I presented this paper at a conference held on 20–21 February 2012 at The University of Sydney (as a second-year PhD candidate). The conference was titled ‘Surveillance in/and Everyday Life: Monitoring Pasts, Presents & Futures’ and organised by The Surveillance & Everyday Life Research Group. See here. The 2012 version of this paper below was revised in December 2024.

Abstract

The science fiction (sf) author Philip K. Dick once characterised paranoia as a modern-day development of an ancient, archaic sense that we had long ago, when we were vulnerable to predators. Commenting on the paranoid experiences of the characters in his novels, Dick said: ‘They’re living like our ancestors did. I mean, the hardware is in the future, the scenery’s in the future, but the situations are really from the past.’ Building on Dick’s thoughts, this paper considers paranoia not as a psychopathological reaction to contemporary surveillance technics but as an expression of the evolved ‘human surveillance system.’ The paper will develop Dick’s implicit claim that paranoia can be understood as a parachronism that is dislocated in the present. It will also develop Dick’s idea that paranoia’s proximity with ‘futuristic hardware’ highlights its vestigiality and out-of-placeness. To do so, the paper will consider paranoia in the context of biological surveillance (eg, the ‘immunosurveillance’ mechanism of the immune system) as well as the clinical technics of biomedical surveillance (eg, X-rays, PET scans, diffraction photography). While the function of paranoia may be to reveal dangers that might be otherwise unseen, what does this mean when all material dangers have already been revealed? For example, if modern clinical technics are understood to fulfil the paranoiac drive to ‘reveal all,’ what does it mean to be paranoid in the clinic? Is it possible to constructively doubt the data proffered by these medical technics? Or should one recognise clinical paranoia as ‘excessive’ so as to embrace clinical knowledge as an answer to this evolutionary paranoia?

1. Paranoia, Evolution and Surveillance

In a 1974 interview with Paul Williams, Philip K Dick described in some detail his ideas about paranoia. I will quote him at length:

Paranoia, in some respects, I think, is a modern-day development of an ancient, archaic sense that animals still have – quarry-type animals – that they’re being watched. Imagine you’re a mole, walking across the field. You gotta have a sixth sense that something’s overhead, cruising, like a hawk. Now, I say paranoia is an atavistic sense. … It’s a lingering sense, that we had long ago, when we were — our ancestors were — very vulnerable to predators, and this sense tells them they’re being watched. And they’re being watched probably by something that’s going to get them. This sense should be abolished by now. We shouldn’t have it. But some people have a lingering sense, when they walk on a field, something’s looking at ’em, see. And that’s what paranoia is all about. And often my characters have this feeling. … But what really I’ve done is, I have atavized their society. That although it’s set in the future, in many ways they’re living – there is a retrogressive quality in their lives, you know? They’re living like our ancestors did. I mean, the hardware is in the future, the scenery’s in the future, but the situations are really from the past.’¹

This quotation, from a 1974 interview with the author, indicates Dick’s view that paranoia connects us (as primates) with other paranoid species on the planet. But it also suggests his view that paranoia is an advantageous phenotypic trait. As a psychological mechanism, it may have arisen as a mutation that, as it turns out, assists survival, steering us away from predation or negative events in general. I open up my talk with this quote today, and I endorse Dick’s hypothesis, not simply because I am a humanities student reading science fiction. Indeed, I am someone probably a lot worse than that: a postmodernist who dabbles in reading science. To justify this position, and to clarify my approach to literary texts and scientific history, I would adapt what Raymond Chandler once said about fairy tales: ‘The spirit of an age is more essentially recorded in its fairy tales than in its most painstaking chronicles.’ As I contend, Dick’s texts are insightful fairytales about medical and biotechnological developments in the 1960s and ’70s. In this sense, his works are a more essential or more suggestive record of the spirit of the time than primary sources or encyclopedic histories.

