Paranoia and social inequality

How might we make sense of the findings of epidemiological research showing the effects of social inequalities without accepting the validity of problematic diagnostic categories used by psychiatric epidemiologists (Rogers & Pilgrim, 2003)? How might we make sense of processes happening at a community and systemic level without neglecting individual experience? How should we conceptualise experiences which are embodied (i.e. felt and transmitted through our biological systems) without falling prey to dualistic or biologically reductionist thinking? In this article, we hope to examine the links between social inequality and paranoia without falling into such traps. We use the term 'paranoia' broadly. Although single symptom research into psychosis has made great strides (e.g. Bentall, 2004) we feel there is benefit to be gained from taking the experience of paranoia as a starting point rather than beginning with an unnecessarily narrow operational definition of, for example, the diagnostic criteria for persecutory delusions. Paranoia, of course, is well-represented in psychiatric diagnostic categories (e.g. paranoid schizophrenia, delusional and personality disorders) and is in some measure a feature of many people’s everyday lives. However, focusing on such categories assumes that the differences between them are both valid and more important than the commonalities in the experiences they represent. Accordingly, we begin by presenting a brief critique of psychiatric thinking about paranoia, followed by a re-theorization that focuses on the social and material constitution of experience through feelings. We end by outlining some implications for intervention.