Paranoia

IT WAS THE beginning of another long week in the trenches of outpatient psychiatry. The telephone rang earlier than usual in my office. “It’s Dr Bouliane, the Director of Professional Services. She sounds really upset” said my secretary.

Dr Boulaine was a general practitioner with a long record of administrative experience; a reliable lady with a reassuring and pragmatic approach to problem -solving. The fact that she was upset was not a good sign.

“It’s Andre’s father, Mr. Guildford. He’s threatening to sue the hospital and all the physicians who have treated his son. He claims we’re all incompetent And he’s already won a large settlement for damages from an old car accident, so he knows the legal ropes very well. I think he means business.” Dr Bouliane was clearly intimidated, as if she could visualize the emptying of the hospital’s already meager coffers into this man’s pockets.

“One second,” I said, at once indignant but cautious. “André is doing extremely well. For a chronic schizophrenic, he is a real success story. He was wandering around the streets of Europe, lost and delusional. Now he’s living in his own apartment, doing volunteer work at the hospital, helping out at the day centre, and taking his meds regularly. I can’t imagine a better outcome”

“His father sees it differently. He claims his son should be cured by now and it’s entirely our fault that he isn’t” Dr Boulaine continued.

“But that’s preposterous!” I said “No court could ever find in his favor” I insisted; still young and naive in my belief in our Western justice systems.

“We have to be cautious” Dr Boulaine reminded me. “You never know how these matters can turn out. In any case we should meet to discuss strategy”

Soon after, I received another call – this time from Mr. Guildford himself. He repeated the same story I had already heard from our Director: how his son had been mistreated and that it was our fault that he was still sick. I tried to explain to him the nature of schizophrenia but he would hear nothing of it

In fact he went on to explain that we were all conspiring to harm his son psychologically and that it was a conspiracy that involved his ex-wife who was still trying to extract money from him after his court victory. He was convinced that it was her intention to bring him to financial ruin. No denial of these conclusions, no logic, no contradictory evidence would be listened to, He was convinced that he was right And the courts generally take paranoids like this very seriously no matter how sick and litigious they are.

The next day it was his lawyer on the phone, asking me to have André evaluated by an independent psychiatrist Despite our Director’s note of caution, I decided to stand my ground.

“Do you know how sick this man that you are representing is?” I challenged.

“Well … ugh …” he stumbled, “He has every right in law to present his case …” he offered meekly, realizing he was on shaky ground.

“Why don’t you lawyers study some psychology? ” I asked, confronting him directly (I was more forthright in those days) “If you want to have him examined, you’ll have to subpoena him. There’s no way I’m going to collaborate with this insanity … You can waste his money and your time, if you choose … but I advise you against it”

This story ended well. The lawyer must have understood, possibly after consulting an independent psychiatrist that the case would go nowhere. We never heard from Mr. Guildford again. But this is not the point and too often, the damage continues. The point is the harm that can be caused by paranoia.

The harm can extend from frivolous lawsuits through harassment all the way to murder. And the 20th century has been the most murderous of all centuries, much of it related to paranoia. But I will return to that point. For now, let’s examine the nature of the beast Paranoia.

Paranoia, according to the Diagnostic and Statistical Manual of the American Psychiatric Association comes in two forms: Delusional Disorder, Persecutory sub-type, and Paranoid Personality Disorder. Delusional disorder involves non-bizarre delusions, for example, those of being followed, poisoned, deceived by spouse or lover or having a disease. A delusion is defined as a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes inconvertible and obvious proof to the contrary. The belief is not ordinarily accepted by other members of the person’s culture or subculture.

The persecutory sub-type applies when the central theme of the delusion involves the person’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed or obstructed in the persistent of long term goals … Individuals and also groups wiüi persecutory delusions are often resentful and angry and may resort to violence against Üiose tfiey believe are hurting them

Let us backtrack here a moment. In psychiatry we have three basic categories to define pathology – neurosis, psychosis and personality disorder. There are other classes like organic mental disorders and drug abuse but we will limit our discussion to these major ones. Delusional disorder is in the realm of psychosis. The other major category of paranoid disorders – paranoid personality disorder – is defined as follows in the DSM-IV:

Diagnostic Criteria for Paranoid Personality Disorder

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following:

(The patient:)

1. suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her;

2. is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates;

3. is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her;

4. reads hidden demeaning or threatening meanings into benign remarks or events;

5. persistently bears grudges, i.e. is unforgiving of insults, injuries or slights;

6. perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack;

7. has recurrent suspicions, without justification, regarding fidelity of a spouse or sexual partner.