Dick’s conceptualisation of paranoia is worth exploring for several reasons. First, it recalls the theoretical writing of Gilles Deleuze and Felix Guattari in the first half of the 70s, especially in Anti-Oedipus. In that work, the authors conceive of the human as a technogenic. Capitalist technologies, such as machines, are in large part responsible for psychic disorder. Moreover, this theory of ‘capitalism and schizophrenia’ supplants or at least supplements the Freudian theory in which Oedipal familial relations during infancy engender psychic disorder. Likewise, Dick’s notion suggests that his characters live amid ‘future hardware’ — machines and other technics — but experience ancient or ‘archaic’ senses of psychic disturbance. The technogenic source of psychic disorder is common to both outlooks.

But Dick’s idea is also worth exploring because it represents a vision of technological surveillance that is not just disturbing but clearly very well understood in popular culture and experience. Of course, technological surveillance is perhaps best represented in the Hollywood adaptations of Dick’s novels: Blade Runner, Total Recall, Minority Report, and the Adjustment Bureau. However, those representations also arguably convey, albeit grandiosely, what is simply the reality of modern digital life. While we do not yet understand ourselves as androids that/who ‘dream of electric sheep,’ we are increasingly familiar with many of Dick’s ideas. For instance, Dick’s fiction, and the quotation above, says a lot about how we see time and being. Humans are at once ancient and futuristic in an inextricable way; thus, human ontology can be understood as an attempt to make this tension coherent. Similarly, Dick’s novels often portray disturbing and threatening surveillance devices: eg, Dr Smile, the psychologist-in-a-suitcase from The Three Stigmata of Palmer Eldritch. In Dick’s fiction, the behaviour (misbehaviour) of these machines is increasingly threatening and more disturbing than that of other humans. Dick’s novels are thus a way to reconnect with that attitude of the 70s and to consider whether now, some forty years later, we have acclimated to these objects and technics. Are we more comfortable with interacting with these machines? And could it be that Dick was overly paranoid about the technics of the future?

If the worlds of Dick’s novels are atavistic, so too is reading Dick’s novels an atavistic practice. To read Dick today might be to enact a strange ‘retrogression’ — to step back into the past whereupon we can examine the visionary pre-history of many current technologies. However, in reading Dick’s fiction, we enter the past and future in this double sense. Take A Scanner Darkly (1977), which is set in 1994. The protagonist is an undercover police operative known as Bob Arctor (real name Fred). At one point, Arctor reflects on whether the ‘scanners’ that surveil his undercover drug manufacturing operation might help him regain control of his life. Arctor has become increasingly paranoid and dissociated under the influence of the hallucinogen Substance-D. It does not help his mental health that he has had to maintain two personalities, Bob and Fred. Nor does it help that he has to wear, when not undercover, a so-called ‘scramble suit’ — a digital cloaking device that makes his real body appear as a scrambled multiplicity of bodies. The holo-scanners that surveil Bob/Fred can see through his scramble suit and detect the reality that beneath. In his state of dissociation, Bob/Fred is led to ask what a scanner sees, and to question whether they might even be capable of seeing himself; after all, Bob/Fred himself can no longer see himself clearly.

The love-hate relationship that Bob/Fred has with the holoscanners in A Scanner Darkly prompts us to consider how surveillance, including through ordinary video surveillance but also medical imaging devices, might engender security and trust in society and the clinic. What do these scanners see? In the clinic, computerised tomography devices can see tumours and magnetic resonance imaging (MRI) devices can see structural damage to bones and organs. However, if these devices can engender trust in their revelations, can they also engender paranoia? Or what about the deep sense of identity loss (ego-death) and hostility as we see arise among characters in Dick’s novels?

Before I move on to the scientific aspects of paranoia, I will note a few scholars’ ideas about paranoia. Nicholas Holm writes that ‘paranoia’ is a vexed term in surveillance studies, and that the concept of paranoia in fact ‘haunts the academic study of surveillance.’² I take this to mean that the discipline of surveillance studies is undergirded by the uncomfortable but understandable notion that its practitioner-scholars are themselves paranoid — that, being excessively anxious about surveillance, they have now come to study it. Thus, they are not just scholars of the phenomenon but its victims or subjects.

By contrast with this negative perspective of the topic, David Harper observes that paranoia, as a phenomenon, may be understood as productive rather than pathological. Paranoia may prompt critical thinking and specialist research on a subject.³ However, as Harper continues, the scholarly goals of surveillance theorists might also be criticised or dismissed as expressions of ‘unwarranted and meaningless suspicion.’ In his study, Harper illustrates that prospect through the example of a researcher who attempts to count all of the devices that recorded her in a single day.

