What is a Paranoid Schizophrenic?
The main difference between a schizophrenic and a paranoid schizophrenic is the paranoid component. Paranoia depending on the degree and whether the patient is appropriately medicated, directly equals the degree of dangerousness. The paranoid feature here can take the form of paranoia of others, ie: family members, political figures, law enforcement, and even world events. Auditory hallucinations are not uncommon and these can take the form of command hallucinations. They actually hear voices telling them to do certain behaviors. When this occurs, combined with poor impulse control the lethality of their behavior rises. There is no rationalization, and clearly no common sense. One does not think or contemplate repercussions or the fatality of taking another’s life. There is no empathetic connection that one human being is tied to others emotionally and literally no concept of right and wrong. The inner torment is so strong from the auditory hallucinations that they must do anything to alleviate this, even if it means taking another’s life.
In interviewing paranoid schizophrenics, their affect is usually bland or inappropriate to the content. They may admit to the death of another, or deny or state that another person did the homicide. This other person is very real to them. (This is not a multiple personality disorder.) In fact that diagnosis has left us, thank goodness. So many hang their hat on this diagnosis, patients and professionals. The inner workings of a paranoid schizophrenic are complex, mentally torturous for them, and dangerous.
They often feel the radio or television is talking directly to them, and often feel they need to act on certain behaviors because of this. It is not uncommon for them to experiment with recreational drugs to subdue the voices, however many times this backfires, and the psychosis worsens. You are now dealing with a dual diagnoses. A major diagnosis of paranoid schizophrenia and a secondary diagnosis of substance abuse or addiction.
Mental health systems are struggling with these types of patients, for the vicious cycle is once they are medicated they cannot hold them any longer and legally must be discharged. They leave, go off their medication and exacerbate into another psychotic state. This unfortunate state of affairs has been going on since I have been practicing, which is about thirty years with no resolution in site. One can only be admitted if there is proof they are a danger to themselves or others. That alone can be a fine tightrope to walk.
How does one determine if a Paranoid Schizophrenic is Dangerous?
Determine lethality of one’s behavior a lot must go into it. Sometimes we do not have a lot. In an ideal situation we need to know onset of symptoms, grades in school as well as behavior going back to grade school, even prior to that birth problems. Was the patient premature? Did the mother drink or abuse alcohol while pregnant? Was the patients developmental milestones on time? We need to know types of acting out behavior, impulsivity, degree of dangerous behavior, was their a disregard for authority? What is the frequency of the acting out? What kind of obsessions do they have? What kind of music do they listen to? Is there a timing with their psychosis and acting out with anniversaries on the calender? This list can go on and on and on. A profile is very important, to try and paint a picture of lethality. Are they religious or spiritual and if so how? As you can see it becomes rather complex and this is not even with any testing done yet.
Determing degree of dangerousness is not an exact science, however we can come very close. The dilemma is treatment and convincing the court system the person is dangerous before the atrocity occurs. That is the most difficult of all. I have no love lost for defense attorneys when testifying as an expert witness.
Paranoid schizophrenics can be very dangerous, unlike other schizophrenic diagnoses. We must be careful as a society to use a generalized label when one atrocity occurs.