At least once all of us have shown
a type of behavior that someone has labeled as paranoid. Nevertheless paranoia
is not a mere hurtful epithet. As a matter of fact the concept of paranoia
hides a serious clinical disorder that this book aims to explore.

Understanding Paranoia has a
double goal: to understand and inform about the nature of the disease, as the
title clarifies, and to oppose the widespread image of paranoia as incurable.
In addition the addressees form a very disparate group: paranoid individuals
themselves, psychotherapists, non-paranoid individuals, and the general public
as well.

Martin Kantor, psychiatrist and
author of this book, suggests remedies and explanations and offers three
different uses of the term: paranoia is, at the same time, a synonym for
feeling persecuted, a comprehensive view of all forms of delusions, a characterological
frame of mind.

The text is divided into four
sections: description, cause, therapy and self-help. Many pages are dedicated
to the former, which proposes detailed descriptions of paranoid behavior and
presents psychopathology as an area somewhere in a continuum between normalcy
and serious disorder.

Starting from the definition given
by the DSM-IV as point of departure, three critical arguments are given against
three accepted ideas on delusions: delusions as inferences about external
reality, as coming entirely from within and as not subject to be corrected. The
thesis that emerges here, certainly not a popular one, is a distinction between
primary and secondary delusions, which differentiates between delusions whose
basis is genetic and organic and delusions that can be classified as products
of individual emotions.

First of all, it is the author’s
intention to educate the general public to the fact that paranoia is not a form
of evil and this is strongly expressed by the leading role played in this essay
by the narration of the everyday life of paranoids. A large amount of samples
are introduced in each chapter.

The book is certainly not a proper
scientific text, but rather a subtle narrative one which intends to explore the
paranoid phenomena as from they manifest themselves to what they really are. No
acid test to distinguish between normal and pathological individual is
suggested. However, some directions are offered. They can be summarized in
questions to which a clinician should answer. Furthermore, five are the
categories in which a paranoid delusion should be included: consistency,
persuasiveness, flexibility, closure and positivity.

Defining paranoia assumes finally a
crucial weight for interpersonal-social aspects and forensic issues.

The chapters dedicated to causes
are unfortunately meager and inadequate: this is the biggest fault in an essay
that wishes to furnish a detailed clarification of a psychological disease. Few
pages are assigned to causes and little of them is scientifically based, as the
author frankly admits. They are the result of his personal observations as a
psychiatrist and impressions collected by his colleagues. Little significance
is attributed to society in facilitating paranoia, whereas a more critical role
is played by the family. Consequently the psychodynamic explanation is highly
preferred and extremely emphasized. No pages on the organic causes of the
disease are included, but this could reflect the explicit purpose of the author
to concentrate on what he defines as secondary delusions.

The third part of the text, which
concerns therapy, is definitely well made. Kantor’s suggestion is an integrated
method of therapy, which includes psychodynamic, interpersonal, cognitive
behavioral and pharmacotherapy techniques. It is an eclectic but well-balanced
approach in which he gives clues and warnings to therapists on how constructing
an efficacious therapy: therapy must be appropriately adapted on each
patient.  

Last but not least, the final
section on self-help suggests to caretakers ways to assist paranoid individuals
and things to avoid with them. Respect, accommodation, humor and appropriate
limits should be rationally combined. Besides there are some specific ways a
paranoid individual can directly cope with paranoia: they involve
self-acceptance, self-control and self-analyze to improve relationships with
others and everyday life.

As a result, Understanding
Paranoia is a collection of narrative accounts and therapeutic indications
for paranoia. It is a good introduction for people who want information about
this disease. It contains excellent descriptions and categorizations of what
delusions generally are. It is a profitable psychological and clinical essay
for therapists and paranoids themselves. Undoubtedly sections dedicated to
descriptions and therapy are the best made, generous in offering details,
painstaking and accurate.

Nevertheless the book fails
partially its purpose: it overestimates the power of narration in the
understanding and it does not lead the reader to reveal what is hidden behind
symptoms, it does not let him go beyond them. For a book whose object is
understanding paranoia, the lack of a deeper etiological explanation is indeed
a considerable imperfection.

© 2006 Elisabetta Sirgiovanni

Elisabetta Sirgiovanni, Ph.D. in
Cognitive Sciences, Department of Philosophy and Social Sciences, University of
Siena, Italy

Categories: MentalHealth, Psychology