In another, more theoretical, way, surveillance and paranoia studies may be seen in evolutionary terms as the means by which vigilance is exercised against threats to various established human liberties — threats that might be, without paranoia, invisible or undetectable. These human liberties could include cognitive independence, physical autonomy, intellectual or creative freedom and certain forms of privacy. As with meerkats, which use quiet surveillance vocalisations to alert their peers to possible predators, surveillance researchers may be understood to perform a similar form of sentinel work. They perform a duty to their peers in carefully identifying the range of threats to our established human liberties imposed on the species by governmental or biopolitical regimes.

Of course, ‘doing’ research on surveillance regimes can be cross-disciplinary and may involve questions related to public law and ethics; in this sense, surveillance research should be understood as consistent with the public interest or as a public good. It is surprising, therefore, that surveillance research tends often to be discredited or criticised. Surely it pays to have someone keeping track of surveillance regimes? However, the criticism may arise from the cultural imaginary, alluded to above, that surrounds paranoia: conspiracy theory and paranoid thinking are, far from rare, actually very common within the population; those modes of thinking can also be anathematic to institutional orthodoxy, contagious, and ‘irrational’. As Harper argues, however, not all forms of paranoia are bad; only those from which distress and perseveration emanate will cross the line over to disorder.

Arguably, paranoia studies and paranoia more generally, need to be reimagined as a mode of thought that can be positively utilised and redirected — not dulled — if it does become dysfunctional. In the context of the hospital (or clinic), extreme paranoid and delusional reactions to medical intervention, including scanning and radiation technics, are treated with utmost seriousness. However, they are often discussed as unusual responses to ‘rational science’ rather than meaningful or instructive responses among patients for whom better or improved protocols for administering treatment should be imagined.

But what if one sees the clinic from Foucault in his Birth of The Clinic (1973) — another book of the 1970s? For Foucault, the clinic is not a room but an épistème: a power structure in which both the medical gaze and biopower combine to make the pathological visible and legible. According to this logic, the body and its diseases are objects that can transcend time; cellular function can be frozen into fixed signs, first as ‘lesions’ and second as disorders. Even genes can become static signals, notwithstanding that double strand breaks (DSBs) will cut through DNA (and repair) at a rate of about 10–50 per day.⁴

With the creation of both written and image-based records, treating a disease may be understood in terms of a ‘case’ and a ‘history’ rather than merely as a list of symptoms. With increasing surveillance, it should be no surprise that extreme paranoia can arise. Consider what is known as Intensive Care Unit psychosis (ICU psychosis), which can arise in patients during times of acute stress. A paper in Neuroscience and Biobehavioural Reviews titled ‘Social threat perception and the Volution of Paranoia’ from 2004 analyses the array of tests undertaken to determine the detection of threats by humans in the social environment. As the authors claim, ‘The neurocognitive mechanisms responsible for fast and efficient threat detection may … have survived as an adaptive advantage in accord with Darwinian evolutionary theory.’⁵

We might tend to think of other species (eg, lions and tigers and bears!) when considering potential predators; and we are prompted to do just that by Dick’s remarks, which seem to suggest the threat of another species attacking and destroying we humans. Of course, another possible predator is technology itself: robots, and so on. But it is probably more to the point today to consider the extent to which paranoia functions as a means of protecting us against the actions of our fellow humans — those who we may regard as predators from within our own species. This is especially cogent when considering the role of paranoia in the context of human medico-surveillance technologies. How do the battery of tests created by the humans and the life sciences to measure illness — for example PET and CT scans — increase paranoia among those tested?

The paradox, predictably, is whether the tests that promise to make us better, and that survey our bodies at extremely close magnitudes, also play a role in activating vestigial paranoiac anxieties. If they do so, it is not simply because we are consciously fearful of the results, or fearful of even these medical technics or technologies themselves. It is due to something ‘other’ — something prior to our conscious recognition of our own impulses or compulsions to be paranoid. It is prior to the impulse to respond to social as well as physical threats. I claim that paranoia — a much vexed term in surveillance studies and, as Nicholas Holm suggests, ‘a theme, an undefined noun [and] a vague proposition [that] haunts the academic study of surveillance’ — can be seen to signify a form of hyper-rumination. This is an excess of mental activity that meditates precisely on that which we do not know, and a form of rumination that frames its conclusions in a negative, fearful, anxious narrative.