Jerrold Post an expert on Political Paranoia and frequent White House consultant has further broken down paranoia into seven essential ingredients:

1. suspiciousness;

2. centrality – i.e. everything has meaning in reference to (the paranoid);

3. grandiosity – the arrogant assumption of his or her own importance;

4. hostility – the paranoid is belligerent irritable, humorless and extremely sensitive to slight;

5. fear of loss of autonomy – i.e. fear that someone else or something else is controlling him;

6. projection – the tendency of people feeling small or inferior to attribute exaggerated size and power to their enemies;

7. delusional thinking.

I would add to the list from my own clinical experience:

1. black and white thinking – an incapacity to see nuances and shades of grey in real life experience; and

2. an obsession with issues of power. Paranoids get fixated on people in power (President Bush, in our time for example) or historically powerful people like Napoleon, Alexander the Great and Genghis Khan.

Paranoia unlike many other individual psychopathologies is also an institutional and political issue. But for now, let us look at the implications of paranoia in the functioning of communities and institutions.

THE MOSQUE EXECUTIVE

This is a local and current story. One of our local mosques has a progressive and modern notion of organization. It is an interesting place of intellectual debate as well as traditional Islamic learning. It was decided that in order to get women more involved in the mosque’s activities a woman would be solicited to become a member of the executive committee. The wife of one of the senior members volunteered to be on the mosque committee.

We were proud of our local mosque – an open-minded place where people of people of different persuasions could gather and learn about their religion and encourage each other in piety. Many visiting Sheihks came and gave guidance. Leaders of many tariqas (Sufi Orders) and Islamic movements came to visit and teach and make dhikr. The woman who volunteered fit right in. She was intelligent, well-educated and interested in spiritual development. She was a good organizer, and mobilized a lot of healthy energy as well.

Then tragically she became physically ill. It began with malignant hypertension and diabetes and progressed to a cardiac condition, bypass surgery and then onto renal failure and dialysis. After numerous treatments and hospitalizations she was finally given a renal transplant. Then the delusional behaviors began. This formerly rational and well-organized individual began accusing other members of the board of stealing money from the coffers, cheating the government and participating in illegal immigration scams. The charges became more outlandish with time and eventually she claimed that members of the mosque were uttering death threats against her. Each time the mosque would attempt to organize an activity, like Eid Prayer or a Mawlid – she would call the building manager claiming to be the chief executive officer and cancel the rental. We would all show up to the location and find the doors locked. We often had to scramble from building to building to find a place for our Friday Prayer or the Eid Prayer. The disruption went from bad to worse.

One day I received a frantic call from the new president of the Mosque. The woman in question had made a complaint alleging death threats on her person to the police, and they were intending to arrest all the members of the executive committee. The committee members were all frightened, understandably so.

I immediately called up the police director and we had a meeting. I then explained to him that this woman was ill and most likely delusional and not to be relied upon, and that the men he was intending to arrest were honest and upright citizens unlikely to make any such threats.

The local police director was in fact aware of numerous complaints that had been made by this lady, which when investigated, had all turned out to be unfounded. He agreed to cancel the arrest orders.

(In this era of heightened sensitivity to gender bias I must add a disclaimer at this point. This story in no way implies that women should not be involved in organizing religious activities as these events could equally well have occurred with a man. There is in fact no gender difference in the frequency of Delusional Disorder)

“Can’t you do something to stop this?” I implored the police chief. “A tragedy could occur down the line.” I was worried that this former executive was getting more and more desperate and that someone could become violent. She did have sons who had no insight into their mother’s illness and were still supporting her in her sense of victimization.

“I’ll call central office and speak to the prosecuting attorney” he agreed after some urging, “We’ll see if we can do something to stop this harassment”

But, unfortuntately, nothing was done and the ex-board-member continued her troublemaking and disruption.

