As anyone who has ever been lucky enough to spend time in a psychiatric hospital knows, you don’t have to be completely mad to be there. A lot of us end up in the care of mental health professionals and jacked up on all sorts of crazy-person meds because something’s just not right: you know it, I know it, the dog in the street knows it. Those people are looking at us funny; those voices just won’t quieten down; it really isn’t safe out on the streets, so it must be better to draw the curtains, triple-lock the door and sit quietly in the dark eating only tinned fruit and bottled water. The old mental weather can get pretty stormy sometimes, even for the most resilient among us, but the thunder and lightning will usually pass, and for the time being at least we’ll be able to function normally again.

Daniel Freeman, God bless him, a professor of clinical psychology at Oxford, has devoted his life to the research and treatment of paranoia and persecutory delusions, which he defines as ‘an excessive mistrust of others in relation to the self’. The man’s a saint, frankly, for putting up with people like you and me, people who are convinced that all those other damn evil people are not at all to be trusted, including people like Daniel Freeman – because what does he know?

It turns out that he knows rather a lot. A professorial fellow at Magdalen College, Oxford, he is a consultant clinical psychologist, a recipient of the British Psychological Society Presidents’ Award for distinguished contributions to psychological knowledge, the author of almost a dozen books and hundreds of journal articles, and a co-founder of the Feeling Safe Programme, a cognitive-behavioural treatment for patients with psychosis, which is proven to be the most effective psychological treatment for persecutory delusions.

The old mental weather can get pretty stormy sometimes, even for the most resilient of us

Freeman estimates that between 1 and 3 per cent of the population experience severe paranoia, that another 5 to 6 per cent have occasional distressing delusions, and that an additional 10 to 15 per cent suffer from ‘regular, albeit milder, paranoid thoughts’. Last year he and his team conducted a survey of 10,000 UK adults in which he found that no less than 40 per cent reported feeling more fearful of others than they felt they should be. So, convinced that your work colleagues are plotting and scheming against you? Equally convinced that you’re slowly being poisoned, brainwashed and bamboozled? Or just utterly convinced that everything you read in the mainstream media is a deliberate attempt to throw you off the scent that will eventually lead – if you just keep popping the old red pills and listen carefully to the never-ending dog whistles and the ravings of all those radical channels that you’ve found on YouTube and on Twitter – to the Big Truth? You are not alone.

Paranoia reads rather like early Oliver Sacks, which is to say the Sacks of Migraine (1970) and Awakenings (1973), before the more literary flourishes and confabulations of his later years. Freeman does a lot of citing of his own case studies and surveys, which are fascinating; offers a little bit of the history of the treatment of certain kinds of mental illness, which is shocking; and reveals how and why the Covid-19 pandemic has proved to be absolutely devastating to our sense of trust, which is highly disturbing. He describes the ‘corrosive’ effects of mistrust on individuals and society, and establishes a number of connections between trauma, anxiety, PTSD, paranoia and delusions. In addition, and as a bonus, we also get some nice glimpses of the author as a young research assistant, working at the Institute of Psychiatry and being sent out into the community to work with people diagnosed with schizophrenia. ‘In schizophrenia, I was taught, we are beyond the pale of rationality – we’re in the badlands of mental illness.’

It was out in the badlands of south London, and in the traditional NHS portakabin waiting rooms at the Maudsley Hospital, that Freeman began to question the treatments being dished out to people suffering from delusions – basically, dose ’em up, shut ’em up and then just ignore them and hope they go away. Inspired by the example of Aaron Beck – a psychotherapist so brilliant and influential that it seems incredible that no biopic has yet been made about his life and work, starring, say, Timothée Chalamet, because, why not? – Freeman went on to pioneer a therapeutic and behavioural approach to the problem of paranoia.

Hippocrates coined the term (para, beside, + nous, mind, thus, literally, out of one’s mind) to describe ‘the delirium sometimes caused by a very high temperature’, but it wasn’t until the 19th century that paranoia was popularised, as it were, by the psychiatrists Johann Heinroth and Eugen Bleuler to denote ‘irrational, illogical, unfounded thoughts’. Freud and his followers, of course, interpreted paranoia in a highly Freudian fashion. Investigating ‘a number of cases of paranoid disorder’, Freud claimed that he was ‘astonished’ – shocked, madame! – to find that ‘in all of these cases a defence against a homosexual wish was clearly recognisable at the very centre of the conflict which underlay the disease’. Not as astonished as the rest of us, alas.

Freeman’s position, clearly highly influenced by the work of Beck, is that

paranoia isn’t a defence against repressed homosexual desire or subconscious low self-esteem. On the contrary, it is rooted in, and fuelled by, a sense of personal vulnerability. And this vulnerability isn’t hidden away in the depths of the unconscious. To find it, we just have to listen to what our patients tell us.

This simple insight leads to a number of pretty obvious conclusions but a radical approach to treatment. For Freeman, paranoia is a ‘marker on a continuum of experience’, with feelings of extreme mistrust ‘no different to happiness, sadness, worry, self-confidence or fearfulness’, and a useful reminder that ‘there is no hard and fast dividing line between mental health and mental illness’. If you’ve ever suffered from any kind of mental illness you’ll know instinctively that that’s about right. If you haven’t suffered from any mental illness for a while, you’ll perhaps be surprised at some of the solutions currently being offered, including Freeman’s use of virtual reality (VR). Basically, Freeman and his team have developed a range of VR experiences to expose people to – and help them manage – situations that might otherwise cause them anxiety.

Although never making it explicit (if you really want explicit, see some of Freeman’s other books, including You Can Be Happy, 2012, and Know Your Mind, 2009) there are quietly lurking within Paranoia all sorts of useful recommendations for anyone suffering from paranoia. This includes: get some sleep; don’t become isolated from others; don’t be so hard on yourself; try not to jump to conclusions about everyone and everything; allow yourself no more than about half an hour of concentrated worrying per day; avoid high THC cannabis at all costs; for goodness sake, encourage your children to get outside and meet people, in order to learn to manage risk independently; and, if you’re a politician, do your best to reduce social disadvantage, since poverty, ill health and discrimination are what enable mistrust to thrive. Also, whatever you do, don’t try to drill a hole in your head to let the crazy voices out: that’s what The Spectator’s for.