If we put paranoia into the Hegelian dialectical terms (thesis, negative (or antithesis), and synthesis) then paranoia might be seen as useful and productive for developing the negative or antithesis.⁶ But it might also postpone the development of a synthesis since it would resist the thesis, which, in everyday life, might compare to the resistance by the paranoid person of logical explanations, or rational hypotheses, for certain events they perceive as negative, or for certain actions they regard as persecutory or predatory. It follows that paranoia might arise among patients undergoing surgery involving close-range body surveillance technics based on a rejection of the ‘thesis’ — of the diagnosis, the information arising from surveillance itself. Consider the syndrome called ICU delusional syndrome.

Of course, ICU psychosis and delusion can arise for many reasons — not only when patients fear a bad medical diagnosis or a surgical procedure. Patients might also doubt their ability to recover from surgery; or they may experience these feelings after the surgery — after they have arisen from anesthesia. My interest in these close-range surveillance techniques is not limited to any particular psychological mechanism. My focus is on the broader point that these devices deliver patients knowledge of an invisible condition hitherto unknown or unknowable. Thus, medical technologies offer us the opportunity to see that which is not perceptible. And yet there remains a crucial gap in knowledge about the self: is the scan correct? Have the images been interpreted correctly? This fear of the unknown within the known is another, new domain of paranoia. The paradox I want to underline is this: while we are fearful of that which is unknown — Does the cancer exist or not? Is my child healthy and well? — there is another way these technics engender paranoia: they present new, unstable, probabilistic knowledge.

One qualification I wish to cite is that I am thinking of paranoia, in a rather Freudian way, as a psychopathology of ‘everyday life.’ Just as surveillance may exist in everyday life as well as in prisons and high-security offices, so it is with paranoia. While, of course, medical scanning technologies are not part of our everyday, this may not be the case for long. The accessibility of imaging is increasing all the time. And as many studies of paranoia in non-clinical populations note, most people are able to self-manage paranoiac distress, notwithstanding its constant presence: that is, most people do not catastrophise or develop chronic syndromes, and most are able to gain emotional distance from paranoid feelings or ideations.

For Freeman and co-authors, paranoia can be associated with submissiveness. Drawing on the work of Allan and Gilbert,⁷ their study, they found

a significant association of paranoia with submissive behaviours. People who have difficulties in asserting themself — which these authors conceptualise within an evolutionary framework as having low dominance and inferior social rank – can be vulnerable to a number of psychological problems. Further, … submissiveness is associated with paranoid thoughts and with angry thoughts and feelings. Attributions that others have negative intentions underlie feelings of anger. We think that in some cases anger may contribute to the attribution of intent in persecutory ideation. However, rather than expressing anger or resentment towards others, individuals may instead ruminate and feel aggrieved owing to timidity or submissiveness.⁸

Thus, by bottling-up feelings of anger in the context of seeing themselves as inferior or of a lower social rank, it is possible for some people to ‘maintain a state in which external attributions and anomalous experiences are more likely, thus leading to the persistence of persecutory ideation.’⁹

Many surveillance studies dealing with paranoia focus on the increasing abundance of CCTV cameras, or the fear of being monitored via social networks. These studies focus on what might be understood as certain ‘known unknowns’ — imagined threats that have a conventional shape or format. For example, typical questions include: Who is the agent that surveils me? Why are they surveilling me? And how might their intrusions into my private life, or the lives of my online avatars, be used against me, or for their benefit? While many such questions remain unanswered in ordinary experiences of public surveillance, they are well-explained in the circumstances of the medical setting: the surveilling agent of surveillance is a doctor; they are surveilling my body because I am pregnant, or because I am suspected of having a disease; and the knowledge acquired by the surveiller will be used for my benefit.

