Psychoanalytic Diagnosis, Second Edition by McWilliams Nancy

Author:McWilliams, Nancy [McWilliams, Nancy]
Language: eng
Format: epub
ISBN: 9781609184988
Publisher: Guilford Press
Published: 2011-08-31T23:00:00+00:00

DRIVE, AFFECT, AND TEMPERAMENT IN PARANOIA

Because they see the sources of their suffering as outside themselves, paranoid people in the more disturbed range are likely to be more dangerous to others than to themselves. They are much less suicidal than equally disturbed depressives, although they have been known to kill themselves to preempt someone else’s expected destruction of them. The angry, threatening qualities of many paranoid people have prompted speculations that one contributant to a paranoid psychology is a high degree of innate aggression or irritability. It stands to reason that high levels of aggressive energy would be hard for a young child to manage and integrate into a positively valued sense of self, and that the negative responses of caregivers to an obstreperous, demanding infant or toddler would reinforce the child’s sense that outsiders are persecutory. There has not been much recent research relating paranoia to temperament; in 1978 Meissner marshalled empirical evidence connecting it with an “active” symptomatic style in infancy (irregularity, nonadaptability, intensity of reaction, and negative mood) and with a thin stimulus barrier and consequent hyperexcitability.

Affectively, paranoid people struggle not only with anger, resentment, vindictiveness, and other visibly hostile feelings, they also suffer overwhelmingly from fear. Silvan Tomkins (e.g., 1963) regarded the paranoid stance as a combination of fear and shame. The downward-left eye movements common in paranoid people (the “shifty” quality that even nonprofessionals notice) are physically a compromise between the horizontal-left direction specific to the affect of pure fear and the straight-down direction of uncontaminated shame (S. Tomkins, personal communication, 1972). Even the most grandiose paranoid person lives with the terror of harm from others and monitors each human interaction with extreme vigilance.

Analysts have long referred to the kind of fear suffered by paranoid clients as “annihilation anxiety” (Hurvich, 2003); that is, the terror of falling apart, being destroyed, disappearing from the earth. Anyone who has experienced this level of dread knows how terrifying it is. The research of Jaak Panksepp (1998) into mammalian affect has identified this kind of anxiety as part of the FEAR system that evolved evolutionarily to cope with the possibility of predation. Panksepp differentiates it from attachment/separation anxiety that belongs neurobiologically to the PANIC system and is mediated by serotonin. Paranoid anxiety tends not to be quelled by serotonin reuptake inhibitors, but is instead responsive to benzodiazepines, alcohol, and other “downer” drugs, which may be why paranoid patients often struggle with addiction to those chemical agents.

As for shame, that affect is as great a menace to paranoid people as to narcissistic ones, but paranoid people experience the danger differently. Narcissistic individuals, even arrogant ones, suffer conscious feelings of shame if they feel unmasked. Their energies go into efforts to impress others so that the devalued self will not be exposed. Paranoid people, contrastingly, may use denial and projection so powerfully that no sense of shame remains accessible within the self. The energies of the paranoid person are therefore spent on foiling the efforts of those who are seen as bent on shaming and humiliating them.

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