suatu kerangka yang menyeluruh dibina daripada hasil dapatan kajian.
Apakah perkaitan secara fenomenologi antara kegelisahan dan paranoia? Adakah ia punca atau natijah paranoia? Adakah kegelisahan wujud bersama paranoia dalam sebuah spektrum sepertimana beberapa jenis kemurungan dengan bipolar? Di manakah kita menggariskan perbezaan antara paranoia sebagai helah bela diri dan klinikal- kes-kes yang dikendalikan oleh Freeman kebanyakannya mempunyai tahap paranoia yang tinggi, yang tampak lebih serius daripada sekadar helah bela diri.
Mungkin intervensi psikologikal terhadap paranoia boleh dilakukan secara intensif kepada populasi berisiko ultra sebagai sebuah usaha pencegahan daripada perkembangan kepada gejala psikotik klinikal. Buat pesakit yang sememangnya mempunyai diagnosis klinikal, mungkin boleh digunakan sebagai intervensi bertumpu bersama dengan ubat-ubatan psikotropik.
Cabaran yang saya boleh fikirkan adalah yang pertamanya, kebanyakan pesakit psikotik klinikal juga mempunyai penurunan dari aspek kognitif. Mereka juga boleh mempunyai simptom anosognosia, di mana mereka sendiri tidak menyedari paranoia yang dialami sebagai sesuatu yang tidak berpaksikan realiti. Disebabkan ini, mereka juga mempunyai kadar kepatuhan terhadap rawatan yang rendah.
Mungkin hanya pesakit-pesakit yang mempunyai tahap kesedaran yang tinggi, tahap kognitif yang baik dan delusi atau mekanisme helah dirinya bersifat ego-distonik (menyebabkan rasa tidak senang) yang berkemungkinan menjadi calon sesuai untuk intervensi psikologikal.
Dan intervensi psikologikal tidak sepatutnya menjadi sebab kepada lambatnya rawatan ke atas psikosis dimulakan; kerana prognosis juga bergantung kepada “duration of untreated psychosis”, maka sebuah kerangka fenomenologi dan klinikal perlu digubal untuk membezakan dua aspek paranoia yang berbeza ini.
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This book compiles the latest psychological studies and treatments on paranoia, written by Daniel Freeman, Professor of Psychology at the University of Oxford. Freeman is among the earliest researchers to have studied the symptoms of paranoia in depth since the 1990s, and he has developed various applications and technologies to study and treat paranoia, such as Feeling Safer, gameChange, and the London Virtual Tube (used to study paranoid phenomena in virtual environments).
Paranoia, or excessive suspiciousness, is one of the central themes of delusional symptoms in schizophrenia. However, the symptom of paranoia itself is not limited solely to schizophrenia. It can also appear in: • Ultra-high-risk populations, where paranoia may be one of the symptoms. The criteria for this population include: the occurrence of brief psychotic episodes (hallucinations or delusions, but with preserved ability to distinguish reality from psychosis), resolution of psychotic symptoms within about seven days without treatment, a family history of psychotic disorders, and a decline in social, occupational, or other functional capacities. Between 15–35% of this population will convert to clinical psychosis within 2–3 years (Fusar-Poli et al., 2013). • Paranoid personality disorder. • Delusional disorder, paranoid type. • Paranoia induced by organic causes, such as cannabis or alcohol use.
Freeman takes a unique stance by understanding paranoia not merely as a symptom caused by biological factors, but also as a defense mechanism—a projection of one’s internal anxiety onto others.
He also argues that paranoia shares psychological origins with anxiety disorders, particularly in cognitive styles such as the tendency to jump to conclusions and catastrophize. However, his discussion remains inconclusive as to whether anxiety causes paranoia or merely coexists with it as an accompanying phenomenon.
Freeman remains optimistic in his belief that by focusing attention on the factors contributing to a patient’s anxiety, paranoia can be managed. He presents several of his studies employing cutting-edge technologies such as virtual reality, which have produced promising results.
