Updated March 02, 2015.

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In this series of articles you will find information about what the experience of schizophrenia looks like from the patient’s point of view. The first article in the series focused on what is commonly referred as voices or auditory hallucinations.The second article discussed other types of hallucinatory experiences. But hallucinatory experiences in schizophrenia rarely occur in isolation. In fact, often times, they are only a part of a complex system of beliefs and thoughts that is usually classified as delusional thinking.

While there are many types of delusions the most common type of delusion experienced by patients with schizophrenia is paranoia. This is the focus of this article.

In essence, delusional thinking refers to a set of rigid ideas and thoughts that are clearly at odds with reality and are not shared by other people with similar cultural backgrounds and values. Rigidity in beliefs, lack of a evidence supporting the belief (“poor reality testing”), and identification of the beliefs as strange and at odds with reality by people within the same culture are all essential parts of the definition. Paranoia is a type of delusional thinking where the experience is of being followed or plotted against.

How does it start?

Paranoid thinking may occur gradually or suddenly. A teenager who is constantly bullied at school by a group of peers while other peers or even teachers seems to be aware of the situation yet choose to do nothings ends up thinking that no one likes him at school. This feeling can escalate to “everybody at school hates me”, then to “everyone at school is out to get me”, and culminate with “everyone is out to get me”.

 Feeling threatened is no longer limited to a specific situation or group of people but an all consuming, terrorizing fear that doesn't let you sleep at night or associate with other people during the day (as they are all part of a plot and likely looking for ways to harm you). When presented with evidence to the contrary (for example the fact that you have a loving family or supportive friends) you might feel even more threatened; as you feel see their failing to recognize the threat leveled at you as clear indication they are also part of the plot. The whole world becomes a trap. You might feel people are talking about you or people are following you. You might feel as if you are under constant surveillance and that there is recording equipment everywhere around (the different electronic devices, concealed behind mirrors, painting, doors that are just decoys) or even that such equipment has been implanted directly in your body or brain. There are no coincidences anymore. People walking together are pairs of agents, people wearing similar colors is how they recognize each other so that they can better tag you, a black Cadillac Escalate parked next door is an official NSA car, a broken down old Nissan Pathfinder is an undercover NSA car. And the fact that nobody seems to believe you is taken as further proof that indeed they are all out to get you. If hospitalization follows, this also becomes evidence of the plot as they are now putting you away and keep you under lock and key because you are the only one who knows about their plot. As they are not real doctors and the medications are poison you will refuse treatment. When the judge decides that involuntary treatment is recommended, you take that as further proof that the plot is wide spread, as it corrupted even the judicial system. Finally, when they put you in restraints to medicate you against your will, you have the final confirmation of their evil intents. You predicted they were out to get you. You were not sure why but now it’s clear: what they wanted to do was to poison or experiment on you, which is exactly what is happening at the time of the involuntary injectable medication, which they force on you after they put you in full body restraints.

Experiencing paranoia is living in a state of constant fear that feeds on itself, relentlessly.

Hallucinations and paranoia

Frequently, the experience of paranoia is embedded with hallucinatory experiences, especially the experience of hearing voices. The voices indicate that you are followed and become evidence that you indeed are. The voices might be also experienced as being generated by a device the plotters implanted in your brain. 

Is it always the same?

The intensity of paranoia might vary. Mild paranoia is experienced as a distrust of people and skepticism about the goodness of stated intentions. Not being able to trust people leads to not wanting to associate or spend time with anyone, the so called social isolation. It might feel safer to keep to your room, behind locked doors and closed blinds.

The more severe the paranoia becomes, the more difficult it will be to leave your secured quarters. Going out to the grocery store can feel like walking under enemy fire in an open minefield. If that is the case you might choose to starve, as taking your chances with starvation might seem a better alternative than being killed as soon as you will leave your shelter.

Severe paranoia is experienced as sheer terror. When you feel terrified you might resort to take whatever measures necessary to protect yourself. Alternatively when you see no other way out and are sure they will kill you might choose to kill yourself first so that they cannot get you.

Severe paranoia or thoughts of killing or harming yourself or others due to paranoid feelings are psychiatric emergencies; if you or a close one experiences such high level of paranoia it is important to get qualified help as soon as possible.

Further reading:

Erin Hawkes: My battle with wchizophrenia: "Rats Were Eating My Brain"

Rober K Lundin: The mind will follow

Elyn Saks: My life with schizophrenia

Kurt Snyder: Kurt Snyder's personal experience with schizophrenia

Schizophrenia Stories