Paranoia and Political Leadership

Paranoia and politics are two topics that have fascinated me for many decades. In this paper, I review psychoanalytic definitions of the paranoid process, summarize our understanding of its etiologies, extract from diverse psychoanalytic sources some general recommendations for treating patients with paranoid dynamics, and make a few comments about the implications of such prescriptions for political leadership. Although they may be dated by the time this paper sees print, I have included some thoughts about the challenges facing Barack Obama and his administration, who seem to be trying to reverse certain paranoid trends in the United States. This paper will reflect my own left-leaning politics, but I have tried to be clear that paranoia is an equal-opportunity political problem, that we are all vulnerable to paranoid responses. As Drew Westen (2007) found in researching the political brain (somewhat to his dismay), the fMRI of a politically stimulated liberal is indistinguishable from that of a similarly engaged conservative.

In recent decades, the term “paranoid,” once the signifier of certain specific psychiatric syndromes, has come to be used rather loosely. This casualness may derive ultimately from Freud's resistance to categorical distinctions between health and sickness and from his explicit acknowledgment of the psychodynamics and psychopathologies that pervade everyday life. In the post-Freudian world, we are quick to attribute paranoia to ourselves and to others, and many of us, even professionals, use the word “paranoid” as a synonym for “fearful” or “unreasonably