How Serious Is Paranoia? Am I Crazy? Do I Need Meds?

I'm paranoid. Does this mean I'm mentally ill? I'm 33 and this started about three years ago. I started seeing shapes in shadows and people following me. It took me like a year to know that real people might not be following me after I talked to multiple friends about it. They all said I was paranoid and wrong. But I still see them following me and sometimes they are listening. My family says I am safe and I believe them, but then I don't know always and I'm scared I'm crazy. Am I mental? Do I need meds? —Scared
Dear Scared,

Having paranoid thoughts does not mean you are crazy. Some people have these thoughts as a result of feeling anxious or stressed. So you have company; other people have feelings like these too. Nevertheless, paranoid feelings are tough to live with and there are ways to help.

First off, you have support from your community. You are lucky that people are standing behind you. I see from your letter that your friends are trying to be helpful and reassuring, and that your family tells you that you are safe. Even though you believe them on the one hand, on the other hand you’re not always sure that they should be believed and you’re still scared. Your folks are telling you that “everything is OK,” but that doesn’t necessarily make it so. People want to make things OK for their loved ones, but reassurance often doesn’t work. It’s like someone is telling you there are no monsters, when they don’t believe in monsters but you do and you know better than they do. What they have to say may not be entirely credible to you, just as you are not entirely credible to them. You might let them know that you are grateful that they want to help, but that telling you everything is OK actually doesn’t work that well. If they truly want to help, they can start by believing that you are having upsetting experiences and that things are not at all OK, as far as you’re concerned. The top way for them to help would be to encourage you to get medical advice, perhaps by accompanying you to the doctor.

The best course of action is for you to get checked out by a medical doctor who will give you a thorough physical examination to determine if, for example, you have high blood pressure, which can cause many different types of unpleasant thoughts and feelings, as can various types of seizure disorders. Certain substances and recreational drugs can also cause feelings of intense fear and suspicion, so if you do use marijuana, hash, meth, LSD, cocaine, alcohol to excess, etc., be aware that this is a possible side effect of drug use and tell your doctor.

You write that these experiences first began about three years ago, and I wonder if you associate this time to any other events in your life. This is a question that your doctor should ask you. You should be completely open and frank in all your responses to help find out what is going on.

Perhaps your doctor will refer you to someone who specializes in understanding experiences such as yours; that person might determine if you in fact are having paranoid thoughts, and what you might do next. A psychiatrist, if you decide to see one, might prescribe a medication that will help control your anxiety, and/or you might be referred to a psychologist or mental health counselor who will engage in talk therapy with you. The therapist will try to understand the meanings of your experiences.

Often people are frightened of seeing a practitioner who specializes in these kinds of issues, perhaps because of feelings of shame or because they don’t really know what happens in a psychiatrist’s or psychologist’s office. Some folks are afraid that if they are prescribed medication, the medicine will somehow make them different in a way that they don’t want, as though the medicine will take them over, as they also fear the doctor might. People are afraid of losing control, or a sense of themselves.

There is a lot of prejudice and misinformation about emotional issues—we tend to see things as though we are living in a movie, maybe a scary one, but not trying to find out what is going on with oneself is much scarier. Please see a doctor and let me know what happens.

Here are some things people sometimes fear about psychiatry:

1. They will think I am “crazy” and lock me up.
2. They will give me medicine that will make me a zombie.
3. They will take control of my life.
4. People will find out and look down on me.
5. It will affect my work life.
6. It will affect my love life.
7. Movies and video games make this whole subject really scary.

People are scared because they don’t know what actually happens in a doctor’s office. In fact, first you will see your regular doctor who will give you a thorough physical checkup. If the doctor decides it is warranted, you will be referred to a psychiatrist or psychologist or mental health worker. The psychiatrist might prescribe medication. The psychologist or mental health worker will talk with you, and then, working together with you, try to find out the meanings behind your fears and what to do about them.

Thanks for writing. I wish you success!

All my best,
Lynn