Many years ago, when I was a practicing psychiatrist with a subspecialty in suicide prevention, I had an incident, that my colleagues called a dissociative episode.
I’m not saying they’re wrong, but I called it something else.
After being sleep deprived from moonlighting (covering for other psychiatrists at state mental hospital), I met with my patient, Nancy (name changed), on a Monday morning. Prior to my working with her she had made three suicide attempts, each of which should have killed her and been hospitalized for one to two months (when prolonged hospitalizations occurred) every year for several years.
Nancy rarely made eye contact with me, but instead stared blankly 30 degrees to the left or right.
Upon sitting down with her on this occasion, the incident occurred.
Suddenly, as I was looking out into the room at her, the color changed to black and white and I felt chills run through me. I thought I was having a stroke or seizure and being a medical doctor, I did a neurological examination on myself that included tapping my knees for reflexes, looking at my outstretched index finger to see if I was seeing double, as well other actions.
My conclusion was that I was all there and not having either a stroke or a seizure. I then had this notion that I was seeing and feeling the world through Nancy’s eyes and feelings.
Sleep deprived as I was, I blurted the following out to her, rather than checking myself: “Nancy, I didn’t know it was so bad and I can’t help you kill yourself. But if you do, I will still think well of you, I will miss you and maybe I will understand why you had to kill yourself to get out of the pain.”
As soon as I realized that I had said it, I thought I had blown it and given her permission to kill herself.
In a few moments after what I said landed in Nancy, she looked as if she woke up from her dazed and lifeless stare and looked me directly in the eyes. And I mean directly. In fact, she held onto my eyes with hers.
Transfixed I said to her, “What are you thinking Nancy?” My fear was that she would thank me for understanding and letting her kill herself.
Instead she looked into my eyes and me and said in no uncertain terms, “If you can really understand why I might have to kill myself to get out of the pain… maybe I won’t need to.”
At that point she smiled sweetly at me as if I had unlocked her from a prison that she couldn’t get out of without someone first going inside to truly be with her by causing her to not just feel understood, but to “feel felt.”
It was a turning point for Nancy and for me.
That incident changed everything for me and demonstrated to me the power of hearing people from “their there” (their P.O.V) instead of trying to persuade them to come to “your here.”
I understand the need to apply science and follow evidence based questions to make treatment approaches more consistent, but I have also experienced that when I was checking boxes and putting people’s mental problems into categories to help with diagnosing them I was creating a distance between us. That distance often added to feelings of isolation that many depressed and suicidal thinking people already feel.
At any rate, I have taken this seeing the world through other people’s eyes to situations.
I have since applied that skill to “channel” (I know my colleagues will still say it’s dissociating) people and see the world and even speak from their point of view. This includes being an advisor to the Prosecution in the O.J. Simpson criminal trial (with a few challenging moments such as this one I needed to face), doing a one-man show playing Steve Jobs in Steve Jobs Returns (where I channeled Jobs returning from the grave and describing what went on in his head and thinking for 1996 to 2007 and the introduction of the iPhone).
In the past year, I have turned my “channeling” to suicide prevention at scale and have written extensively about it including this article: “Why People Kill Themselves – It’s Not Depression,” which to date has had 500,000+ views and 80,000+ reads. What has actually helped me to “channel” suicide prevention is to approach it via Design Thinking.
Failure to Launch Paranoia: What Lies Beneath
Recently, a number of my colleagues and parents have brought to my attention a young adult who is quite paranoid and refusing treatment. Several of these children have anosognosia, which is a deficit of self-awareness that a person has anything wrong with him or her.
On a broader scale, I think it’s safe to say that most if not all people experiencing paranoia also have anosognosia, namely it’s never about them, it always about what others are trying to do to them, as in control them.
Recently, I had another of my “episodes” where I channeled feeling paranoid and this is what came to mind as I was feeling it.
I realize that I am completely dependent on others for my existence which includes food, a roof over my head, having transportation to get around, needing money to use for basic necessities of everyday life, having a job, etc.
In all of these instances, I have no ability to provide any of them for myself.
Now here is the hook.
As completely dependent as I am on others for my existence, I am as completely distrustful of anyone who tries to help.
I think that is because I feel that their helping me requires me to think like them, go along with what they say and tell me to do, agree that whatever they say or do is correct and that anything I think or do that is different is wrong.
Furthermore, anything I think or do is not just wrong, it is in their eyes resistance and it triggers in others their trying to make me do things their way.
The crazy thing is that if I could think and do things their way – a way that works for them, but not for me – I wouldn’t need them to help me and I wouldn’t be dependent on them.
But I can’t do that because there’s something inside me that tells me that if I think and do things their way that something bad will happen, such as I will lose myself and my self and be lost forever and never make it back to sanity. I’m not doing this on purpose to be difficult, it is something that to the core of my being I believe is true and I don’t care what anyone tells me to the contrary.
If I can’t make it to their ‘sanity’ or back safely to my ‘insanity,’ I will instead shatter and fragment and fall through the cracks, which is too unbearable to risk.
In truth, down deep what is the most unbearable thing for me and fuels my paranoia is the shame and humiliation of knowing that all my peers have moved on and the awful belief that I will never catch up is too horrible to think about. So I am not even aware of what I just said and it’s easier to just stay “paranoid and stuck.“
You might share the above with someone who might be experiencing paranoia to see if they can relate to it and if so, have them explain how they relate to it. And if and when they do that, just listen and have them keep clarifying what they are saying.
Don’t give advice, express an opinion, lecture or confront them with what are they going to do.
Instead, just thank them for being willing to open up to you and tell them that you’re sorry for having never truly understood where they were coming from, especially about the shame at the end.
Leave it at that saying you’d like to leave it where it is instead of rushing in to throw some solution or advice, that they’re not asking for, on it and that perhaps you and they can talk more about it whenever they want to.