Last month I had a patient come in with the chief complaint of “I need something for my nerves”. Normally as physicians we worry about those encounters where the patient is asking for pain pills or nerve pills. Those medications are highly addictive and are hot sellers on the black market. However, this particular patient was not someone who I would have expected to be a “pill seeker”. I had seen her several times in the past and she did not fit that profile at all.
I went into the room and found her pacing and wringing her hands. I asked her to tell me what happened to trigger the severe anxiety she was experiencing. She told me that the previous week her adolescent son was driving home from work at night and accidentally hit a pedestrian. It was a poorly lit road and the pedestrian was wearing dark clothes. Unfortunately the pedestrian died from internal injuries. The police did not ticket the driver, alcohol was not a factor, and no one pressed charges.
As you can imagine, this woman was very upset. She was not sleeping well, she hadn’t been able to go back to work, and she was afraid to even leave the house. She said that she thought everyone in the community was talking about her and her family behind their backs; that they were judging them and thinking the worst of them; that she feared the victim’s family was going to attack them in revenge.
Webster’s dictionary defines paranoia as:
a serious mental illness that causes you to falsely believe that other people are trying to harm you or
an unreasonable feeling that people do not like you, are trying to harm you, are talking about you etc
The first definition describes a medical condition found in patients with schizophrenia. It is a serious mental illness that requires psychiatric care and strong anti-psychotic medication. The second definition is what my patient was experiencing. We’ve all experienced that kind of paranoia at one time or another, though maybe not to the degree she was. Consider these examples and see if you can relate:
- The middle school girl who feels everyone is looking at her and laughing at her because of a pimple on her nose or a bad haircut
- The high school football player who missed a play and imagines everyone is angry with him, disappointed in him, and is talking about him behind his back
- The college student who answered a professor’s question incorrectly or flunked a test and thinks that the professor and other students think he is stupid or is a loser
- The foreigner from the same country as recent terrorist attacker who feels that his neighbors and co-workers are judging him, discriminating against him, or thinking the worst of him
- King David who said in Psalm 31:11-13
Because of all my enemies,
I am the utter contempt of my neighbors
and an object of dread to my closest friends—
those who see me on the street flee from me.
I am forgotten as though I were dead;
I have become like broken pottery.
For I hear many whispering,
“Terror on every side!”
They conspire against me
and plot to take my life.
The step between prudence and paranoia is short and steep. Prudence wears a seat belt; paranoia avoids cars altogether. Prudence washes with soap; paranoia avoids human contact altogether. Prudence saves for old age; paranoia clings to every penny. Prudence prepares and plans; paranoia panics. Prudence calculates the risk and takes a plunge; paranoia never enters the water. (Pastor Ed Delph as quoted in the Glendale Weekly paper on March 6, 2014)
Going back to the second definition of paranoia, I believe the key word there is “unreasonable”. I would also suggest the word “irrational”. With my patient, I had the opportunity to speak truth into her life. I told her that though it seemed in her mind that others were looking at her with scorn and anger, in reality, either they were feeling badly for her and her family, or maybe it wasn’t even “on their radar” at all. I told her that the devil looks for these kinds of opportunities to whisper lies to us that cause us to doubt and to despair. I reminded her what the Bible says about this enemy:
Be strong in the Lord and in his mighty power. Put on the full armor of God, so that you can take your stand against the devil’s schemes. For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms. Ephesians 6:10-12
Humble yourselves, therefore, under God’s mighty hand, that he may lift you up in due time. Cast all your anxiety on him because he cares for you. Be alert and of sober mind. Your enemy the devil prowls around like a roaring lion looking for someone to devour. Resist him, standing firm in the faith. 1 Peter 5:6-9
I advised her to seek legal counsel and gave her some suggestions on how to find it. I recommended she see a counselor to talk about these anxious feelings and ways of dealing with them, and gave her a list of counselors in the area. I gave her a prescription for a small quantity of a mild sedative so she would be able to get some sleep (a good night’s rest can completely change one’s outlook on life). I asked her to schedule a follow up visit with me in 1 month so I could make sure she was getting the help she needed. Last but not least, I prayed for her, asking God to grant her and her family peace and encouragement during this difficult time and to comfort the family of the victim.
Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus. Philipians 4:6-7
You keep him in perfect peace whose mind is stayed on you, because he trusts in You Isaiah 29:3