This book primarily focuses on summarizing Freeman’s research and career achievements in the study of paranoia. He has successfully demonstrated that subclinical paranoia (that is, as a defense mechanism rather than as part of a biological syndrome like schizophrenia) is far more prevalent in the general population than previously believed—and that traumatic experiences, bullying, sleep deprivation, and substance use such as cannabis contribute significantly to its development.
Personally, I wish the book had offered a more integrative framework built upon these findings.
What is the phenomenological relationship between anxiety and paranoia? Is anxiety a cause or a consequence of paranoia? Do anxiety and paranoia exist on a shared spectrum, much like the relationship between certain forms of depression and bipolar disorder? Where do we draw the line between paranoia as a defense mechanism and as a clinical condition? Many of Freeman’s case examples involve individuals with high levels of paranoia that appear more severe than mere psychological defense.
Perhaps psychological interventions targeting paranoia could be implemented intensively among ultra-high-risk populations as a preventive measure against the progression to full-blown psychosis. For patients already diagnosed with clinical psychosis, these interventions could be used as adjunctive therapies alongside psychotropic medication.
However, one challenge that comes to mind is that most patients with clinical psychosis also experience cognitive impairment. They may also exhibit anosognosia, a lack of insight into the unreality of their paranoid beliefs. Consequently, they often demonstrate low treatment adherence.
Therefore, perhaps only patients with higher levels of insight, good cognitive functioning, and ego-dystonic delusions or defenses (i.e., those that cause internal distress) would be suitable candidates for psychological intervention.
Moreover, psychological intervention should not delay the initiation of treatment for psychosis, as prognosis is closely tied to the duration of untreated psychosis (DUP). Thus, a coherent phenomenological and clinical framework is needed to distinguish these two different aspects of paranoia.
Pretty interesting although I did find myself losing interest towards the end (hence the two-month long reading time). Freeman explores clinical paranoia with his psychologist hat on, making this book a clear, in-depth study of the phenomenon. Kind of reminded me of Bessel Van Der Kolk’s The Body Keeps the Score in the way he approached the topic (real-life cases, what methods he used with patients, etc)
Ma nüüd päris täpselt pärast selle raamatu lugemist ikkagi aru ei saa, kuidas on omavahel seotud paranoiad ja luulud ja ärevus ja kõik muu säärane. Need mõisted ja nähtused on üksteisega läbipõimunud, nii et üks tekitab teist ja teine tekitab esimest vastu, ja nii nad võimendavad muudkui teineteist positiivsete tagasiside ahelate kaudu. Aga erisusi on raske teha ja seepärast ongi seni olnud odavam ehitada hullareid ja elektriravimassinaid.
Kuna sedasorti asju on väga keeruline uurida, siis lugesingi seda raamatut peamiselt selleks, et teada saada, kuidas neid asju uuritakse. Kuidas näiteks eksperimentaalselt näidata, et unepuudus ise tekitab luulusid, mitte et unetus on pelgalt luulude kõrvalmõju (mis ta on ka) jms. Autor kirjeldas neid eksperimente raamatus omajagu, ja need olid üsna põnevad küll. Kuid nagu ma juba eelpool mainisin, siis need kesksed terminid jäid mulle natuke ebaselgeteks. Mäletamistmööda olid need palju paremini läbi kirjutatud Randolph Nesse "Heas põhjuses end halvasti tunda", kus oli päris pikk sissevaade deprekaga seotud terminoloogia ja selle sisustamise ajalukku. Selles raamatus võinuks midagi sarnast teha paranoia ja luulude kohta. Ajalugu oli sisse toodud küll, aga põgusate üksiknäidetena, milledest autor õite kiiresti üle libises ja neid enam pärast teemaga ei sidunud.
