The Interpersonal Perspective

The interpersonal perspective is concerned with how human beings interact and how these interactions support, invalidate, and elaborate the self-image. Sullivan is considered the father of this approach, reacting against the classical psychoanalysis of Freud, whereby pathology was always a property of the person. Instead, Sullivan saw psychopathology as emerging from an individual's relationships and patterns of communication.

According to Sullivan (1956, p. 145), there are two requirements for the development of a paranoid "slant" on life. The first is an intense insecurity related to some kind of inferiority, whether real or perceived. So intense is this insecurity that it constantly intrudes on awareness, producing considerable anxiety. Because future paranoids believe that the inferiority is easily observed by others and cannot be disguised, it becomes a deficiency in the self that is beyond repair, producing chronic feelings of insecurity, shame, and humiliation, felt most acutely in the presence of others.

The second requirement is a transfer of blame, away from themselves and onto others, whereby, "It is not that I have something wrong with me, but that he does something to me" (Sullivan, 1956, p. 146). All of us, according to Sullivan, have at some point been unfairly blamed by significant others and left with a lingering bad feeling, only to conclude, "I wouldn't have this sense of discomfort if other people didn't treat me unfairly" (p. 147). Faced with chronic feelings of insecurity, the paranoid apparently takes the additional step and concludes that humiliation is not the by-product of social relationships, but their purpose. Thus released from psychosexual bondage, early abuse and intense feelings of inferiority or insecurity, whatever their origin, can be seen as an essential part of the development of the paranoid personality. Sullivan's explanation accounts for how someone as brilliant as Stephen, who is not an abuse victim, nevertheless develops a paranoid personality disorder despite his objective gifts.

The old saying that all relationships are based on trust is trite but true. We trust our friends and parents to be well intentioned, to have our best interests at heart. We trust that our significant others will be loyal and faithful. We trust that teachers will present the issues in an interesting and illuminating way, though we know that this is often wishful thinking. Whatever the relationship, the foundation is a mutual respect for each other as human beings, an I-thou relationship. Paranoids respect others, but only in terms of their potential for harm, as invaders or infidels. Only the strong survive. Everyone is best regarded as a treacherous psychopath, ready to cheat and deceive with sadistic joy. Others can only be trusted to pretend to be trustworthy. When the drawbridge is lowered, the enemy will march in nonchalantly, seize the element of surprise, and wreak havoc. Attack could come from any direction, at any time. This is the ultimate implication of Sullivan's (1956): "He does something to me."

By reacting as if everyone were the enemy, paranoids seek to secure their safety and autonomy and protect themselves against outside influence. To make the world safe for themselves, paranoids develop interpersonal characteristics designed to forestall attack, secure protection, and establish formal channels for relating to others but also prevent attachment and dependence, noxious signs of weakness. Autonomy, rationality, and control form the keystones of their strategy, with many manifestations both subtle and gross. Paranoid delusions, in particular, may be seen as rationality run amok, reconstructions of social reality famous for their internal consistency, a hallmark of a good scientific theory but infamous for being completely wrong, as we will see in the cognitive section, next.

Autonomy is so important that paranoids sometimes imagine themselves as being, ideally, something like a fascist state: totally self-sufficient, yet fearsome enough to intimidate aggressors on their borders. No person is an island, but paranoids nevertheless require total control over what happens in their own life. Marcus provides the arch example of this, ruling his classroom with an iron fist and keeping careful records of all his activities as an educator. No one is going to surprise Marcus with something unanticipated. Toward the normal range, paranoids may flourish in relatively isolated venues where they make the rules and call the shots and control whom they interact with and who interacts with them. By making social contacts from the safety of their own turf, they control who enters their world and to what extent, choose the fronts on which they are willing to risk vulnerability, and moderate their degree of exposure. Many small business owners, for example, succeed because paranoid traits are adaptive in such settings. Paranoid styles can function competently on their own, then, but need to do so from great interpersonal distance and on their own terms.

When thrust into social settings, paranoids become acutely aware of issues of social rank and status. Weakness is despised as inconsistent with a self-image of strength and invulnerability. At times, they may harp on the faults of others as a means of projecting dissatisfaction with their own shortcomings. Preoccupied with their own insecurities, they are notoriously sensitive to perceived slights, which indicate that others are on the attack, expect them to submit to external control, or consider them inferior. Like compulsives, they tend to have little or no sense of humor, perhaps because levity might be an invitation to let down their guard. Moreover, a precariously low self-esteem makes it impossible for paranoids to laugh at themselves. Ambiguous communications may be interpreted as veiled insults, proof positive that others wish to attack them. By responding angrily with their own insults and threats, paranoids establish a reputation for being abrasive, contentious, and "dug-in."

Although paranoids function best on their own, they do sometimes surround themselves with those considered tirelessly loyal. Such trustworthy souls function as the eyes and ears of the paranoid. As the interpersonal parallel of a buffer state, loyal persons function to insulate paranoids from the anxiety associated with interaction with the surrounding world, which tends to increase their reality distortions and systematized delusional content. Nevertheless, paranoids usually believe that loyalty is extremely fragile. When the moment of truth arrives, they expect their associates to break ranks, leaving them alone and defenseless. Ron, for example, eventually trusts the interviewer enough to share some of his issues, only to have that trust collapse quickly later in the same session. Paranoids believe that loyalty is nonexistent or easily bought and sold. Interpersonal relationships are thus infected with ambivalence; paranoids want to trust but are deeply fearful of harm or betrayal.

