Is paranoia increasing?

On the evening of 15 February 1996, the 147,000-tonne tanker Sea Empress ran aground on rocks at the entrance to Milford Haven harbour in south-west Wales. Over the next week, 72,000 tonnes of crude oil and 360 tonnes of heavy fuel oil seeped from the wreck into the sea, contaminating 200 kilometres of the Welsh coastline, much of it part of the exceptionally beautiful and ecologically diverse Pembrokeshire Coast National Park. More than 50,000 birds were killed or injured.

The devastating effects of the Sea Empress disaster weren't confined, however, to the flora and fauna of the national park. In the wake of the oil spill, local people found themselves experiencing a range of health problems, including headaches, nausea and skin irritation (Lyons et al., 1999). And yet when the accounts are examined closely, something curious emerges. The first symptoms were reported as early as the first day of the incident; at that stage very little oil had escaped from the wrecked tanker. Whatever was causing these first headaches and feelings of nausea, it wasn't the Sea Empress. Indeed, people living on stretches of the coast that were entirely unaffected by the spill also complained of symptoms.

How do we explain physical symptoms without an obvious physical cause? In the case of the Sea Empress disaster, it's likely that they were the direct result of anxiety. It's an established formula. Take one catastrophe, add extensive media coverage, and watch public anxiety grow.

Think back, for example, to the anthrax scares that swept the US in September and October 2001. During these weeks, letters containing anthrax spores were sent to a number of senators and media organisations. Five people died and a further 17 were also infected.  With anxiety in the US already ratcheted to unprecedented levels by the September 11 attacks, hundreds of people soon began reporting that they too had been the victims of anthrax poisoning, with many complaining of symptoms. In one case, a teacher and student reported minor chemical burns after opening a letter containing some type of powder. Subsequent analysis revealed that the envelope contained no such powder. All in all, there were more than 2300 such false alarms.

The responses to the Sea Empress oil spill and the 2001 anthrax scares point up something fascinating about the way we reason. Put simply, the more often we hear about something, and the more emotive that event is, the greater its impact on us. We're susceptible, suggestible, suspicious creatures, easily moved by the appearance of things, and much less influenced by the way things actually are.

This has a direct bearing on the question we ask: Is paranoia increasing? Because, although we don't – and now won't – have the sort of historical data that would allow us to produce a conclusive answer, in Paranoia: The 21st Century Fear (Freeman & Freeman, 2008) we set out the grounds for believing that paranoia is indeed on the rise. And one of these is related to precisely the kind of reasoning that the Sea Empress disaster, and the anthrax scares, so compellingly illustrate.   

Reasoning and the media

Paranoia is the unfounded fear that  other people want to harm us. What  we understand now is that there is a connection between experiences as apparently diverse as mild suspiciousness and severe delusions. These are not unrelated psychological phenomena; they are in fact the opposite ends of a spectrum of paranoia, with their similarities far outweighing their more obvious differences. Overestimation of risk from others is central to all of these experiences of paranoia.

From the comfort of our armchairs, assessing risk can seem a pretty straightforward business. All we need to do is calmly and logically assess the available evidence, right? Regrettably, however, human beings do not usually think logically. Well-known research by the cognitive psychologists Daniel Kahneman, Paul Slovic, and Amos Tversky has shown that, instead of logic, we use all kinds of shortcuts, hunches and rough-and-ready rules of thumb to make sense of the world (Gilovich et al., 2002; Kahneman et al., 1982). These reasoning heuristics can be helpful, saving us time and effort and speeding along the decision-making process. But they aren't always great at helping us get an objective view of events.

The availability heuristic, for example, means that our view of something – and especially our sense of its prevalence or likelihood – is hugely influenced by how easily we can remember or imagine it. This is especially true when the event in question has significant emotional resonance for us. The way we think about the world is hugely influenced by the number of times we hear about an event and by the magnitude of its emotional impact on us. Objective facts cut much less ice. This means we're vulnerable to all kinds of irrational, unjustified fears – to paranoia, in other words. And if you're inclined to doubt it, think back to how you felt about swimming in the sea after having seen Jaws for the first time!

For most of us, what we know about the wider world comes largely from the newspapers, TV and – increasingly – the internet. The media can have a peculiarly forceful effect on us, especially when it comes to descriptions of traumatic events. The mass panics caused by the reporting of the Sea Empress disaster or the anthrax attacks are potent examples.

If the media play such a big role in influencing the way we think, we'd better hope that their coverage is calm, objective and accurate – because, as we've seen, our own reasoning is often just the opposite. Unfortunately, the view of the world we're presented with by the media is often a distorted one.

Part of the problem is encapsulated in the newsroom cliché 'if it bleeds, it leads'. Much of the media prefers one-off episodes of conflict, death and disaster, preferably involving clearly identifiable victims and culprits – or at least items that can be made to fit this template. Complicated, ongoing stories are seen as much less newsworthy. So a murder or terrorist scare is a lead item; several thousand people dying each day from starvation rarely merits a mention.

