Paranoia as a Survival Mechanism
In some instances, paranoia or paranoid delusions could be conceptualized as a survival tool created by the brain. This idea was touched on early on by Silk (1921) in his discussion of delusions and hallucinations playing a role in the psychotic patient as a defense mechanism. Patients with disorders such as PTSD, who may present with the naturally occurring hypervigilance of the disorder, have learned to adapt to the environment that was observed to be a threat to the patient. So, these hypervigilant reactions, such as looking over your shoulder to see who is behind you at all times or always sitting with your back to a wall in a room, can be viewed as a way to help the person survive based on their prior exposure to a threatening stimulus.
This idea can also be applied to situations in which the paranoia that a patient exhibits is out of touch with reality, for example, patients that present with beliefs that “the Mafia” or FBI are following them and are out to harm them. The behaviors that the patient exhibits in response to the paranoid beliefs may be engaged in as a natural survival instinct. If I believe someone is out to harm or kill me, I am naturally going to want to take action to protect myself or flee from the situation, hence the innate fight-or-flight response kicks in.
Also, take the situation in which a patient may be refusing to eat certain foods from certain individuals or may be refusing medication. In many of these instances, the patient may believe that the food or medication is being poisoned and will refuse the food or medication as a way to avoid a potential life-threatening situation. This also gives the patient a certain amount of perceived control over their environment. The solution to getting these patients to eat or take their medications, especially while in the ED, may be as simple as reassuring them that they are safe and that the food or medications have not been tampered with.
Unfortunately, if the paranoia is not based in reality and is causing impairments in the person’s ability to function or maintain relationships with friends or family, the person may present to an ED for evaluation.