However, the medical setting arguably gives rise to certain different paranoid questions — many at an interpersonal level — about the nature of the medical surveillance regime itself. Does this technology have any negative side-effects or risks? Is the diagnostic conclusion of the doctor an appropriate and medically sensible one? Like Dick says, the hardware and scenery is in the future — in the ‘biotechnological age’ — but the situations are really in the past. But this situation, as Foucault’s arguments in The Birth of the Clinic attests, is intrinsically political: governed by relations of power designed to overcome bodily threats and even (in fantasy) the threat of death itself. These questions are worth asking because they go to the heart of what it means to be paranoid in a surveillance regime; they can assist in analysing these regimes beyond simply the parameters of privacy.

2. Cognitive Behavioural Studies of Paranoia

One of the tests, interestingly, by which behavioural scientists have assessed whether those suffering from schizophrenia and/or paranoid and persecutory delusions possessed cognitive biases (as opposed to the possibility that these schizophrenic individuals were paranoid because, in fact, there was something important and threatening to be paranoid about), involved timing how long it took such individuals to name the ink-colour of threat-related words such as ‘paranoid’ when these were presented to them on a piece of paper, versus meaningless strings of O’s, neutral words, or words signifying negative affect, and compared with depressed or ‘normal’ individuals, or so-called controls.¹⁰ Since the schizophrenia patients were slower to name the ink-colour, these ‘findings were interpreted as evidence for heightened pre-attentive processing of threatening information in schizophrenia patients with persecutory delusions.’¹¹ Similarly, those suffering these persecutory delusions, when told stories containing threatening content, recalled, when asked to recall propositions from the stories, more of the threatening propositions than the threatening control group.¹²

As a slightly more recent study argues, ‘the perception of threat is a central feature of paranoia almost by definition.’¹³ However, this more recent study, when considering a range of empirical tests undertaken in relation to paranoia that are similar to the aforementioned word and story tests, suggests that ‘there is considerable evidence that paranoid patients have indeed actually experienced an abnormal frequency of adverse events such as discrimination and victimisation.’¹⁴ In other words, paranoid patients may indeed be expressing a conditioned avoidance response (or ‘CAN’) in relation to experiences quite realistically and actually already had by them previously. As the study explains,

Not only does this [past experience and memory of past experiences] affect evaluations of the past, but also, because there is a tendency to rely on recollection of past events when making predictions about the future (called the availability heuristic … ) it also tends to inflate estimates of future negative events.¹⁵

In addition to this, there is evidence that paranoid patients have a tendency to preferentially recall threat-related, as opposed to simply neutral, information.¹⁶ Moreover, paranoid patients tend to make inflated or exaggerated assessments or estimates about future negative events even after controlling for the above events (or for the availability heuristic), as well as for the effects of comorbidity — that is, the possibility that these memory-based influences may coexist with another syndrome or syndromes, such as depression or anxiety.¹⁷ As this later study claims, it is the somewhat inexplicable origin of the inability of the paranoid patient to desist in making inflated assessments about the immediate threat-quotient in relation to future and current events, notwithstanding his or her apparently fully conscious psychical resolution of past-threats, that is suggestive, for neuroscientists, that a ‘specific abnormality in the mechanism responsible for aversive processing’ exists in paranoid patients which makes a ‘large contribution to the formation of paranoid delusions.’¹⁸

Of course, before we speak of the abnormalities that characterise paranoia — in terms of biochemical or physiognomic abnormalities — it is worth considering the behavioural and psychological habits that are facilitative of the same. For example, attribution theory considers how events are explained — or to what causes paranoid and other so-called ‘normal’ (neurotypical) people attribute them. Since most neurotypical people are thought to attribute negative events to external causes — a phenomenon known as the ‘self-serving bias,’ which is said to buffer against self-esteem loss in the face of failure and other threats to the self — there is thought to be a natural tendency to regulate or self-surveil paranoia, keeping it in check. Some studies have suggested that paranoid patients tend to attribute negative events to excessively external causes¹⁹ and especially external personal causes.²⁰ However, because of the inconsistency across paranoid people in relation to self-esteem, models of paranoia have linked inconsistent or unstable self-esteem itself to paranoia — paranoid patients are not excessively low or high in self-esteem, and in most instances there is no bearing of self-esteem on the existence of paranoia.²¹

