This essay is a review of David Bell's 'Paranoia' (Cambridge: Icon Books, 2003).

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BOOK REVIEW
David Bell (2003). Paranoia, Ideas in Psychoanalysis Series (Cambridge: Icon Books),
pp. 78, ISBN 1-84046-377-5
INTRODUCTION
This book explains the basic issues in studying paranoia as a clinical entity. It then
applies the ensuing insights to make sense of the socio-cultural implications of
paranoia through literary representations.
The attempt to connect the clinical with the cultural is not without import since
David Bell is affiliated to the British Psychoanalytic Society and the Tavistock Clinic
at London and is one of Britain’s best-known psychoanalysts.
In this brief introduction to the problem of paranoia, Bell argues that we must
differentiate between dangers within and dangers without. The human subject
cannot flee from dangers within since it emerges in the form of anxiety.
Since the subject cannot flee from himself, the only way to manage this anxiety is by
seeking recourse to the mechanism of projection. Using this mechanism, an internal
danger is projected onto the external world making it thereby easier for the subject to
manage himself. Projection, needless to say, is the main defensive mechanism in
paranoia.
It is through the study of paranoid patients that Sigmund Freud arrived at his
formulations on projection before his observations on this and other defense

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mechanisms were taken by up his daughter Anna Freud in her own work on ‘the
ego and its mechanisms of defense.’
The main difference between the occasional use of projection as one among a
number of defense mechanisms and paranoia is this:
In paranoia, projection is the main psychic defense. Bell uses the term ‘paranoia’ to
encompass both paranoid anxiety and paranoid ideation.
The former is more commonplace; the latter emerges often as a rationalization of the
former. Bell underlines Freud’s celebrated comment on the relationship between
psychopathology and culture where hysteria was understood to be a caricature of
art, obsessional neurosis comparable to a private religion, and paranoia to an
imitation of a philosophical system.
FREUD & KLEIN ON PARANOIA
Bell explains the structure of paranoia by invoking both Sigmund Freud and Melanie
Klein. The Freudian theory of paranoia is to be found in his case study of Dr. Paul
Schreber; this case study is based on Freud’s reading of Schreber’s book in 1903 since
the latter was not actually his patient.
Freud diagnosed Schreber as suffering from a full-blown psychosis accompanied by
paranoid anxiety, hypochondria, and delusions of persecution. Schreber also
suffered from the fantasy that he was going to be impregnated by God following his
conversion into a woman and that the offspring of such a union would be given the
task of saving the world.

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Delusions such as these are common in paranoia, but they are not synonymous with
the disease. The delusions represent the patient’s attempts to cure himself and
recover the connection that he has lost with the external world. What is particularly
of interest in Freud’s reading of Schreber’s memoirs is the fact that it offers a
transformational grammar of paranoia.
As Bell points out, Freud is working on the transformations of a single proposition: ‘I
(a man) love him (a man).’ The subject, verb, and object of the sentence are all
transformed to generate the paranoid structure in question. The verbal
transformation is from the idea of love to hate. The object is transformed from male
to female. And, finally, the subject is transformed from ‘I’ to ‘she.’
Bell argues that this transformation has stood the test of time though Freud might
have overplayed the fear of homosexuality in paranoid structure. The reader will
note that homosexuality has much more acceptance now than before. So it is worth
asking whether the homosexual element was a contingent or a necessary feature in
Freud’s theory of paranoia.
In addition to Sigmund Freud, Bell invokes the work of Melanie Klein as well in his
exposition of paranoid states.
The splitting of reality into good and bad that is characteristic of paranoid ideation is
also a mechanism that Melanie Klein locates in children when they attempt to handle
a primary object.

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Children typically split the mother into good and bad parts. The good part is that
which looks after the child’s needs while the bad part is that which doesn’t rise to
the occasion.
The essential twist to the process of splitting in Klein is not the fact that the child
perceives the mother as absent or missing, but the fear that he experiences that the
mother could be malignant.
A child’s world-view is itself an extension of this default program and analogously
split into good and bad. This is known as the paranoid-schizoid position ‘because
the world is colored by projective mechanisms and schizoid because it is dominated
by splitting processes.’
The cultural significance of this process is obvious. It has analogues in literature,
philosophy, and religion, and transcends the imperatives of any particular culture. If
it takes on an excessive form however it can lead to historical aberrations like
fascism or racism.
It must be pointed out however that the problem of paranoia in individuals or
cultures can be quite tricky to determine as the following piece of oft-cited wit
demonstrates: ‘Just because I am paranoid doesn’t mean that you are not trying to
get me!’
An aspect of paranoia that Bell does not address in this book is that which is at work
in the context of globalization, hyper-competition, the pressures of having to live as
a global village, stress induced by information over-load, and the ubiquity of
communications and communication technology in everyday life.
The Age of Anxiety, in other words, is increasingly giving way to the Age of
Paranoia. So it may well be the case that the analyst has a lot more to worry if the
patient did not exhibit any symptoms of paranoia than if he did.
Bell is also correct to point out the prevalence of urban paranoia as a common
manifestation of normal forms of paranoia.

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The demand for security in urban communities seems to be endless and no number
of precautions is able to reduce the paranoia in question since the occupants of these
urban communities are trapped in ‘a vicious circle of omnipotence and projection’
from which they cannot extricate themselves.
SOURCES OF PARANOIA
The main source for such forms of paranoia is the excessive severity of the superego.
Though the superego as a psychic mechanism is internalized by identifying with the
parents, it may well be the case that the real parents do not embody the primal
excess that it represents. The severity of the superego then can only be understood in
terms of the projection-introjection process in the child who locates his archaic fears
elsewhere and then refinds them in himself.
Bell introduces two resonant examples from the work of Franz Kafka.
The first is from The Trial (1915) where Herr K, the protagonist, has to continually
placate the inhuman representation of the Law for reasons that are not clear.
The second example is In the Penal Colony (1919) where the Law is embodied in a
harrowing machine that writes quite literally the crime committed on the body of the
accused. The jouissance of this mad encounter swallows up even its own keeper
since the sanctity of the machine must be maintained at all costs in a paranoid
universe.
Literary representations then, as Sigmund Freud was amongst the earliest to
discover, can be an invaluable source of insights on the structure, formations, and
symptoms of paranoia. Bell is only following in this tradition by invoking these

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examples from Franz Kafka, but he also identifies other sources of paranoia such as
‘defense against the awareness of vulnerability,’ difficult aspects of reality itself, and
‘depressive pain.’
CONCLUSION
Bell concludes his analysis of paranoia by examining its relevance for society and
politics given the increased concern with security in recent years.
Bell’s conclusion is that while we must find ways of maintaining our security needs,
we must be careful not to over-react and find ourselves in a paranoid universe
where no reasonable measures are able to increase our sense of well-being in the
world because we have forgotten the analytic difference between dangers that arise
from within and those that arise from without.
This is exactly the kind of book that will get even those with little or even no
exposure to the clinic interested in psychoanalysis because it will help them to make
sense of their own reactions and responses to the paranoia of everyday life in the
language of the psychoanalytic symptom.
I couldn’t recommend it more highly for those who would like to get a handle on the
psychoanalysis of society and culture that is based on what were originally clinical
insights.
SHIVA KUMAR SRINIVASAN