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Understanding ParanoiaReview - Understanding Paranoia
A Guide for Professionals, Families, and Sufferers
by Martin Kantor
Praeger, 2004
Review by Elisabetta Sirgiovanni, Ph.D.
May 2nd 2006 (Volume 10, Issue 18)

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.

 

İ 2006 Elisabetta Sirgiovanni

 

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


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