Studies involving humans and rats in relation to avoidance conditioning have shown that once successful avoidance of, for example, an electric shock, has been achieved, the avoidance response — pulling a lever to avoid the electric shock, for example — becomes ‘resistant to extinction.’²² That is, when the aversive stimulus (the electric shock) is magnified, repeated more often, or otherwise made prevalent, the avoidance response becomes more entrenched. In this context, I would like to characterise surveillance as a kind of aversive stimulus, In our increasingly medicalised world, and with the increasing use of devices and instruments suited for surveillance of our bodies, these medical technics with which we are familiar become continuously more entrenched as a source of paranoia. Or, rather, our paranoia about them, as an aversive response, become increasingly more entrenched. This would apply to scanners of all kinds: X-rays, FMRI scans, and so on. And consider the use of functional imagery with positron emission topography (PET). This is a technic in which a radionuclide is introduced into the human body, and traced throughout it to produce an image of a functionality. There is a small risk of radiation poisoning, which can only enhance the paranoia, the aversive response, that underlies their clinical imaginary.

As I have said, there is of course a Foucauldian sense in which these technologies might also be considered surveillance devices. However, again, that are also aversive stimuli to which we might develop psychological responses, such as avoidance conditions. I would suggest that this might occur not because we might misread these devices as predators. Rather, it is because we sense, as Dick’s characters sense, that these technologies can at any time be repurposed for exploitative ends: as instruments of the state, as technologies leveraged by the medical profession, or as technics of oppression and of exclusion. This is what Foucault, in The Birth of the Clinic, described as the medical gaze. That gaze separated the patient’s identity from the medical body they inhabited.²³ The medical gaze, aided by these devices, is a scopic regime whose purpose is not just altruistic; it can be misused, it can depersonalise, and it can be invasive. Is it really not intuitive to say that these devices might engender paranoia?

3. Paranoia in Philosophy and Society

Thus far I have considered paranoia as a vestigial trait that might be reactivated or reanimated by medical technics in the case of the ICU setting. However, there is another philosophical understanding of paranoia that regards it as an ideological reaction to historical situations or épistèmes. Deleuze and Guattari, for instance, describe paranoia in Anti-Oedipus (and later in A Thousand Plateaus) as a ‘reactionary arrest’ by which the ‘deteritorializations’ of identity and subjectivity brought about within capitalist societies are ‘reterritorialized’ — or, in other words — reinscribed or inscribed with new meaning or by the paranoiac.²⁴ Reterritorialisation in Deleuze and Guattari’s lexicon means to ‘write over’ an old (deterritorialised) regime with new symbols, new laws, new authorities, and so on. Arguably, the process of deterritorialisation and reterritortialisation marks the end and beginning of what Kuhn called a paradigm or of what Foucault called an épistème. Paranoia, say Delezue and Guattari, plays a role in this process, and serves the aims of reterritorialisation. It is a mode of questioning and undermining the established order.

At one point, the authors’ comments recall Dick’s thinking on the atavistic societies his characters inhabit, as well as the distinction between the archaic and the futuristic, or the ancient and the modern. Of course, this is not a great coincidence, as Anti-Oedipus was published in 1972 — only two years before Dick’s interview. Deleuze and Guattari state that

… modern societies … are caught between the Urstaat that they would like to resuscitate as an overcoding and reterritorializing unity, and the unfettered flows that carry them towards an absolute threshold. They recode with all their might, with world-wide dictatorship … [and] they are torn in two directions: archaism and futurism, neoarchaism and ex-futurism, paranoia and schizophrenia.²⁵

Deleuze and Guattari seem to contrast the symptoms of paranoia and schizophrenia. But while they are different, even polarised or binary conditions, they see them both as logical responses to capitalistic territorialisations in modern society. By contrast, the DSM-IV-TR classified paranoia as a subtype of schizophrenia, as well as a separate disorder, namely, Paranoid Personality Disorder (PPD).²⁶ Both schizophrenia and PPD are relatively uncommon among the general population. They have also emanated, as a two-part classification, from Emil Kraeplin’s nineteenth-century textbook of psychiatry, a nosography in which ‘dementia paranoides’ (qua paranoia) and ‘dementia praecox’ (qua schizophrenia) were distinguished.