As their fearfulness grows, paranoids feel the need to control those around them. They must know the whereabouts of others at all times and know what they are working on and why. In effect, paranoids seek the security of omniscience by monitoring the activities of their associates or family members, sometimes almost to the point of obsessive checking. In this way, the all-seeing eye keeps suspiciousness under rein. Because everything is known, there is nothing to fear. At the same time, however, paranoids impress others as being intensely private, volunteering almost nothing about their emotional life or their activities beyond what business immediately requires. No one should know the paranoid's business, but he or she must know everyone else's. By putting others on a need-to-know basis, paranoids protect themselves against the plots of others. Knowledge is power, and there is no reason to give that power away. Loyalty to paranoids thus means submitting to their need to control while making others' own life an open book.

As the severity of the disorder increases, the need for control gives way to an active, searching suspicion. When others resist the subject's all-seeing eye by walling off, the paranoid assumes they have something to hide. As a result, the need to know and control becomes more intense. The scrutiny of others grows more as paranoids seek to reassure themselves that no threat exists. False accusations may sometimes be used deliberately to test the loyalty of confidants, a necessary evil designed to provoke others so they can judge others' reactions.

Exasperated by constant observation and mistrust, otherwise friendly souls may break off their relationship with the subject without explanation. The inner circle of trusted confidants naturally becomes smaller and smaller as tired and frustrated friends end their relationships. Former associates may be seen as having defected to the enemy camp, carrying with them secret information that might be used to develop even more nefarious plans. Some individuals become obsessed that a mole lurks somewhere in their midst, taking mental notes on their activities and passing information back to an unseen coalition. Paralyzed with fear, paranoids in positions of power may launch witch-hunts that divide and demoralize their own organization, as has sometimes happened in spy agencies. By this point, submission and openness are no longer enough to allay their fears. Events that fail to confirm their suspicions only prove how deceitful others can be.

As their relationships become increasingly strained, they also become more affectively intense. Rationality gives way to increasingly distorted reconstructions of social reality. By projecting the negative aspects of themselves onto others, paranoids are confronted by the very things that they find intolerable. What the public sees is a crazy person who seems certain that he or she is being persecuted and who seems bent on exposing conspiracies that do not exist or exacting vengeance for evil deeds never committed. Anger, resentment, and hostility invade these paranoids' communications. Becoming even more hypersensitive, they may feel unforgivably wronged by casual acquaintances who have no role in their life beyond delivering the morning newspaper, for example. Such sensitivities create numerous long-standing grudges. They may assert that others have exploited them, taken credit for their ideas, stolen promotions, or undermined their reputation, as the case of Stephen shows. Ostensibly pleasant social engagements are particularly suspect, a diversion intended to lull the paranoid into a false sense of security.

Another important barrier to normal interpersonal relationships is the paranoid's attitude toward feelings of attachment and dependence. Paranoids defend their autonomy not only against hidden threats but also against tender emotions, which signal vulnerability.

In effect, control of others becomes a substitution for attachment. In the personality style range, paranoids are fiercely loyal to those who are certain to be loyal to them. At the level of disorder, however, tender emotions are associated with weakness; intimacy is threatening. This could be a factor for Ron, who chronically doubts both his wife and his best friend. A skeptical and stubborn person thus gives way to someone who is irascible, cynical, and, possibly, dangerous.

When feelings of attraction are projected, paranoids begin to believe that others are deliberately creating in them a desire for closeness or dependency. In response, they keep their distance. By hardening themselves against a need for love, they purge themselves of susceptibility to deceit or subjugation. Spouses may report that the paranoid is cold and rational, reluctant to share emotions, intolerant of intimacy, secretive without good reason, overcontrolling, insecure, mistrustful of family and close friends, hypersensitive to criticism, unwilling to negotiate conflicts, prone to develop grudges that are held for years, quick to make harsh judgments, convinced that others are working against him or her, and incredibly jealous. Suspicions that sexual partners have been unfaithful are an important diagnostic criterion.

The interpersonal development of the paranoid personality has been described in detail by Benjamin (1996) using her SASB model. First, future paranoids tend to have parents who are "sadistic, degrading, and controlling" (p. 314). Although loyalty to the family is expected, harsh punishment is delivered with a cold, serious attitude and the implicit message that the child is so inherently bad or evil that cruelty is justified. Future paranoids, she states, thus learn to expect attack and abuse and come to identify with abusive caretakers. Second, the parents of future paranoids expect autonomy and punish emotional dependency. If the child gets into a fight, the parents' response may be, "What did you do to set it off?" (p. 315). Alternatively, tears might be greeted with contempt or with threats of further discipline. The result is a mistrustful, isolated adult who fights back neediness, detests dependency, and never asks for help.

Benjamin (1996) further states that future paranoids were often scapegoated and compared unfavorably with other family members, basically continuing the earlier notion that the child is fundamentally bad and, therefore, deserves punishment. The child was accused, not of stupidity or laziness, but of being arrogant, hostile, stubborn, or excessively dominant or independent. Parents might adopt an obvious double standard, preferring certain children while blaming, disciplining, and holding grudges against the paranoid for events that were clearly beyond his or her control. To humiliate the child, the parents might discuss him or her with others in a negative light, even with the child present. The result is an adult highly sensitive to issues of power and status while being overly concerned with whether rewards and punishments have been meted out equally.

Finally, according to Benjamin (1996), future paranoids were rewarded for competence in some area that the caretakers approved, particularly a parenting role. Because high performance was expected, the accomplishments or contributions of the subject were not much appreciated, contributing to increasing levels of resentment over the years. The result is an adult who functions well when left on his or her own but creates and exacerbates conflict through demands for acknowledgment of his or her contributions.

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