Expert: Pay Attention to Paranoia

Dr. Welner, an associate professor of psychiatry at NYU School of Medicine and has been the lead examiner on some of the most complex and sensitive cases of recent years, including a number of mass shootings. He appeared on "Good Morning America" to discuss the need to bring give paranoia the clinical attention it needs, and added to those remarks for ABC News.

The mental health field has been very successful in taking the stigma out of many conditions like depression, anxiety and post-traumatic stress disorder. But schizophrenia remains a term that inspires fear in many and shame in families, including the patients themselves, and the avoidance is part of a long-standing problem that needs to change.

Schizophrenia is a condition that affects the rationality of thoughts, emotions, communication, relatedness to others and interpretation of the environment.

Schizophrenics' perspectives are often distancing, and their faces expressionless. It is easy to experience them as unfeeling, or cold, because their outward appearance reflects differently. A schizophrenic's emotional tone may include hostility, which can be intense.

To some afflicted more severely, that may mean hearing things that others don't hear, or even seeing things that others don't see. To make matters worse, those voices are typically disparaging, often profane and commenting on someone in the third person. Imagine having to navigate through your day through a jangle of voices saying, "You're a loser," "Shut the ---- up," or "You should lose weight, everyone thinks you're a lard." Such a tragic burden, such a distraction.

Even for those who don't have hallucinations, schizophrenia is a tough condition to carry. A schizophrenic has difficulty with the correct frequency of communication, interpersonal skills, efficiency, new information and complex demands. Unfamiliar circumstances separate those with this condition in ways similar to the autistic. They have difficulty relating to others, and others have difficulty relating to them.

Furthermore, the person with schizophrenia labors under an uncertainty of who he is, his place in the world, what he aligns with. That fragility affects sex orientation, religion and future pursuits.

People with schizophrenia -- and others with paranoid disorders -- use defense mechanisms just like the rest of us. Their limitations, however, affect the defenses they use. Schizophrenics' defenses may be irrational displays of anger and hostility, or irrational ideas of persecution or grandiosity. Thinking may be replete with the most peculiar preoccupations of death, sex and religion.

Paranoid schizophrenia is a subtype of schizophrenia in which persecutory thinking or ideas that others refer to you or mean you harm are prominent. Those with paranoid schizophrenia often function at a "higher" level that those with other subtypes, but they are still notorious for intense hostility and for being quick to suspicion, prickly and highly defensive. They differ from those with merely suspicious personalities by having frankly bizarre aspects to their behavior, speech, appearance and or/manner.

Now imagine having that kind of condition and reading -- or being told -- that you just have to live with it because it is incurable.

Is it any wonder that those who might be told they have schizophrenia, especially in their late teens to early 20s, might refuse dealing with mental health professionals in order to refuse dealing with the illness?

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