71
ILLNESS AND INTERACTION:
A CASE OF PARANOIA
Atwood D. Gaines
Department of Anthropology
San Francisco State University
San Francisco, California
Social interaction is a reflexive, interpretive, and adjustive pro-
cess (Mead 1964; Schultz 1967).   Social interactionists view the matrix
of social life as grounded in everyday social interactional processes,
in the meanings brought to, exchanged and derived from social inter-
course (Blumer 1969). Interaction, whether among the unacquainted or
the acquainted, is viewed as patterned by interactionists. The patterning
of interpersonal behavior is seen as deriving from a learned and shared
set of implicit assumptions which form the basis for a grammar of social
behavior.
As a grammar of a language constitutes a set of rules governing its
use, so each culture has assumptions about self, humankind, and society
from which social interactional rules are generated. The assumptions of
the social games (Bailey 1971) must be learned and employed if one is
to participate in social life as a community member in good standing.
Studies of social interaction have traditionally been concerned with
the analysis of regularities in social interaction as they occur in
various societies (Goffman 1959; Bailey 1971). Some studies have con-
cerned violations of such interactional norms. Some of Garfinkel's
studies (1967) exemplify this approach. Further, Garfinkel (1967)
suggests that the assumed interactions of everyday life are actually
creative accomplishments, since the success of these interactions is
actually problematic, requiring artful negotiation in the accomplishment
of seemingly mundane engagements.
The subject of this paper is the social interaction of a person ex-
periencing an acute paranoid episode. In interactional encounters, the
subject continually violated an overarching definition of the situation,
that of negotiation, held by other actors. That is, the subject had de-
fined all face engagements as opportunities for the discovery of the
nature of, and the characters involved in, a plot against him. Thus,
while normal interaction is a reflexive, interpretive and adjustive
process, our subject failed on all counts. He could not empathize with
other's position in interaction, nor could he interpret in an acceptable
manner the symbolic meanings presented in interactions. As well, Donald
(the subject of this paper) did not adjust himself to the presentation
of gestures of others. Donald approached each interaction with a pre-
defined stance, took no notice of the managed stances of others, nor of
their situation when he accused them of misconduct. He failed to adjust
himself to new situations and interactants for, in his eyes, the situa-
tions and the actors were all the same.
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Thus, he violated an overarching assumption of interactants, that
each encounter and its meanings, and those which derive from such en-
gagements, are all negotiable features of the social process. Donald
failed to allow others to negotiate with him the definition of situa-
tions or the nature of the social selves they presented. This process
of negotiation,and the assumed negotiable character of specific situa-
tions allows for the artful accomplishments which are interactional en-
counters.
I first take up the problem of entree and how I gained rapport with
the subject of this paper, Then I consider some of the problems involved
in the study. This is followed by a general delineation of the char-
acteristics of persecutory paranoia relevant to the study of social in-
teraction. The remainder of the paper considers the social interaction
of the subject in private and public places and in unfocused and focused
interactional encounters from a dramaturgical perspective.
ENTREE
The subject, referred to as Donald, is a former teacher in his
early fifties. Donald believed the author to be endangered, as he was,
by a persecuting community of malevolent plotters. This group of persons
is called a pseudocommunity by clinicians and "is a reconstruction of
reality. It organizes the observed and the inferred behavior of real
and imagined persons into a conspiracy, with the patient as its focus"
(Cameron 1963:486).
The author could be trusted more because he too was an object of
the plotters than because of our very long friendship. It is probably
true, however, that this friendship gave rise to Donald's belief that
both of us were endangered. I was Donald's teammate, and as a team member,
I was allowed to observe the back as well as the front region behavior
of Donald. That is, I was privy to the construction of new assumptions
in private spheres which Donald used in his public behavior.
PROBLEMS OF THE STUDY
As Donald's trusted team member, I was expected to perform in con-
cert with him. But because I was aware that my team member's perceptions
of reality were problematic, I often had to "communicate out of character."
