Can the mental health system cause paranoia? By Tamasin Knight

Since I have been actively involved in mental health I have noticed that a number of people labelled paranoid have had some additional previous psychiatric diagnosis. This set me wondering that perhaps the emergence of this paranoia rather than being caused by biochemical imbalances or even psychological vulnerabilities, may be more likely to have its roots in peoples involvement with the mental health system and as a result of the prejudice and discrimination received from the public.
Once you are diagnosed you have to live knowing that you have less rights than a criminal, knowing that you can be forcibly drugged and knowing that 46% of consultant psychiatrists want to erode your rights further by introducing Compulsory Treatment Orders. Is it really that difficult given this situation to start generalising especially as all of this is likely to put you in a suspicious state of mind? The diagnosed person may start speaking metaphorically - the fear that the mental health system is out to get them is transferred to another powerful authority such as the FBI or the Mafia. Feelings that people are conspiring against you or are spying on you could also be explained in this way. The woman who complains that there are video cameras in her flat recording her may be displaying a reaction to experiences of being watched on a ward or after having her parents instructed to monitor her eating patterns.
It may also be that a lot of what users say that sounds like paranoia is really a reflection of reality that the mental health professions would rather not acknowledge. The man who claims that secret meetings are being held about him may well be accurately describing the many meetings in which various mental health workers will discuss him. The person who says that people are stealing their thoughts, while being compulsorily administered neuroleptics is about as close to the truth as one can get.
In addition, due to the nature of the mental health system it seems perfectly understandable that people may find themselves in a suspicious state or ‘paranoid’ in a more general sense because of it, but I feel this is more a natural response to the system that anything else - ‘just because you’re paranoid doesn’t mean they’re not out to get you!’ Indeed, I feel such suspicion is necessary sometimes if the oppressive and unhelpful practices are to be changed. Being given endless excuses as to why you cannot see your notes and if you eventually do get to see them observing that various chunks have been blanked out can start people off wondering, what are they trying to hide? When mental health workers insist on turning every positive about you into a negative - high achievement becomes a symptom of obsession, having ambition turns into grandiosity -surely it is not hard to come to the conclusion that they are against you. And when you know that you can be sectioned surely at least sometimes, it is difficult not to feel persecuted and that they are out to get you. It has been shown that people living under the oppression of racism become more paranoid than those who do not. This seems to be because the genuine and understandable suspiciousness in response to the racism generalises to other matters. Similarly is it not possible that because people are in a suspicious state caused by the mental health system they may start to make ‘paranoid’ inferences about other situations - neutral comments become criticism and mockery, the noise downstairs a burglar.
The discrimination those with psychiatric diagnoses receive from the public may also have a part to play in the development of paranoia. Is it really that difficult for someone repeatedly turned down for jobs because they use the mental health services, someone who lives among prejudiced neighbours, someone who has to endure the almost daily dose of negative media coverage, to become suspicious in other situations or of their friends? When they join a new group they may become convinced that other members are talking and laughing about them. If you come to see that your whole community is against you, when new people enter, what evidence do you have to convince yourself that they will be any different? Similarly if people are used to being treated unfairly by others, when they receive a silent phone call in the middle of the night, what evidence is there to suggest that this is not workmates trying to make them tired so they perform badly in an assessment the next day?
Again people being discriminated because of their diagnosis may speak metaphorically or, their worries about prejudice may become exaggerated. Maybe they are listening to me through the walls. Maybe they are watching me each time I leave my house. Maybe they are reading my mind so they can find out how to distress me further. However, after listening to others who have been harassed and truly persecuted because of their diagnosis, these exaggerations do seem understandable if not factually correct. Indeed, considering the conditions under which many users have to live, it seems that the person who says that others ‘have got it in for me’ may be showing exceptional insight into the prejudice and discrimination often directed towards those with psychiatric diagnoses. In cases where it seems that prejudice/discrimination played a major part in causing someone’s distress perhaps it might be better to help them cope with prejudice rather than to try and convince them via drugs or Cognitive-Behaviour Therapy that they live among loving neighbours and it is them with the problem.
These two suggested causes, the mental health system and prejudice/discrimination, need not always be two separate factors. The most obvious combination would seem to be in the cases of prejudiced mental health workers, but I also find that the issue of diagnosis can bring about a union. I have often found that prejudice seems to be caused by the diagnosis itself, rather that the actual experiences. If you tell someone that you have a ‘mental illness’ or say what your diagnosis is, the result can be prejudice and misunderstanding. However, if you describe exactly the same experiences, saying for example how you felt, instead of using diagnosis, the person you are talking to often seems to be more sympathetic and show less prejudiced behaviour. So it may be that the prejudice caused by the labelling process can assist in causing paranoia.
It would seem that there are several ways to prevent or reduce this ‘secondary’ paranoia, yet I feel that the first and perhaps most important one is simply the recognition that some of the practices used in the mental health services can be paranoia inducing.

'Tamasin Knight is an undergraduate at the University of Exeter, and in addition is developing alternative ways of helping people who are experiencing distressing beliefs with a grant from the Mental Health Foundation.
She can be contacted at: T.M.Knight@exeter.ac.uk'

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