The question My friend has been unwell for a year. She is convinced her neighbours are trying to damage her property and trying to get all the locals against her. She installed CCTV cameras, then became agoraphobic and, although she managed to go back to work, she remains suspicious of everyone. She is stuck with her anger about her neighbours ruining her life and not wanting to give up her house although she has never been happy there.

I am not sure how to help her any more. I thought that I did not want to challenge her beliefs as she felt alienated enough, but part of me wants to say that I do not think that the neighbours would bother to follow her everywhere, convince hundreds of people to monitor her moves, tap her mobile or persuade people at work to cough at her “to make her think she is mad”.

My approach was to say the neighbours are not nice (they have never been) and she needs to find a place where she feels safe and to sort out her mental health as it has been affected by the bad relationship with her neighbours, a divorce and lockdown.

I would appreciate your advice. I know she is poorly and needs support, but I am not sure how to help her.

Philippa’s answer I cannot save you from anxiety about your friend, but let me see what I can do – although I should warn you it will be woefully inadequate – which is what I fear you will have to be, too. Accepting our own limits and uselessness is a necessary lesson sometimes. You appear sensitive and sensible and sound like a great asset to her. I guess that being on her own and feeling that she is surrounded by hostility has pushed her into paranoid delusions.

Why do we humans have a propensity to tip over into this state? I speculate it is because even though believing that everyone is out to get us feels scary, it is more comfortable – more survivable – than believing that we are invisible and count for nothing in everybody’s mind. Because, if no one knows whether we are breathing or not, we might as well cease to exist and, for many of us, this is terrifying. Therefore, convincing yourself that they are all out to get you becomes a handy defence mechanism.

What I’m saying is that paranoid delusions are often, in my humble and flexible opinion, an unconscious reflex to defend against not mattering to anyone, which makes us feel very unsafe. Having delusions means that her fear finds an outlet that she can cope with, whatever her original fear is – probably that of not mattering to anyone – she doesn’t have to face it if her mind comes up with a delusion instead, and her delusion (that she matters so much that the whole world is conspiring against her) would be easier for her to live with than total insignificance. Phobias are a similar phenomenon, only in the case of a phobia we know we are being irrational.

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When you are phobic about something, you know you are being neurotic, but with paranoid delusions you are in a more serious psychotic state. Both conditions make you less able to connect with others, but a psychosis makes you difficult to reach as well, because your subjective experience differs so wildly from everyone else’s.

This lack of connection matters because the people around us are like mirrors in which we see ourselves. How people respond to us works as a sort of system of checks and balances for our mental health.

The long lockdowns have played havoc with our minds. When every person is a probable source of infection and death we grow wary, especially of strangers. The pandemic made everyone a bit neurotic. Cognitively, we might know we would be missed if we disappeared, but our bodily experience of being isolated can trigger a fear state and then the brain comes up with narratives to make sense of it. In your friend’s case, her neighbours were experienced as hostile and they were probably the only people she saw. She is sensitive. You cannot be scolded out of sensitivity.

You are doing the right thing by understanding, listening, being available. Having calm people around her will be the best thing. At the moment, you are not challenging her, but not colluding either, so you are actually doing great. You sound as though you are being sensitive and your intuition of what she can take by way of challenge is probably good. If you could persuade her to see a psychiatrist that would be ideal, but couch it in terms of getting a professional person on her side, rather than telling her she’s mad. I don’t like thinking of people as mad, I prefer human, because if we had her constitution and environment and experiences, we would all be liable to fall into the same hole. Seeing a professional is desirable as she may be at risk of suicide.

I hope if I ever fall down the hole she has fallen down, I have someone like you in my life. Short answer: you are doing great.

If you have been affected by any of these issues, contact the Samaritans on 116 123

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