And here we get to another interesting aspect of the social dynamic. In the last article we talked about the obsessional social institutions of our times. The institutions that work by procedures and protocols in lieu of active problem-solving. So when a paranoid individual appeals to an obsessional institution, he is invariably taken seriously and his disruptiveness is facilitated. It is as if the institutional services were a lever to give the paranoid more power.

One of the favorite activities of the above mentioned mosque executive was to go to the Register of Financial Institutions and modify the executive role to include herself and other often fictitious persons; or else real people unaware of her actions. When confronted with this maneuver, the obsessive bureaucrats would say there was nothing that they could do to stop her. When the police were addressed, they would claim it was a civil matter, not a criminal one, and when the civil lawyers were contacted, we were warned, that it would be very expensive to proceed. Thus, a stalemate was created.

It has now been at least three years since this began and nothing is resolved. The mosque has been paralyzed. None of the procedures recommended by the bureaucrats have worked. One feels caught in the middle of this ‘Kafkaesque” scenario; faced with no solutions and mounting frustration. We thank Allah that nothing tragic has occurred. Yet.

PARANOIA: ITS CAUSES AND PHENOMENOLOGY

When we were confronted with a problem in psychiatry, we were encouraged as students to think in a bio-psycho-social model to formulate the case. The biological aspect has to do with factors such as genetics, familial tendencies, neurochemistry and associated medical problems. Psychological aspects include intra-physic dynamics, interpersonal relationships, and early family history. Nowadays, due to the development of cognitive psychology, we look for distorted modes of perception. Social dimensions include social class, immigration, ethnicity and current events such as war, political strife and famine. I have argued for a long time in psychiatric circles to expand the model to include spiritual aspects (I dare not say “religious” since religion is anathema in many ‘scientific’ circles). My attempts have been to no avail.

Spirituality is considered to be “scientifically soft” and lacking in “objective” measures. However, as far as I am concerned it is most vital. Some existentialists have managed to get away with talking about dimensions of meaning, instead of spirituality, and thus have avoided sounding too subjective. Irving Yalom for example. In general, however, spirituality is not given its rightful place in human experience – not in psychiatry and psychology at least. In a future article I will go into more depth about the biopsycho-social-spiritual model and its general relevance in conceiving of ‘the good life’. For now, let me confine myself to the two bestknown psycho-dynamic theories of paranoia.

The first theory involves the notion of projection. It goes as follows: we have certain tendencies within ourselves that are intolerable to our consciousness. They may be sexual in nature; or violent ones in another theoretical formulation. In Freud’s original formulation of paranoia in the case of Dr Schreber, the forbidden impulse was of a homosexual nature. (It must be said that Freud was fixated on things sexual and often came to bizarre conclusions based on that fixation) Freud’s logic went as follows: “I love him” (homosexual tendency), became “I hate him” (also unacceptable), leading to “he hates me”, and finally, “he persecutes me.” Dr Schreber was a highly intelligent judge who suffered a severe delusional disorder. His delusion involved the idea that divine forces were changing him into a woman so that God could have sex with him. The result of the union would be the bringing into being of a new race that would restore humanity. From the point of view of Christian theology, we could call this the “Mary Complex.”

According to Freud, the delusions were triggered by a homosexual attachment to his doctor – Dr Flechsig. The illness began with a series of hypochondriacal delusions – believing he was suffering from the plague and that he was missing his stomach and intestines. How one gets from homosexual attachment to the doctor to hypochondriacal and megalomanie delusions involves too much psychoanalytic hypothesizing for our current purposes. Suffice it to say that Freud’s general explanation of paranoia involved transforming the idea of “I love him” (unacceptable homosexual wishes) to “I hate him” (also unacceptable) which is then projected outward into “he hates me” and thus the persecutory delusions ensue.

Schreber eventually recovered most of his intellectual and functional capacity, while still remaining delusional, as is often the case in his illness; even before the days of anti-psychotic medication. So despite his delusions he was able to play a social role. This is one of the reasons paranoids can be so dangerous. In the case of schizophrenia, for example, mostly people are very aware of the person’s illness and thus their credibility is undermined. Not so with paranoia.