The media's sense of what is newsworthy can sometimes mean that certain stories are over-reported. Dangers are exaggerated; threats magnified. What are the biggest causes of death, for example, in England and Wales? In 2005 it was cancer (140,000 people) and heart disease (120,000) (Office for National Statistics, 2006). In contrast, there were around 600 deaths attributed to assault (murder) and 50 terrorism-related deaths (the latter is an unusually high figure that includes the London 7 July attacks). Yet in the last three months of 2005, the mass-market tabloid Sun mentioned cancer 517 times, heart disease 166 times, murder 899 times and terrorism 390 times. So although cancer kills more than 200 times the number of people who are murder victims, murder gets almost twice the amount of coverage. Your chances of dying of heart disease are approximately 2400 times greater than your chances of being killed in a terrorist attack. But you're more than twice as likely to read about terrorism in your morning paper than you are to see coverage of heart attacks. This bias isn't confined to the tabloids.

Every age has its bogeymen. Table 1 [see PDF] gives the number of references to these hate figures in the tabloid Daily Mirror and the broadsheet Times. The trend is almost always upwards. In the last quarter of 2006, for example, the number of references to terrorists in The Times was almost three times the figure for the same months of 1995. (The figure for 2005 is even higher, though this isn't surprising given that 2005 was the year of the London tube bombings.) The events of 9/11 and the so-called 'war on terror' are clearly part of the explanation for this rise, although it's interesting to note that the number of references is already up in 2000. Also, remember that the UK wasn't blissfully insulated from the threat of terrorism in 1995. Although the situation in Northern Ireland was improving, the IRA was still considered a serious threat. And look at the rise in references to criminals. These have shot up, even though for much of this period the crime rate has fallen.

We argue that this over-reporting of dangers fosters a culture of paranoia. After all, it's hard to stay cool when everyone else is panicking. But our belief that paranoia is increasing isn't based solely on our understanding of the way human beings think and the influence of the media. A number of social factors are also involved, and we now turn to two examples.

The urban nightmare

We're living through a momentous shift in the development of the human race (Brockerhoff, 2000). For the first time in our 200,000-year history, half of humanity now lives in urban areas.

There are now more than 90 cities with populations in excess of three million and 19 so-called 'megacities' with more than 10 million residents. Two thousand years ago, when the world population was around 200 million, there were only 40 cities with more than 50,000 inhabitants. The overwhelming majority of the population lived in rural communities. Although industrialisation, imperialism and other changes began a slow migration to cities in the 18th century, in 1800 only 5 per cent of the world's population lived in urban areas. By 2030 that figure is likely to rise to something like 65 per cent. As the epidemiologist Tony McMichael (2000) has commented: 'This ongoing move from countryside to city is as momentous a change in human ecology as was the ancient move from hunter-gatherer itineracy to agrarian settlement.'

One interesting consequence of this increase in urbanisation may be an increase in paranoia. An impressively consistent literature now shows that the occurrence of psychosis increases in urban environments (e.g. Kirkbride et al., 2006; Marcelis et al, 1998; Sundquist et al., 2004; van Os, 2001). For example, a 2004 survey of all Swedes between the ages of 25 and 64 (4.4 million people) revealed that people living in the most densely populated parts of the country had almost twice the rate of psychosis of those in the least populated areas (Sundquist et al., 2004). When researchers have looked at the spectrum of psychotic experiences, the findings are remarkably similar. A study of 7000 people in the Netherlands, for example, found that people in the most urbanised areas were twice as likely to report occasional mild hallucinations and delusions as people in the least populous parts of the country (van Os et al., 2001). If we're more likely to suffer paranoid thinking in cities, it seems almost inevitable that the current rapid growth in urbanisation will bring with it an increase in rates of paranoia. An increasingly urbanised population is likely to be an increasingly paranoid one.

This connection between living in cities and paranoia also ties in with emerging psychological research. There is beginning to be a convergence in evidence (e.g. Bentall et al, 2008; Freeman et al, 2008a) that paranoia arises from an interaction of affective processes (especially anxiety, depression, worry and interpersonal sensitivity), anomalous experiences (such as hallucinations and perceptual anomalies), and reasoning biases (particularly jumping to conclusions, and belief inflexibility).

The Camberwell Walk Study indicates that urban environments have an impact on several of these factors (Ellett et al., 2008). Fifteen patients with persecutory delusions were asked to walk down the Camberwell Road from the Institute of Psychiatry, buy a newspaper, and come back. Afterwards they were given a range of psychological tests. Their test scores were compared with those of 15 patients, again all with pronounced paranoia, who'd simply stayed at the Institute listening to a relaxation tape. In many ways Camberwell is typical of inner-city London: built-up, busy, and ethnically very diverse. It's also an area of considerable poverty. Compared with relaxation, walking in this environment made patients think more negatively in general about themselves and other people and increased the jumping-to-conclusions reasoning bias. This kind of innovative experimental study adds an important link in the connection between urbanicity and paranoid thinking.