In other words, I was forced to assist the other teams, tacitly and tact-
fully to allow them to maintain the impression or impressions they were
attempting to foster in a given social situation (Goffman 1959:167).
I often had to counter my teammate's impressions by entering into collu-
sion with the other team or audience in order that they might save their
own show. Such behavior mitigated against the aggressive reactions of
others and allowed them to be less defensive. This was important be-
cause defensive maneuvers were quickly perceived by Donald and interpreted
as a defense against the penetration of a veil of silence enclosing the
pseudocommunity's team secrets. It is also important to note that de-
fenses often take the form of aggressive behavior, precisely the kind of
73
behavior which Donald was anticipating. Such occasions became focal
points for the expression of Donald's own aggression which he brought
to each interactional encounter.
In Coffman's terms, I was sometimes an informer. "The informer is
someone who pretends to the performers to be a member of their team,, is
allowed to come backstage and to acquire destructive information, and
then openly or secretly sells out the show to the audience" (Goffman
1959:145). The sellouts were not, of course, attempts to harm Donald,
but rather they were attempts to minimize interactional conflict and
dissonance.
"Whenever an audience exercises tact, the possibility will arise
that the performer will learn that they are being tactfully protected"
Goffman 1959:233).   When this occurred, Donald immediately concluded
that the audience members were trying to "fool" him, i.e., act as though
they did not know of, or were not part of, the plot.
Further problems also developed due to my own failings. Emotional
control would sometimes prevail over cognitive control. Because of the
emotional tone of Donald's interaction, I had to maintain, or at least
try to maintain, an imperturbable face with which to counter Donald's
emotional state. Cameron provides a rationale for use of a presentation-
al face.
An ability to tolerate suspense and shift
perspectives is the product of mature ego-superego
development. In an emotional crisis, this ability
may be lost even by maturely organized adults.
When such a loss occurs, a person's only salvation
lies in his being still able to share his fears and
suspicions with somebody who is less emotionally
involved and can be trusted. The shocked or
frightened adult can then treat a trusted confidant
as his temporary substitute ego-superego, making
use of his confidant's reality-testing, social skills
and detached perspectives. Through some such maneuver,
he experiences the enormous comfort of sharing his
anxiety with someone who is concerned but does not
get upset. He gains the advantage of seeing things
from cooler, more objective points of view [Cameron
1963:477].
My efforts sometimes failed, but apparently I was generally able to main-
tain the proper face (Goffman 1967:5), since I was never rejected or
classed with the conspirators.
There is a very fine line between detachment and understanding of
the paranoiac's conceptual systematization of the world. I could not
behave in a manner which reinforced Donald's belief system, nor could I
express my disbelief in a threatening or aggressive way. In the first
instance, a shared perception of events, actions and behavior serves to
74
reinforce the paranoid's belief system, one of which is already very
resilient, and resistant to change. To help the paranoid, it is neces-
sary to penetrate the projective system. In the second instance, there
is a danger in the fact that either hostility or aggression are perceived
by the paranoid as definitive behavioral characteristics of members of
the pseudocommunity. Attacking Donald's beliefs, then, would mean to
Donald that I was a member of that group. I would then have been unable
to help Donald in my capacity as a trusted co-victim. Donald, if he
had been left alone to cope with reality, would have continued to build,
expand and reinforce his delusional paranoid system. Continual develop-
ment of the delusional system would occur because Donald would not re-
ceive the perhaps dubious benefit of a differing perceptual viewpoint
from a substitute ego-superego, as Cameron's quote explained.
This balancing act was made much more difficult by the fact that
psychotics like Donald are (sometimes) extremely irritating and frus-
trating to deal with.   One expects repeated "corrections" of the psychotic's
interpretations of events to bring about an instant realization of the
falsity of his beliefs and conclusions. Incongruities in conflict with
Donald's delusional system were continually glossed over. Everything said
had to be phrased in a suggestive rather than a contradictory manner for
it was very important to maintain the impression that Donald's percep-
tions were possible and not simply ridiculous. I had to understand and
see the plausibility of an interpretation without agreeing that it was
correct.