Notwithstanding these contrasting classifications, the most salient difference between the diagnostic understanding of paranoia on the one hand, and the philosophic understanding on the other, is the different degrees to which these mental phenomena are linked in each approach to modern societies. Philosophers tie paranoia to culture and to history; psychiatrists tie paranoia to an archaic, special or phenotypic (genetic) trait. Of course, this distinction is not clear-cut, and many theorists of psychiatry have blended these approaches. Kenneth Paradis, for one, highlights paranoia’s particular connection with both modernity (culture) and desire (psychology) as follows:

As an epistemological rather than nosological descriptor, paranoia is a term that participates in the discursive management of the individual’s tendency to remythologize modernity’s disenchanted cosmos; it is a wrong way to find personal meaning in a seemingly indifferent universe. Paranoia is a modern grotesque: it reveals the modern ideal of objective knowledge as shot through with desire, and the modern ideal of effective, even-handed administration as shot-through with presumptions of hierarchy, privilege and exclusion … ²⁷

In response to Paradis, I would argue that paranoia is also activated by medical technics — with those devices with which we have been made to become very quickly familiar: electrocardiograms (ECGs), X-rays, and so on. Many of these devices can be misperceived as threats — not directly or consciously, but in a broad and irreconcilable sense that is difficult to rationalise or grasp. These paranoid feelings stem from the range of social meanings accorded to these technics, their potential to reveal unwanted diagnostic information, and a desire to avoid the threat posed by that information. As Christine Hassenstab states in her consideration of the ultrasound and its images, the device marks a ‘technological nexus where visibility [of the uterus] could join with some form of subjectification or end in actual subjectification.’ In her theorisation, ‘subjectification’ is a process by which the body and identity of the patient is turned into a locus of observation, analysis, and interpretation; it is a process by which the mother comes to recognise herself as a domain of possible knowledge: ‘the way the subject experiences ‘[her]self in a game of truth where [s]he relates to [her]self.’²⁸

As Hasenstab further suggests,

… we need to understand how patients, especially women, negotiate medical images. We need to remember that while images are dependent on culture and society for their meanings, these images can have multiple meanings.²⁹

Given the multiplicity of meanings engendered by medical and other close-range surveillance technics, understanding how patients or practitioners will or should manage even a slight risk of iatrogenic harms (psychopathological symptoms) may be perplexing. Indeed, how one negotiates these epistemological meanings may not be as clear-cut as Paradis suggests. The remythologisation of modernity’s so-called ‘disenchanted cosmos’ seems often already to have taken place; for example, a survey of popular media or the medical literature orbiting a particular treatment modality will variously ‘disclose’ a wide range of potential side-effects. Far from an individualist modern grotesque, in this context, paranoia is takes the form of a collective unconscious — or ‘unconscious-becoming-conscious’ — about the nature of medicine and its threatening obverse.