Victimisation

Urbanisation isn't, however, the only social factor that may be contributing to an increase in paranoia. We might add to this, for example, an increasingly flexible employment market, in which the idea of a job for life has long gone, replaced by much greater mobility of employees, and more reliance on short-term contracts and part-time positions on the part of employers. All of this breeds uncertainty, stress, and fuels competition in the workplace, encouraging us to  see our colleagues as rivals and potential threats. We might also add to the list increasing levels of isolation, illicit drug use, wealth inequality, CCTV cameras…

In psychological research on psychosis a factor that has gained recent attention is trauma (see Morrison & Larkin, 2006). Study after study has shown that people who experience trauma (e.g. a serious illness, accident or assault, or the death of a loved one) are at greater risk of psychological problems, including paranoia.
The same is true for people who've been victimised (e.g. suffering discrimination, bullying, or physical or sexual abuse). A British survey of 8000 people, for instance, found that people with a history of victimisation were twice as likely to suffer from paranoia (Johns et al., 2004). In one particularly compelling piece of research 2500 people aged between 14 and 24 in Germany were asked to describe any traumatic experiences they'd undergone in their lives. Follow-up interviews were carried out around three years later, from which it emerged that the young people who'd originally reported serious trauma were almost twice as likely to have gone on to develop psychosis as those who hadn't experienced any trauma (Spauwen et al., 2006). This probably doesn't come as a huge surprise to you. Being raped or bullied or violently mugged are not experiences one can take in one's stride, and they aren't likely to do much for our faith in other people either. After having suffered these kinds of trauma, paranoia can seem less a delusion than a reasonable viewpoint on the world.

So if trauma and victimisation can lead to paranoia, are they – and hence paranoia – on the rise? For many of these experiences, the detailed data over time don't exist. The ground is much firmer though when we look at crime figures. Being the victim of a crime – even a relatively trivial non-violent crime – is often an enormously traumatic event for individuals. In 2005/06, around a quarter of the adult population of England and Wales – approximately 10 million people – were victims of crime. That's a vast number, of course, but it's a big improvement on the figures for 1995, when almost 40 per cent of people were victims. Now, although crime has fallen over the last decade or so, this is small beer when compared to the dramatic increase in offences since the 1950s. In England and Wales in the mid-1950s, for instance, there were around five crimes per thousand of the population; in 1997 that number was 89.1. On the back of this rise in crime there is likely to have been a rise in suspiciousness.

Whether the figures are rising or (as in recent years) falling doesn't seem to make much difference now to our perception of crime rates. Most people say that crime is increasing. For example, each year in the British Crime Survey two out of three people report that crime in the country has increased in the past year (Home Office, 2008). So a dramatic rise in crime over the past half century has not just made millions of us victims of traumatic events. It seems also to have seeped into our consciousness, making us feel increasingly threatened and vulnerable, and stoking our sense of paranoia.

Keeping it in perspective

Muggers, vandals, delinquent teenagers, paedophiles, rapists, corrupt officials, malicious colleagues, gossips, spies, and blackmailers – none of these are entirely the figment of our fevered imaginations. The trick, of course, is to keep a sense of perspective, recognising that these kinds of danger are rare and making a calm and measured assessment of risk (see Freeman & Freeman, 2009). When we look at the data on rates of paranoia, however, it appears that many of us are finding that trick increasingly difficult to pull off. At any one time, around a quarter of the population are having regular paranoid thoughts, with lots more people probably experiencing them occasionally (e.g. Johns et al., 2004; Freeman et al., 2008b; Rutten et al., 2008).

Levels of paranoia can be seen as a critical marker of the psychological and physical health of society. One study across 40 US states, for example, found that high levels of suspiciousness were associated not only with less social cohesion (e.g. membership of voluntary groups), but also with more deaths (e.g. from cancer) (Kawachi et al, 1997).

So should we expect more people appearing in clinics with severe paranoia? A rise in paranoia does not make that inevitable: services see only the tip of the iceberg of people with psychiatric problems; there is a reticence about disclosing paranoid fears; and the factors leading to more paranoid thinking may not cause the high levels of distress and social disability typically seen in clinics. But the answer to the question is simply unknown. Research into paranoia is at an early stage. This isn't to say that it was ignored in the past, but rather to acknowledge that it was always seen as a symptom of something else (schizophrenia, for instance). As such, paranoia was of purely secondary interest, of significance only in so far as it could help in the business of making a diagnosis. We believe, on the other hand, that paranoia is an experience of such centrality that it merits study in its own right.

While much research has been done and more is in progress, we have a long way to go. A key strategy – yet to be initiated – would be to take regular surveys of paranoia levels among the general public. As these sorts of systematic data become available, we'll know for sure whether our fears really have got the better of us and whether – as currently seems likely – the 21st century is truly a new age of paranoia.

Daniel Freeman is a Wellcome Trust Fellow at the Department of Psychology, Institute of Psychiatry, King's College [email protected]

Jason Freeman is a writer and editor

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