In dealing with a paranoid, one must fight, in a real sense, to
maintain one's own mental equilibrium. This struggle can be easily
understood when one realizes that the paranoid's system is not hallucina-
tory or illusory, but rather it is a delusional construction of social
reality. The things a paranoid sees are always very possibly true:
there is always something there, some grain of truth in the paranoid's
interpretation. The difference in belief lies only in interpretation,
and everyone is aware of their own periodic misinterpretation in their
day-to-day interactions. Occasionally, then, I found myself saying,
"Maybe Donald was right about that." In fact, the plausibility of
paranoid thinking makes it easyto be taken in if one is unsuspecting.
Many persecutory paranoids succeed in convincing acquaintances of their
stories of persecution (Cameron 1963:484). It is only when one observes
the individual social phenomenon upon which a paranoid builds his belief
system that one can recognize the problematic nature of his interpretive
system.
Additional problems in this study were the constraints placed on my
own natural behavior. For example, when alone with Donald, it was neces-
sary that I exercise caution in what I did and said. Much non-goal
behavior had to be eliminated. This elimination was to insure that my
behavior was not such that Donald would interpret it as meaning anything
other than that which I had consciously intended. The nature of my im-
pression management derived from the problems associated with rigidity
of interpretation. Conclusions he drew always became facts, not possi-
bilities, not probabilities, but incontrovertible facts.
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A cycle of suspicion,to conclusion,to fact which then became an
operational basis for behavior is exemplified by a conclusion Donald
came to about his doctor. The situation arose after I had spent some
time with him and could suggest he seek help. Before Donald would consent
to a visit to a psychiatrist, he insisted that he see his own doctor
whom he trusted. After we had seen the physician, I happened to remark
"I didn't know he (the doctor) had become completely grey." Donald said
that when he first began to see this doctor, "All of his hair was black.
This was many years ago, of course." Donald then lapsed into a period
of silence, after which Donald said, "I see something here" (a phrase
frequently used by Donald which indicated a new insight). "That wasn't
my doctor. They put someone up to that"' Donald would not see the
doctor again because he had established it as a "fact" that his doctor
was being impersonated by one of the conspirators.
Another problem in the study came from the ironic fact that very
soon Donald's beliefs, like those of other paranoids, came to be true.
Paranoid behavior can be bizarre to a degree which results in the scru-
tiny of the paranoid by others. Thus people do in fact begin to talk
about them because of their suspicious behavior. This required tact to
explain to Donald why he occupied the attention of others without implying
that he was at all peculiar in behavior or appearance. In making such
explanations, I always ran the risk of confirming Donald's suspicions
about others and giving rise to the idea that I, too, was a member of
this dangerous, plotting community.
When such events occurred, I came to doubt my own sense of reality,
i.e., sanity, and conversely the "insanity" of Donald. After all, people
really came to be in collusion (in an interactional sense) against him.
Could I then say he was delusional?
In Laing and Esterson (1964) we find that persons who are labeled
schizophrenic and who are institutionalized are actually more in touch
with the objective reality of their family interactions than were their
other "sane" family relations. As in Laing's case history of Maya
Abbott (Laing and Esterson 1964:31-50), Donald came to doubt his own
sense of mistrust. In Donald's case this mistrust was a sign of recovery;
in Maya's case this mistrust was the main precipitating factor of her
paranoid schizophrenic condition. (I should note here that Donald showed
no schizophrenic symptoms.)
The problems in the study, then, had to do with the difficulty of
continually and politely telling Donald that his perceptions of reality
were problematic while remaining in sympathy with him and his plight.
We will now turn to the pertinent general characteristics of para-
noids, keeping in mind the striking homology found between textbook
paranoids and some of those individuals so labeled.
