Paranoia is the unfounded idea that other people are deliberately trying to harm an individual.

Studies reveal paranoia is widespread in the general population. There is a distribution for paranoia just as there is for anxiety and depression. Evidence shows societies that are more unequal, and have less social cohesion, have higher rates of suspicion and paranoia. It is related to mistrust and is linked to living in cities in higher densities. Insomnia is also now seen as a factor for paranoia.

Transcript Hide Robyn Williams: Paranoia, especially at this time of year, has become an art form. Psychiatrists study paranoia and schizophrenia, but psychologists not quite so much, which is why Professor Daniel Freeman of Oxford is such an interesting investigator. Daniel Freeman: Yes, I was first working as a psychologist with people with schizophrenia, and at that time it was actually quite rare for psychologists to work with people with schizophrenia. It was very much thought that it was an organic brain disorder and that psychological process perhaps had much less to do with the problems. And I was particularly interested in the experience of paranoia when people had unfounded ideas that others were deliberately trying to harm them in some way, to spread a conspiracy or to physically harm them, or that everyone was against the person. Really I started off by taking the idea, well, that perhaps actually this doesn't occur with people with severe mental illness, but maybe there is a continuum in the general population, just as there is for phobias. So, many of us have some fear of heights and a few of us have very severe fears. And I thought that was actually quite likely with paranoia. So I did some experimental studies in the general population showing that in fact paranoia was quite common in the general population. And in some of these studies we're using virtual reality, so presenting people with a neutral social scene in virtual reality, a train ride, very neutral, and showing that actually about one in three of the general population saw hostility from the computer characters. Robyn Williams: They actually inferred that someone was after them, even though the 'them' didn't exist? Daniel Freeman: Well, they were thinking that, for example, some characters were staring at them to make them upset or that some of them were trying to harm them in some way if they could. They knew that they were in a virtual environment, but they still had some of the thoughts that they had in day-to-day life. And in fact it correlated, so that people who had suspicions in virtual reality also were more likely to report them in day-today life. And so this is fascinating, so I've also looked at some epidemiological datasets for the nation in Britain and that again showed there is a distribution in the population of paranoia, just like there is for anxiety and depression, that many of us have a few suspicious thoughts, and a few people have many. There is no sort of 'them and us', it is not that most people don't have paranoid thoughts and a few people have many, it seems that they are evenly distributed across the population, or many of us have them, much more than was previously thought. And actually there is also evidence that societies that are perhaps more unequal, have less social cohesion, are all societies where there is a bit more suspicion in the general population. So paranoia certainly can be a problem for the individual, and I work in hospitals and see people who have severe experiences, but also it's perhaps the mark of the health of a society, the levels of mistrust within it. Robyn Williams: So you can actually see some common characteristics about where people come from, where they live, and some of their social histories that begin to make sense in terms of this delusion. Daniel Freeman: Yes, I think in the paranoid spectrum it's quite clear that you're more likely to have paranoid thoughts if you're younger and if you live in cities or were raised in cities, for example. It also links to taking illicit substances such as cannabis. But as a psychologist what I'm particularly interested in is that people who tend to worry more, people who aren't sleeping so well, people who feel more miserable about themselves, are also more vulnerable to paranoid thoughts. So one really interesting longitudinal study we've just finished recently, we looked at 2,500 people in the general population, followed them up over 18 months. And the people initially who didn't have paranoid thoughts but had insomnia had a three times greater risk of subsequently developing low-level paranoid thoughts, which is the first time this has been examined and the first time it's been found. Robyn Williams: Lack of sleep does that? Daniel Freeman: It's one of the factors it seems, and it's probably not so surprising because when we don't sleep so well we feel more anxious and we feel more depressed. And when we're more anxious we anticipate threat, and when we're depressed we also feel a bit vulnerable to ourselves. So it's just another step on to making us also think that perhaps we might be the target of others' hostility.

Robyn Williams: That is very interesting because I woke up at four o'clock last night, and I'm sure my IQ is 10 points down. Daniel Freeman: Sleep has so many effects. There is certainly evidence that [lack of sleep] makes us miserable, it makes us depressed, and it probably affects our frontal lobes which are responsible for some of our higherlevel reasoning. And also of course if you don't sleep so well you just feel odd and different, it's a bit like having a hangover. And when we're in that state we can misinterpret it. So somebody might go out and go, well, I'm feeling dreadful because I'm not sleeping or I'm stressed, but sometimes we might actually find the explanation in the way others are looking at us or the way other people are reacting to us. Robyn Williams: Is it like many of these syndromes of the mind that underneath is a kind of useful thing, in other words, it used to be quite handy to be wary, just in case, but if you rank it up a bit, if you take it to a level that is counter-productive, then it becomes a sort of disease syndrome? Daniel Freeman: I think that's an excellent explanation, I think that's right. Every day we make decisions whether to trust or mistrust people, whether to share a confidence with someone or hand over our credit card, and it's adaptive, and of course there are dangerous situations, we sometimes should be wary. But it's very hard sometimes to be sure about the intentions of another person, so it's quite error prone, and therefore we make errors, that's on the paranoia spectrum. And of course if people have been bad to us in the past we're even more likely to jump to that conclusion, even when it is not the case. Robyn Williams: It just so happens you mentioned cannabis before. We've had on one of our programs, Ockham's Razor, a bit of a stand-off between at least two people on whether there is a link between smoking cannabis and psychosis, who knows, even schizophrenia. One person says that the studies show practically nothing, another says there is a clear indication. Do you have an opinion? Daniel Freeman: I think my opinion is that it certainly can induce paranoid thoughts when you're taking it, in some people, and I think the evidence shows that if you take it at a very young age, perhaps before the age of 14, that that actually probably puts you at risk of later developing schizophrenia. But clearly it is not inevitable, many, many people smoke cannabis and many people smoke cannabis without having these sorts of effects. But I think it is a factor in some cases. There is no single cause of psychosis, I think there are multiple factors often interacting, but I think cannabis is probably one of them. Robyn Williams: Finally, when your book Paranoia came out, what was the reaction both in public and amongst the profession? Daniel Freeman: I think that it certainly initiated discussion, particularly we argued that paranoia may be on the rise, and I think that really got people discussing it, and also I think the word 'paranoia' is just generally in the last few years a lot more used, not just because of the book but because I think of events that are happening in our society, it is a term that we are just using and thinking about a lot more. And it links into this idea of social cohesion, which is very important. Robyn Williams: You're implying of course that social cohesion is diminishing and therefore paranoia, as you'd expect, is increasing. Daniel Freeman: That's right, exactly. So there is a slight irony that we are all living more in cities and being more close together, but the closer we get actually we seem to get further away and more distrustful of people at a psychological level. So I think it's an important topic where we have to think about how do we increase trust in our societies and at an individual level. Robyn Williams: Daniel Freeman is a professor of clinical psychology at Oxford, and his conclusions about the burgeoning of paranoia in our ever more crowded cities bear reflecting on, same with firms.