Despite the fact that psychoanalysts still believe firmly in this formulation, many clinicians, including the renowned Emil Rraepelin, a contemporary of Freud, found it far-fetched and unsupported by evidence. In fact “projection” is a much wider phenomenon that goes well beyond paranoia. According to the psychiatric dictionary, projection is the process of throwing out upon another the ideas or impulses that belongs to oneself. The person who blames another for his own mistakes or seeks a scapegoat is using the mechanism of “projection.” This phenomena is ubiquitous.

The other major psychological theory of paranoia has also been preceded by the clinical observations of Rraepelin. He believed that paranoia was a kind of psychological compensation for the disappointments of life. In this regard, he was a forerunner of the contemporary theories of narcissism.

The name most clearly associated with the theory of narcissistic development is that of Heinz Rohut He postulated that paranoia emerged from a “fragmented self.” This fragmented self was caused by repeated failures and frustrations (in his theory: failures of empathy and recognition) and that this led to serious breaches of self-esteem and self-image.

The end result is narcissist rage. This narcisstic rage is then accompanied by a world-view which contains the conviction that the environment is essentially inimical (read hostile). The relevance of this formulation will be seen when we analyze certain historical political figures a little later. For now, we will confine ourselves to the individual.

THE CASE OF MRS MULLINS

The paranoid lives in a world of danger, as the centre of malevolent attentions. The ever-present danger concentrates his senses. Believing that he is under unrelenting surveillance, his every move observed; he fears that letting down his guard for a minute may be fatal. He is a submarine on patrol in hostile waters, its periscope constantly scanning die horizon for the enemy, the paranoid searches constantly for subtle clues of danger. (Robert Robins and Jerrold, Post-Political Paranoid)

Mrs Mullins was one sick person. Many years *previously she had a job related accident at the factory where she was employed. She had injured her back and had been on disability pension ever since. But, she was convinced that the doctors who treated her and evaluated her for her disability pension at the time, had conspired to make sure she never recovered. She explained this as a conspiracy between the union and employer to keep her from returning to work since she knew things they wanted to keep hidden. What these things were she could never quite explain. Although a menial and repetitive job, she claimed to enjoy her work and miss the sense of accomplishment she got there – all of which just made her feelings of incapacity even more bitter.

Although her story really didn’t make sense, she was convinced it was true. She would bring me medical reports from the period – now 15 years old – to point out the inconsistencies in the written charts. For example, she would indicate that the examining psychiatrist mentioned that the medical report was insufficiently documented, preventing him from arriving at any meaningful conclusions. Or she would point out that there was a missing x-ray report in the file, or that two orthopedic consultants she had seen had come to different conclusions and both of their conclusions contradicted the x-ray reports.

When I would point out that all of these apparent inconsistencies were normal occurrences in insurance reports and medical assessments, she would hear nothing of it. When I would point out that insurance doctors often minimized the organic pathology in order to save the insurance companies money from paying the full indemnity, and that there was nothing personally vindictive in these procedures, she would just get more adamant and insistent The persecutory ideas would then begin to expand and amplify to include her ex-husband and his mother-who must have been involved as well-in the conspi-racy preventing her full recovery.

In addition to these beliefs, she was also convinced that the neighbors were spying on her in order to come in and steal her money and possessions. She became more and more reluctant to leave home. Her daughter who lived downstairs was now being constantly harassed to keep all doors of the house locked at all times and to draw the curtains regularly and to make sure that the chain was tied up on the front gate. Any forgetfulness on the part of the daughter would meet with suspicious hostility and a sermon on the need to be very careful of potential thieves and to not trust anyone.

Mrs. Mullins was now a prisoner of her own delusions. She has no friends, since she suspected everyone from the postman to the electrical contractor of wanting to steal from her or charge her for unnecessary work. Her only important relationships, with her two daughters, were increasingly contaminated by her anxiety and hostility.

One of her daughters came to see me, after her mother blew up at another lady in their meditation group and accused her of casting spells and trying to make her ill. This was the last activity in which she had participated before becoming totally housebound.

Working with the daughter, who had her own problems revolving around her ex-husband, we tried to develop strategies to help the mother. She was convinced, of course, that she had no problems at all and was not in need of any treatment. This was unfortunate, as we do have reasonably effective medication for paranoid disorders – atypical antipsychotics. The mother would hear nothing of seeing a psychiatrist.