THE PERSECUTORY PARANOID PSYCHOTIC
"Paranoid reactions are attempts to escape from tension and anxiety
through processes of denial and projection, which result in more or less
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systematized delusions" (Cameron 1963:473). "The types of paranoia are
described according to their content as: megalomaniat persecutory,
erotomania, mania of jealousy, etc." (Freud 1920:366).
One should not, however, be misled by such categories. Megalomania,
as is true with other forms of the condition, is one of many components.
It is not an isolate and may be present with a paranoid state labeled
as persecutory (Freud 1920:367). For example, often paranoids come to
a very logical conclusion (as did Donald) which relates their persecution
by numerous and diverse people to their sense of self-worth. That is,
if the individual is the object of so much interest and concern, he must
be of great importance. The specific label, then, is generally derived
from a dominant theme in the individual's condition which is the princi-
pal but not isolated theme of the clinical picture.
Other aspects of the condition are pertinent here. Paranoid condi-
tions, by their evident utilization of the defense mechanism of denial
and projection (Freud 1966), are attempts to avoid the destructive
effects of previously unconscious impulses and fantasies which intruded
on preconscious and conscious psychodynamic organizations. In positing
a developmental chronology of defense mechanisms, Anna Freud notes that
the "expulsion of ideas or affects from the ego and their relegation to
the outside world would be a relief to the ego only when it had learned
to distinguish itself from that world" (Freud, Anna 1966:51).
The denial of hostility in the self, and its projection into the out-
side world forming the delusional pseudocommunity are actually attempts at
anxiety reduction and self cure. By placing evil and hostility outside
himself, the paranoid is better able to cope with them, for the self is
redefined as purely good and a victim of the hostility of others who are
seen as purely evil.
Because the individual believes himself to be the object of a plot of
mammoth proportions, he is often given to solitary ruminations. In these
instances, the paranoid searches for, and always finds, confirmations of
his beliefs in the actions and words, or lack thereof, of others in past
social encounters.
These perceived confirmations of the malevolent intentions of others
are both real and imagined. But this distinction is not made by the para-
noid* Nor is the distinction made between conscious and unconscious
attitudes and/or action of others.
"It is a striking and generally recognized feature in the behavior
of paranoiacs that they attach the greatest significance to trivial
details in the behavior of others. Details which are usually overlooked
by others they interpret and utilize as the basis of far-reaching con-
clusions" (Freud 1938:162),o "The category of the accidental, requiring
no motivation, which the normal person lots pass as a part of his own
psychic functions and faculty actions, is thus rejected by the paranoiac
in his application to the psychic manifestations of others. All that
he observes in others is full of meaning; all is explainable" (Freud 193B:
163).
77
The paranoid is hypersensitive to the unconscious traces of hostility,
contempt, dislike, indifference or fleeting moods in others.    He then
magnifies their existence and assumes "that what seems clear to (him)
must be equally clear to others. . . . This creates an atmosphere of
misunderstanding, questioning, distrust, uneasiness and resentment.
Such an atmosphere usually follows the actively paranoid person wherever
he goes" (Cameron 1963:478).
The meaning of the attribution of consciousness to the behavior of
other people plays a large part in the disruption of interactions between
the persecutory paranoid and others. Normally such interaction is "a
presentation of gestures and a response to the meaning of those gestures"
(Mead in Blumer 1969:9).   Mead uses gesture in this sense to signify both
the expressive and linguistic aspects of interaction.
"To make inferences on the basis of incomplete evidence, and even
leap to conclusions which may turn out to have been unwarranted, are not
necessarily abnormal procedures. It is only when the inferences and the
conclusions become fixed, adamant, inflexible, and untouched by contrary
evidence that we begin to speak of the delusional thinking" (Cameron
1963:471) characteristic of the paranoid psychotic.
