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One of the most successful mots of popular sophistication — it is heard even on TV detective shows — is ascribed originally to Henry Kissinger: “Even paranoids have enemies.” Had he said, precisely paranoids have enemies, it would have befuddled his listeners, since paranoids are supposed only to have delusions about enemies, and Kissinger knows better than to appear to be more than one step in advance of his interviewers.
The real existence of the enemy is a vital element in the economy of the still-coping paranoid. The enemy is the proof that there is a standard of virtue in the world as well as the evidence of his own innate potency and superiority in the face of the standard (since the enemy will not come out in the open and fight like a man, where everyone can see him). If the enemy does not exist, he will create one, embodying all that the paranoid finds detestable in the human condition, choosing and nurturing him carefully. The enemy is not created out of the whole cloth, but rather under conditions dominated by the paranoid's own internal dynamisms. It is nonetheless true that paranoid thinking is a statement about the external world. The world listens to such statements — often attending more to the tone of voice than to their objective validity — and has ways of replying to them. And the paranoid responds (this time, perhaps silently): Aha! Just as I thought.
Swanson et al. correctly point out the limited usefulness of the nosological dictum of the American Psychiatric Association's Manual of Mental Disorders, according to which the hallmark of the psychotic paranoid is his delusion: “This clearly is too narrow a criterion for paranoid conditions in general; the paranoid personality is not delusional, nor are the subclinical paranoid phenomena which are transiently seen in many individuals.”1 However, the “state of the art” in psychotherapy (in contradistinction to the popular culture) does not permit much assurance in going beyond the A.P.A. to any certitu