1. Philip K Dick, Interview with Paul Williams (31 October and 2 November 1974), reproduced in Paul Williams, Only Apparently Real: The World of Philip K Dick (Arbor House, 1986). ↩︎
2. Nicholas Holm, ‘Conspiracy Theorizing Surveillance: Considering Modalities of Paranoia and Conspiracy in Surveillance Studies’ (2009) Surveillance & Society 7(1): 36. ↩︎
3. David Harper, ‘The Politics of Paranoia: Paranoid Positioning and Conspiratorial Narratives in the Surveillance Society’ (2008) 5(1) Surveillance & Society 10; also see David J Harper, ‘Deconstructing “Paranoia”: Towards a Discursive Understanding of Apparently Unwarranted Suspicion’ (1996) 6(3) Theory & Psychology 423. ↩︎
4. Michael M Vilenchik and Alfred G Knudson, ‘Endogenous DNA Double-strand Breaks: Production, Fidelity of Repair, and Induction of Cancer’ (2003) 100(22) Proceedings of the National Academy of Science USA 12871-12876. ↩︎
5. Melissa J Green and Mary L Phillips, ‘Social Threat Perception and the Evolution of Paranoia’ (2004) 28 Neuroscience and Biobehavioral Reviews 334. ↩︎
6. Although it is well-known that Hegel did not actually employ these terms, many studies accept as a ‘traditional idea’ that that Hegel’s dialectics ‘follows a thesis-antithesis-synthesis pattern.’ See, eg, John ME McTaggart, A Commentary of Hegel’s Logic (Russell and Russell Inc, 1964 [1910]) 3; Geoffrey RG Mure, A Study of Hegel’s Logic (Oxford University Press, 1950) 302; Michael Kosok, ‘The Formalization of Hegel’s Dialectical Logic: Its Formal Structure, Logical Interpretation and Intuitive Foundation’ in Alisdair MacIntyre (ed), Hegel: A Collection of Critical Essays (University of Notre Dame Press, 1972) 243. ↩︎
7. Steven Allan and Paul Gilbert, ‘Submissive Behaviour and Psychopathology’ (1997) 36 British Journal of Clinical Psychology 467. ↩︎
8. Daniel Freeman et al, ‘Psychological Investigation of the Structure of Paranoia in a Non-Clinical Population’ (2005) 186(5) British Journal of Psychiatry 434. ↩︎
9. Ibid. ↩︎
10. Green and Phillips (n 5) 335. ↩︎
11. Ibid. ↩︎
12. Ibid. ↩︎
13. Michael Moutoussis et al, ‘Persecutory Delusions and the Conditioned Avoidance Paradigm: Toward an Integration of the Psychology and Biology of Paranoia’ (2007) 12(6) Cognitive Neuropsychiatry 495, 498. ↩︎
14. Ibid. ↩︎
15. Ibid. ↩︎
16. Richard P Bentall, Sue Kaney and Kim Bowen-Jones, ‘Persecutory Delusions and Recall of Threat-Related, Depression-Related, and Neutral Words’ (1995) 19(4) Cognitive Therapy and Research 445. ↩︎
17. Ibid. ↩︎
18. Moutoussis et al (n 13) 498. ↩︎
19. Christopher F. Fear, Helen M Sharp and David Healy, ‘Cognitive Processes in Delusional Disorder’ (1996) 168(1) British Journal of Psychiatry 61–67. ↩︎
20. See Richard P Bentall, Peter Kinderman and Sue Kaney ‘The Self, Attributional Processes and Abnormal Beliefs: Towards a Model of Persecutory Delusions’ (1994) 32(3) Behaviour Research and Therapy 331–334. ↩︎
21. See RP Bentall et al, ‘Persecutory Delusions: A Review and Theoretical Integration’ (2001) 21(8) Clinical Psychology Review 1143–1192. ↩︎
22. Michael Moutoussis, Jonathan Williams, Peter Dayan, and Richard P Bentall, ‘Persecutory Delusions and the Conditioned Avoidance Paradigm: Toward an Integration of the Psychology and Biology of Paranoia’ (2007) 12(6) Cognitive Neuropsychiatry 495, 501. ↩︎
23. See Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception, tr Alan M Sherdian (Routledge, 2003) [1963] 9. ↩︎
24. Gilles Deleuze and Felix Guattari, Anti-Oedipus: Capitalism and Schizophrenia, tr Robert Hurley, Mark Seem and Helen R Lane (University of Minnesota Press, 2000 [1972]) 260, 277. ↩︎
25. Ibid 260. ↩︎
26. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders: DSM -IV-TR (4th ed, 2000) 313–14. ↩︎
27. Kenneth Paradis, Sex, Paranoia and Modern Masculinity (State University of New York Press, 2007), 24. ↩︎
28. See Maurice Florence, ‘Foucault’ in JD Faubion (ed), Michel Foucault: Aesthetics, Method, and Epistemology: Essential works of Foucault 1958–1984, vol 2 (The New Press, 1994) 461. ↩︎
29. Christine M. Hassenstab, ‘The Inspection House: Panopticism, Gynopticisim and Prenatal Genetics Screening’ (2007) 9(1) Theory and Science https://theoryandscience.icaap.org/content/vol9.1/hassenstab.html. ↩︎