This article series will look at Theodore Millon’s explanation of the concept of paranoid personality disorder. Unsurprisingly, one of the most prominent symptoms of those with paranoid personality disorder is a tendency to not trust people. Such individuals desire to be fee of relationships on the grounds that their self-determination might be put at risk. They tend to misread the actions, thoughts and intentions of others, thus producing a great deal of social upheaval. Indeed, they believe that they find hidden motives to persecute or harm them where there are none at all.
The word “paranoid” itself has its roots over 2,000 years ago, in medical literature preceding even that of Hippocrates. From the Greek, it means “to think beside oneself” and was used broadly to refer to all sorts of serious mental disturbances. It had no place in the modern medical world, however, until the 18th century. Shortly after this, Heinroth, in 181, followed the structure o Kantian psychology and used the word to refer to a large number of disorders. So Theodore Millon:
“Those of the intellect were termed paranoia; disturbances of feeling were called paranoia ecstasia. Also proposed were the parallel concepts of Wahnsinn and Verruchktheit (the latter term is still in use as a label for paranoia in modern-day Germany). Grieseinger picked up the term Wahnsinn in 1845 to signify pathological thought processes and applied it to cases that exhibited expansive and grandiose delusions. In 1863, Kahlbaum suggested that paranoia the exclusive label for delusional states.”
The French psychiatrist V. Magnan, in 1886, used the term to refer to those with psychotic disorders. Magnan identified a subset of these disorders, which he termed “chronique delirium,” as progressive in nature, proceeding through irritability, pessimism and hypochondria, eventually leading to delusions and hallucinations, and culminating in dementia. Thanks to its German usage at that time, Kraepelin, in 1895, used the term to refer to “highly systematized and well-contained delusions in patients who otherwise lacked signs of personality deterioration.” He argued that paranoia refers only to a small class of patients, and opted to replace it the way Guslain had in the early 19th century, with the term “paraphrenia.” He intended by this to indicate that there was a combination of paranoid delusions and the kind of deterioration which he believed to be present in what is now known as schizophrenia.
Kraepelin believed that around 40 percent of patients with paranoid delusions degenerated ultimately to a state of schizophrenia and that the majority of even those who did not would remain debilitated.
“Kraepelin appears t have conceived the systematized delusions of paranoia to be a first stage of what could turn out to be a general deterioration process. In the second stage, if it occurs at all, the patient decompensates to paraphrenia, identified by bizarre thoughts and perceptual hallucinations; in this form, Karepelin specified that many functions of the personality that are not directly associated with thought and intellect remain moderately well preserved. or example, the patient’s mood is not unstable of fragmented but is consistent with his or her disordered ideas. For many patients, however, paraphrenia is a transitional second stage that eventuates in dementia praecox. At this final level, all personality functions have disintegrated. Thus, the patient’s moods are both incongruous and random, and no longer consonant weith the delusional content.”
Kraepelin referred in 1896 to the most severely deteriorated paranoid states as dementia paranoides. It is important to emphasize that he insisted both that delusional states exist on a broad spectrum of severity and that there is frequently progress from one stage to another, whether from paranoia to paraphrenia, or from paraphrenia ro dementia praecox (schizophrenia). However, there is a point at which he seems to acknowledge that paranoid tendencies has its own developmental endpoint that cannot be reduced merely to that of a sub-stage of schizophrenia. It is along these lines that the concept of paranoid personality disorder becomes relevant. So Kraepelin:
“The most conspicuously common feature was the feeling of uncertainty and of distrust towards the surroundings…The patient feels himself on every occasion unjustly treated, the object of hostility, interfered with, oppressed. His own people treat him badly…In indefinite hints he speaks of secret connections, of the agitation of certain people. Things are not as they ought to b everywhere he scents interested motives, embezzlement, intrigues…Such delusional ideas, which emerge sometimes on one occasion, sometimes on another, are closely accompanied by a great emotional irritability and a discontented, detected mood. The patient is difficult to get on with, is faultfinding, makes difficulties everywhere, perpetually lives at variance with his fellow-workers, on trivial occasions falls into measureless excitement, scolds blusters and swears.
As a rule, heightened self-consciousness can be easily demonstrated. The patients boast of their performances, consider themselves superior to their surroundings, make special claims, lay the blame for their failure solely one external hindrances. [The paranoid] seems to me to be essentially a combination of uncertainty with excessive valuation of self, which leas to the patient being forced into hostile opposition to the influences of the struggle for a life and his seeking to withdraw himself from them by inward exaltation. Further a strong personal coloring of thought by vivid feeling-tones, activity of the power of imagination and self-confidence might be of significance.”
The paranoid individual was characterized briefly described around the same period by others. K. Birnbaum, in 1990, for example, described the “sociopath” as a paranoid individual whose overvalued ideas were heavily laden emotionally and continued dominated his psyche. Of course, the term “sociopath” would later come to be used in a markedly different respect, more along the lines of antisocial personality disorder. E. Bleuler (1906) blamed the emergence of paranoid traits on an “excessive stability” of the individual’s emotions prior to the onset of the disorder. He thus blamed this, not on errors or misinterpretations of social cues or situations, but in excessive fixity of emotions. So Theodore Millon:
“They possess a resistance to change that leads to the rigidification of beliefs and ultimately, by being compounded over time, the implacable delusional system we term paranoia. However, Bleuler spoke of those with “paranoid constitution” whose false assumption and inordinate sensitivities do not necessarily attain the form of obvious delusions.”
A Meyer’s position (1908, 1913) was similar to that of Bleuler. He also noted the inability of the paranoid to adjust his beliefs to facts. Instead, he persists in them and fails to adapt. They isolate themselves in order to counteract the efforts of others to attempt to rectify their mistaken beliefs.