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Paranoid: Exploring Suspicion from the Dubious to the Delusional

The man in the bed watches me walk into the room. According to his nurse, that is what he has been doing all day: keeping vigil over the comings and goings of the hallway. At the patient’s behest, they have pulled back the curtain that usually surrounds the bed to offer a modicum of privacy, allowing for a full view of the long corridor. But unlike those patients simply curious about the bustle of the hospital or passing time as they recover, this man’s watchfulness has darker origins.

“Are they still out there?” he asks, as I pull up a chair to the end of the bed.

“Hi Mr. Jones, I’m Dr. Riddle. I’ve come by to talk with you about what been going on lately,” I say, as I’ve done hundreds of time by now. “Is who out there?”

His brows furrow; I seem to have dropped down a notch in his eyes by not already knowing the answer. “They know I’m here. I saw the way that guy looked at me when the ambulance brought me here. That’s why I have to leave. I can’t stay.” He drops his tone. “It’s the FBI.”

“I can tell you’re worried —”

“Wouldn’t you be? You try being followed every day, never knowing where. Never knowing when.”

I glance down at his ankle, pins projecting from the broken bones. “What happened to your leg?” I ask, attempting to veer toward a different subject, though I am doubtful we will get far.

“They were in the house. Had to go out the window.” He shrugs, matter of fact, and continues watching down the hallway.

Paranoia. It is the stuff of nightmares and horror films, but for all too many it is a very real part of their lives.

We have all experienced brief brushes with paranoia. We may worry that others are talking behind our back at work without any objective evidence. We might misplace something, but jump to the conclusion that it was stolen. In these cases, though, we are usually able to reality check, to recognize that the water-cooler chatter is just about the weekend’s sport victories and that the lost object can be found wherever we left it.

But when paranoia continues to grow, unchecked by reality, true tragedy can result. Sometimes that tragedy is personal: the paranoid person living out a solitary life, or, in the case of Mr. Jones, fracturing their ankles after leaping out a second-floor window. And sometimes, that tragedy can grow to massive proportions that end up splashed across headlines. We have seen this repeatedly. Consider the Virginia Tech massacre, the Oklahoma City bombing, or recent events like the San Bernardino shooting. This is paranoia turned deadly.

In his book, Paranoid: Exploring Suspicion from the Dubious to the Delusional, psychologist David J. LaPorte delves into this world.

The book combines research and case studies with personal observation to help us better understand the paranoid individual. Having spent a fair amount of time with individuals like this, I found LaPorte’s descriptions accurate and illuminating, though his solutions a bit lacking.

To someone with paranoia, LaPorte writes, “nothing is ‘innocent,’ happens by chance, or appears as it seems. A shrug, a wave of the hand, or a cough can all have meaning. … Minor events of innocuous things in the environment can be twisted to fit the paranoid individual’s belief system.” He illustrates the illogical with cases — such as the man who, fearing he is being poisoned through the heating system of his house, turns it off and wraps himself in bubble wrap and duct tape.

LaPorte also delves into the origins of paranoia, arguing that it offered some degree of evolutionary advantage. Those “who developed more refined aspects of trust/suspiciousness,” he writes, “had an adaptive advantage as they more readily were able to identify friends.” He describes the common causes of paranoia, including drugs and dementia. And he goes into detail regarding the violence that can emerge from paranoia, offering an entire chapter of often grisly stories.

While LaPorte does offers an overview of potential treatments, including medications, psychotherapy, electroconvulsive therapy, and even “psychosurgery,” the book is somewhat lacking in what to do about paranoia. I wanted more on where the research stands regarding what we should be doing for these individuals. LaPorte has made a convincing argument that paranoia is a real problem — highlighted with recent mass shootings — but fails to fully explore the next steps.

So where do we go from here? The last chapter does touch on this to some degree, focusing on the need for a better understanding in order to better care for and deal with these individuals. However, it leaves one with more questions (and fears) than answers.

Paranoid: Exploring Suspicion from the Dubious to the Delusional

Prometheus Books, September 2015

Paperback, 300 pages


Paranoid: Exploring Suspicion from the Dubious to the Delusional

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Megan Riddle

APA Reference
Riddle, M. (2016). Paranoid: Exploring Suspicion from the Dubious to the Delusional. Psych Central. Retrieved on September 28, 2020, from
Scientifically Reviewed
Last updated: 5 Feb 2016
Last reviewed: By a member of our scientific advisory board on 5 Feb 2016
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