Instead, we attempted to contact her general practitioner – a responsible and caring professional who was willing to make a try at treatment We figured that Mrs Mullins would agree that she was very anxious and then perhaps we could pass the anti-psychotics off as anti-anxiety medications. It was by no means a certainty, but it was worth a try. All went according to plan until Mrs Mullins reached the pharmacy with her prescription.

“What kind of medication is this anyway?” She asked the pharmacist. Unsuspecting and naïve, the young pharma-cist responded promptly

“Oh it’s the new type of anti-psychotics . . . Why are you taking this medication, Mrs Mullins?”

That was it Mrs Mullins turned on her heels and walked away from any further treatment

This is not an uncommon outcome. Unfortunately like the female executive of the mosque, Mrs Mullins kept harassing her close family and suspecting her neighbors. The situation eventually worsened to such an extent that she became suspicious of her daughters as well.

These are the cases that make us humble as doctors and make us reflect on our nature as human beings. Our minds are weak and vulnerable. We all have “quirks” in our thinking and doubts where we shouldn’t have. We often believe in our own conclusions and convictions even after we have been proved wrong many times in the past. We continue to believe in and behave in concert with our “mind-productions” even when they are destructive and self-defeating. Allah reminds us in his Holy Book that He and He Alone is All-Knowing and All-Powerful. The human mind, on the other hand, is vulnerable to distortion and prone to error.

IN THIS series of articles we are trying to probe into the various vagaries of the human mind thorough the perspective of psychology and psychiatry. We have examined the nature of obsessionalism in the last article. We have looked at individual and institutional aspects of paranoia in this one. Now we will proceed to the historical and political level where these phenomena play themselves out in grander and more terrifying dimensions.

HITLER AND STALIN

The twentieth century has witnessed the most devastating effects of paranoia, probably since the beginning of recorded history. The two most famous perpetrators of mass murder in this century were Adolph Hitler (actually Adolf Schikelgruber) and Joseph Stalin (originally Iosif Dzhigashvili). Together they were responsible for between 50 and 60 million deaths in a period of only 20 years. Quite an accomplishment in a century that was supposed to represent the highest achievement of civilization.

Although diagnosis is best done within the confines of a consulting room, the documentary evidence is so abundant in the case of Hitler and Stalin that we may venture a reasonably accurate diagnosis despite the distance of history.

Both men were clearly very ill from a psychological point of view. This in itself is a very frightening reality, as both had reached the pinnacle of the social hierarchy in two supposedly advanced countries with well-developed infrastructures and long histories of intellectual and cultural achievement. This could easily prove to us that no society is safe from the wiles of Shaytan and thus from the deepest levels of evil.

Hitler fit the profile of delusional disorder-persecutory and granthose type. Most of his persecutory delusions were about Jews – that they were poisoning the blood of the German nation, that they were “the demon of the disintegration of peoples” and that they were trying to destroy the racial foundations of the German people that they had set out to subjugate. It turns out that Jews are a popular target for paranoid projections. In other situations, the preferred targets may be blacks, the CIA, the mafia, and any other peoples or institutions seeming to have power.

As Muslims, considering the early conflict between Islam and the Jewish tribes of Medina and the more recent conflict in the Middle East, it is incumbent upon us to be careful not to cross the line from real conflict and even war, into paranoia. With everything going on in the world today, it would not be surprising for Muslims themselves to be the next target of paranoid projections. To some extent this is already happening in some of the western countries, where anyone appearing Arab or brown-skinned or wearing traditional Islamic clothing becomes identified as a potential terrorist.

Coming back to Hitler; he not only had persecutory delusions, but also granthose ones. He believed that only the Aryan race (left undefined) could recreate an uncorrupted culture. He also believed that he had been given special powers by Providence, to lead the Aryan nation into its rightful place as the dominant power in the world.

Hitler’s concern with racial purity is all the more curious, given his own dubious origins. His paternal grandmother, Maria Anne Shickelgruber, gave birth to his father, Alois, out of wedlock at age 41. There were serious concerns that the biological grandfather was Maria’s Jewish employer, for whom she had been a housekeeper at the time of Hitler’s conception, and who continued to send monetary aid for a number of years after his birth. A relative of Hitler was threatening to blackmail the Fuhrer with the information he had about Hitler’s biological grandfather. Whether the story is true or not, it is clear that Hitler was haunted by the possibility of having Jewish blood for most of his life.

