Understanding paranoia
What can family and friends do? Living with a paranoid person is exceedingly distressing, made worse by the person's own lack of insight into their condition, and occasional aggressive outbreaks. Families, friends and carers should not suffer in silence. They should ask friends and relatives to help out, and try to get some time away. If the delusions have a religious content, it may be worth contacting an appropriate person at the local church, mosque, temple or synagogue. The following strategies may be helpful.
Establishing control It's necessary to help the person separate out what he or she can or can't control. For example, someone may not be able to stop hearing voices, but may have more control over how they interpret and react to what the voices say. This is particularly important if voices are very self-destructive, urging people to hurt themselves or attack someone else. There is a growing body of literature on coping with hearing voices, and this is an area where CBT has been beneficial.
Supporting good judgement It's important to sort out those things that could have some basis in reality ("the bus driver is unfriendly") from those that couldn't ("the milkman is poisoning the milk"). It can be very damaging to the paranoid person's self-esteem if it's always assumed that everything they say is wrong. Recognising when he or she is showing good judgement is helpful and therapeutic.
Foreseeing difficulties It's best to anticipate problems, rather than waiting for them to happen. For example, when moving to a new area, or a new job, it's a good idea to talk over the kind of difficulties that might arise, such as the threat of mixing with new people. Any visitors also need to be aware of the problem.
Distinguish facts from assumptions It's much better to regard thoughts as assumptions based on evidence, rather than as solid facts. Assumptions and evidence can be questioned and discussed, and can therefore be revised. This is the approach used by cognitive behaviour therapists. Acquiring information about paranoia can make the disorder seem less mysterious and threatening, and can give everyone additional hints on coping.
Communicating honestly When someone with paranoia believes something that is almost certainly incorrect, it's always necessary to stand firm. Say that you accept that they have their beliefs, but that you don't share them.
Avoiding confrontation To tell someone they are stupid or talking rubbish is disrespectful, dismissive and unhelpful. It damages self-esteem, gives the impression that you do not care about the person, and is liable to make things worse.
Encouraging independence It's a mistake to be over-protective, over-involved or critical. Everybody needs space to live their life, as well as respect and love. It's also helpful to encourage general conversation about things other than the person's delusions.
Taking a positive approach People suffering from paranoia are often intelligent, imaginative and talented people. Their paranoia is really an unfortunate misuse of their imagination. It's well worth looking through it towards the positive qualities that underlie it. Many people have turned their irrational thinking around and eventually made it work for them, not against them.
Self-help groups There may be other families in the neighbourhood who have similar difficulties, and you may be able to find this out, perhaps via the hospital or local health centre. There's no need to leave the therapy entirely to the professionals. Families can help each other.