Paranoid With the Truth
An Essay by Elissa Ely

Oct. 23, 2001 -- I was reading an old medical chart. According to the Diagnostic and Statistical Manual of Psychiatry, the patient's symptoms were straightforward, almost generic. She was convinced of plots against her, invisible but malignant forces that spent strangely flattering amounts of energy on her destruction.

No hospital could save her. She offered a proof. She was wearing a green shirt on the ward, “But green was the color of the Wicked Witch of the West who had shriveled to death.” And now the patient was herself beginning to lose weight. Any reassurances were ridiculous against evidence like that. Case closed.

I was skimming with a highlighter, marking her medication trials. The psychiatrist writing in the old chart must have practiced in a more elegant era. His penmanship curled. He could have been using a quill tip by coal light. The sentences were complete, the phrasing was poetic, his thoughts were just as unhurried and eloquent.

"We are paranoid with truth. Dim, hovering forces with unknown amounts of strength and unknown resources wait to dip their arrow tips in our blood." Elissa Ely

One sentence struck me dead. “This patient,” he wrote, after she had flung a chair at someone in what she thought was self-defense -- “This patient shows the cardinal symptom of paranoid schizophrenia, an essential terror of the annihilation of her own existence.”

There it was. What we've all been feeling, the essential terror that we will suddenly cease to exist as so many others suddenly ceased to exist. We are paranoid with truth. Dim, hovering forces with unknown amounts of strength and unknown resources wait to dip their arrow tips in our blood.

In the hospital, a number of patients know exactly who caused the terrorist attack. Each can give the perpetrator's home phone number. A few agonized patients have confessed to causing it themselves. The violent have grown more violent, the self-injurious more self-injurious, the quiet almost invisible. In a way, what happened is no surprise to them. They live with the essential terror of annihilation all the time.

Outside the hospital, in the world that functions smoothly because it's always taken stability for granted, I've heard of several suicide attempts. These are people on opposite sides of the country -- stable people who've never met one another -- but who now have something in common. They no longer feel the tacit guarantee that allows a day to proceed. They are paranoid with truth.

My little girl rides a tricycle around the living room carpet, deep in thought. “You know,” she says, double-parking for a minute by the kitchen door, “my school's in a tall building.” She's five years old, and her school is two stories tall, but that's tall enough for her to begin to worry about her existence.

There are a hundred techniques in the treatment of paranoia. There are medications for misdirected thought and medications for incapacitating anxiety. There are phrases to assure someone that their lampshade holds no bomb. And there are actions, like sitting next to a patient instead of across from them so that they'll know they don't have to endure alone. These are helpful things for delusion, but I wonder what will be helpful for reality.

Elissa Ely is a psychiatrist living in Massachusetts.