Hitler was by no means a normal person. His sexual orientation seemed to be particularly perverse – he had strong inclinations towards voyeurism, appears to have been totally uninterested in normal heterosexual relations and to have suffered from coprophilia (fascination with, and attraction to feces). There were reports that in arguably his most serious relationship, with his niece Geli, he had requested that she urinate on his head. In another report with the German actress Renate Muller, Hitler “lay on the floor, condemned himself as unworthy, heaped all kinds of accusations on his own head, and groveled around in an agonizing manner … She finally acceded to his wishes to kick him. This exited him greatly and he became more and more aroused.” Here, we are no longer in the realm of paranoia, but rather in one of the sexual perversions – masochism. To think, this was the leader of one of the great nations of the world!

Stalin, on a superficial level, seemed like a more wholesome human being. Both Hitler and Stalin had violent and sadistic fathers. Both came from humble origins; in Stalin’s case, from illiterate Georgian peasants. Stalin’s relationships, however, such as that with his second wife Nadya – although difficult and conflicted had a certain normality about them. He was loving to his children, especially Svetlana, his daughter, and although not a faithful husband, he was deeply attached to Nadya and never recovered fully from her suicide in November 1932. (An interesting parallel in the life of Hitler was that of the seven women he had some kind of relationship with, six either committed suicide or made serious attempts. Geli, previously mentioned, succeeded.)

The paranoia of Stalin, which at least early on took the form of a paranoid personality, was more ubiquitous and all-pervasive than that of Hitler. He trusted no one and believed firmly that , in politics, no one should be trusted. Even the suicide of his wife, who had deep depressive bouts and most likely suffered from manic-depressive illness (now known as bipolar disorder) was seen as a betrayal. Deceit and treachery were second-nature to Stalin and he believed that everyone else was similar.

All of the former leaders of the Bolshevik movement – Trotsky, Zinoviev, Kamenev, and Bukharin (“the favorite of the whole party” according to Lenin) were implicated as conspirators and condemned.

In the late 1930s, during the purges of the communist party and the military, he had the chief of the general staff, the chief political commissar of the army, the supreme commanders of all the important military districts, 99% of all Soviet ambassadors, 98 out of 139 of the Central Party Committee, as wefl as the two chiefs of the secret service who had been responsible for killing all the others, killed. In the name of socialism, several million peasant families were deported, and the survivors were settled in distant Siberia.

Stalin was also responsible for the mass starvation of several million Ukrainian peasants, during the great famine of the early 1930s – a famine designed to accelerate the process of collectivization. Through his machinations, the Communist Party was decimated, most of its top leaders were eliminated, and their families cruelly persecuted. Arrests and executions ran into the millions. Such are the devastating effects of paranoia.

THE CONTEMPORARY SITUATION

There is no lack of paranoia in the contemporary world situation. In fact it is front-line and center on the world stage. In the Arab world, with all its current divisions and difficulties; conspiracy theories abound and multiply every time a major event occurs. The events of September nth were particularly fertile in this area. The Jewish world is still haunted by the Russian pogroms of the 19th and early 20th centuries and the German Holocaust. And now America and Western Europe, as well, fear terrorists at every turn of the road. The recent events in Spain have just underlined the ever-present threat

Unfortunately, there is no simple solution to this pervasive problem. Every time people and nations are under threat and feel devalued, they look for a cause outside of themselves. Rarely does an individual or a nation, have the lucidity and humility to search for the causes within themselves. Rarely do we, as Muslims, look to Allah, may He be exalted – and say “What have we done wrong?” or “How can we correct our ways.” It is much easier to blame others – the Americans, the Jews, the CIA, the Freemasons, and so on.

Spiritually speaking, paranoia is a form of shirk (making partners with Allah). Paranoia means that we believe evil is in control of the world and thus we have forgotten the Real Controller – Allah. Paranoia means that we believe in intermediary causes asbab) and not in the ultimate cause-‘the Absolute (al-Haqq). In this way, Paranoia is the opposite of Iman (faith). And paranoia has always heralded the downfall of a nation. May Allah protect us from this scourge.