When Susie woke up that morning, she didn’t expect that she’d be sitting with a paramedic at 10 pm. The incredible feeling of energy, sociability and freedom during the day that she had put down to her morning coffee had, by the evening, tipped over into confusion and terror as she concluded that the whole room was plotting to assassinate her. Susie had developed a persecutory delusion. This might be a one-off experience, or it may be the beginning of a lifelong challenge to manage her experiences. At the moment, we can’t fully explain why it happened, or how best to treat it.
Sadly, Susie’s experience isn’t unique. The core of a persecutory delusion, paranoia – the unwarranted belief that others want to intentionally harm you – occurs frequently in a clinical setting. It’s most often associated with the psychiatric disorder schizophrenia but shows itself in epilepsy, Parkinson’s disease, insomnia, encephalitis and drug abuse. Paranoia increases the chance of suicide fivefold in the general population and can hinder the therapeutic process in any healthcare setting. After all, you wouldn’t want to see your nurse for a vaccine if you thought it was part of a plot to control you. Worse still, developing strong paranoid beliefs at a young age can damage the foundations of forming and maintaining relationships – the lifeblood of being human. In turn, this stunts the ability to secure a job, a family, and all the other opportunities in life we take for granted.
Current mainstay treatment and management of paranoia still rely on the original observations made by physician Henri Laborit in 1952. Laborit noticed that chlorpromazine – a drug often used for its tranquillizing properties – also reduced the distress his patients suffered around their persecutory beliefs. Since then, a series of innovative studies have identified that drugs like chlorpromazine work by blocking dopamine – a neurotransmitter in the body – and that experiences such as Susie’s might be in-part explained by changes to how dopamine shapes the way information is communicated in the brain. However, this type of treatment only works in around a third of people and predicting when and for whom it will work is extremely difficult.
While newer drugs have taken the edge off some of the awful side effects of earlier treatments – such as agitation, muscle spasms, and sleep problems – making treatment more clinically acceptable doesn’t alone solve the core scientific problem of why strong paranoid beliefs occur. Despite extensive research into dopamine transmission as it relates to paranoia in illness, how these brain changes might relate to the normal social, psychological, relational changes in all of us remains largely unexplored. This blind spot means that we don’t have a fundamental explanation of human behaviour to help us understand what might go awry in illness. Part of the reason we haven’t yet got to this point may be that, until fairly recently, we viewed experiences like paranoia as an aberrant, abnormal human trait, separate from the seemingly otherwise rational mind.
Paranoia may be wholly understandable, intuitive and reasonable, especially when we consider our evolutionary roots. New evidence in behavioural and evolutionary science is uncovering that our minds are far more social than previously thought. All of us have distinct neural functions that strengthen and maintain relationships to our friends, family and strangers, and these fundamental interpersonal processes shape the way we learn about other, more prosaic aspects of life like following a map or learning mathematics. This isn’t even unique to humans, as we find similar conserved social brain function across all manner of species that have any semblance of social structure. This has raised the important question as to whether experiences like Susie’s might be explained by changes to similar core brain processes that regulate and manage our social environment: coalitional cognition.
In fact, while we’ve used Susie’s distressing and relatively extreme experience as an example, paranoia isn’t something limited to illness at all. Our pre-existing ideas about others based on our genetic and developmental history interact with our current social context to shape our sensitivity to experiences in the moment. But they most likely won’t force us to seek clinical support. We have all had experiences where we’ve been a bit wary that others might be trying to take advantage of us with little evidence to back up our intuitions, but maybe it wasn’t something we thought too much about. While we can think about this on an individual level, we can actually see this play out on a wider scale. Conspiracy theories demonstrate how an unwarranted belief about an unseen, intentionally harmful organisation might be shared by entire communities. Science suggests that strong, gravitational paranoid beliefs like the one that Susie had can be found at different intensities throughout the general population. Further, research has shown that, regardless of our preconceived ideas of others, interaction with someone who has differing political beliefs or higher social status increases the probability that we think others are being intentionally harmful. Lending support to this idea, we’ve shown that the neurotransmitter involved in paranoia in illness, dopamine, is also involved in our interpretations of how intentionally harmful we think others generally are.
Anthropological, cultural and archaeological research shows clear evidence that being a social animal is at the core of being human, and this is reflected in our brain function. This is because our social, psychological and behavioural expressions are inseparable from how our brain works – our body is a community, and together we form ecosystems. To discuss the social, psychological and biological as separate entities is to ignore years of scientific evidence, but sometimes when we wish to explain different aspects of a phenomenon it’s helpful to break explanations down into the separate factors to understand how different levels of the ecosystem interact. Paranoia is no different; it’s a change to the interpretation and management of human relationships. Social changes shape our brain, and our brain can shape how we perceive social changes.
Testing how our social world is reflected in the mind may be the crucial step forward to help understand what Susie might be going through, and what we can do to stop life being so distressing for people in her shoes. This has implications for our understanding of paranoia in illness and health, but also perfectly illustrates how attuned our brain is to social relationships, and might be a better, more complete explanation of the mind.
The science of the social brain matters. This is for Susie, and this is for you.