Üldse oli selle tekstiga see häda, et see oli minu jaoks natuke liiga hõre. Nagu seiklusromaanid on hõredad. Palju on tegutsemise kirjeldamist, ja kõik jooksis ladusalt (tõlge oli väga sujuv) aga nende tegutsemiste põhjendamist jääb väheseks. Freeman ütleb, et aga vat siis järgmine mõte oli see, et uurida seda ja toda. Ja siis kohe on, et mõeldud-tehtud. Edasi kirjeldab ta seda tehtud-faasi. Aga mõeldud-faas jääb natuke liialt pinnapealseks minu jaoks. Aga ega ma pole ka vist selle raamatu sihtrühm. Pikad inimesed polevat ju paranoilised, kuna ei kannata madala enesehinnangu all. Aga tegelikult ka. Ma olen kohati isegi mõelnud, et peaksin olema veidi rohkem paranoilisem, nt oma kolleegide suhtes. Need paar korda, kui mind on täiesti alusetult mingites jamades süüdistatud - need löövad mind tavaliselt pikalt täiesti rivist välja, sest ma ei oska üldse oodata midagi säärast. Nii et väike paranoia tuleb mõnikord ehk isegi kasuks (sellest muide juttu polnud selles raamatus).
For someone who has been struggling with paranoia for several years, this book is incredibly relatable. Despite some readers considering it an oversimplification of paranoia, I found the explanations satisfying and insightful. Freeman does an excellent job of unpacking the complex psychological concepts behind the condition, while also unveiling various truths about its causes, symptoms, and the psychological and social implications of living with it. The book invites readers to explore paranoia in depth, all while maintaining a clear and accessible language throughout.
This study also comes with a deep sense of empathy and understanding for those struggling with paranoia. Freeman doesn't reduce the phenomenon to mere irrational thinking but acknowledges the real suffering it causes.
The book isn't only relevant for individuals experiencing paranoia, though; Freeman also explores how societal and cultural factors shape and amplify paranoid thinking. He examines how media, social media, and political climates foster feelings of distrust and suspicion, tackling the widespread conspiracy theories that permeate our societies. This is supported by the many studies Freeman has led throughout his career, making the book a valuable resource for understanding the broader context of paranoia in today’s world.
While the book may not delve deeply into real-world cases, provide a more comprehensive view of emotional and environmental factors, or offer a detailed discussion of treatment options, I still find it to be a great starting point for anyone looking to understand the paranoid way of thinking. It’s particularly valuable for those affected by paranoia or for anyone who interacts with or supports someone dealing with it.
Daniel Freeman’s Paranoia: A Journey Into Mistrust is a fascinating deep dive into one of the most pervasive yet often misunderstood aspects of human psychology. The book explores paranoia not just as a clinical disorder but as a spectrum of thoughts and feelings that affect all of us to some degree.
Freeman, a clinical psychologist, does an excellent job of balancing scientific research with real world examples, making the topic accessible without oversimplifying it. He traces the roots of paranoia from evolutionary survival instincts to modern day social anxieties, showing how mistrust shapes everything from personal relationships to political beliefs. The book also highlights the impact of trauma, mental illness, and societal pressures on paranoid thinking, making it both a psychological study and a cultural critique.
What stands out most is Freeman’s ability to make the reader reflect on their own tendencies toward mistrust. While some sections can feel a bit dense with research, the writing remains engaging, and the insights are eye-opening. If you’re interested in psychology, mental health, or simply want to understand why we sometimes assume the worst then this book is for you.
Very thorough chronicle on the history of the study of Paranoia within the UK, including an interesting segment on the usage of (costly, though immensely effective) scripted VR scenarios in treating debilitating social paranoia. The ending section felt slightly lackluster compared to the rest of the book which was deeply insightful.
Generally pretty good if shallow in places and covers some interesting aspects for a general audience. I wish he had been a little more ruthless in places trying to find the truth
Paranoia is an inspiring and powerful book that engaged me at every step. Dr Freeman, his colleagues, his patients and his research are so important to understanding the world and people around us, and gave me a different perspective and approach to paranoia, mistrust and how embedded and vulnerable this mental health condition really is. Dr Freeman’s writing was elegant and inspiring, and in general this was an excellent book.