The paranoid psychotic sees neither hallucinations nor illusions,
but rather has delusionso There is a great difference. The delusions
are firmly grounded in social fact; there is something there, but the
paranoids' perception of such evidence, however slight, transforms it
into further proof of a conspiracy.
"In a certain sense, the paranoiac behavior is justified; he perceives
something that escapes the normal person; he sees clearer than one of
normal intellectual capacity, but his knowledge becomes worthless when
he imputes to the others the state of affairs he thus recognizes .      .
he projects into the mental life of others what exists in his own un-
conscious activity" (Freud 1938:163).
The persecutory paranoid derives meanings not only as objectively
observable products of social interaction, but also from his own sub-
jective systems (psychological) of delusion, denial and projection. The
paranoid's interpretation is thus highly idiosyncratic. As such, the
system of interpretation is not shared by others. The basic interaction-
al expectations are breached because its fundamental assumptions are un-
shared.
We mentioned earlier the hypersensitive character of the paranoid.
Coupled with this is an insensitivity of the paranoid to the meaning of
his own acts, words and gestures. The consequences are profound. The
individual's insensitivity stimulates avoidance by both friends and
strangers. Where avoidance is not possible interactants soon develop a
dislike for an individual who imputes malevolent motives to them and who
clearly feels enmity toward them for no apparent reason. The avoidance
and dislike which the paranoid soon begins to experience seem to him to
be objective evidence that his construction of reality was and is quite
justified.
70
The need for justification of the paranoid's reconstruction of
reality is great. The paranoid creates a delusional set of assumptions
and characterizations of the motives of others in order that he may
express the aggression and hostility he feels toward himself. The per-
ceived evil and destructive characteristics of others serve as justifi-
cation for the expression of destructive impulses toward them; destruc-
tive impulses which, if not directed at others, would be directed at the
self.
As there is an element of the self-fulfilling prophecy in the para-
noid condition, it seems to me that this is actually an unconscious
design in the illness. That is, given that the paranoid reaction is an
attempt to save the self from the self, it may be the case that there
remains a residue of self-destructiveness which seeks gratification
throuqh or by means of the delusional system. This notion makes sense
given that a paranoid does, in fact, create the very world he fears.
One of the methods by which this hostile world is created is the
paranoid's compulsive search for clues left intentionally or uninten-
tionally by the plotters. The trivial unrelated things noted in daily
interaction are connected by the paranoid into an ever-tightening web of
intrigue. The lack of basic trust is fundamental here: the paranoid
is never secure in interactions with others. Insecurity is manifested
by suspicious looks, stares and verbal expressions of mistrust which
are all too clearly recognized as such by others. The behavior of others,
in turn, is seen by the paranoid as threatening and unpredictable. As
a result, the paranoid is always ready to attac , for he feels unjusti-
fiab'ly threatened and attacked.
"Each individual aligns his action to the action of others by ascer-
taining what they are doing or what they intend to do, i.e., getting the
meaning of their acts" (Blumer 1969:82). As one can see, the persecu-
tory paranoid does not "align his action to the action of others" in
the same way others do. His alignment is made only before, but not at
the inception of, or during the course of, an encounter.
Further, this process of getting the meaning of other's acts is
effected by understanding the position of the other individual so one
can see oneself as others do and then structuring behavior to fit that
view (Mead 196.4).  But "above all, he (the paranoid) lacks skill in im-
agining himself as being in another person's situation, in taking the
other person's role and seeing things from the other person's perspec-
tives" (Cameron 1963:500). Unable to see himself as others see him,
the paranoid proceeds on a single course in social interaction. This
course consists of watchfulness, probing questions and, usually, verbal
attack. Social alienation cannot help but result. The paranoid sees
such interactional alienation as resulting not from his own actions, but
rather from the conscious hostile efforts of others.
The paranoid is unable to see himself because all his attention is
focused elsewhere as "when one is running away from someone who is
chasing him, he is entirely occupied in this action, and his experience
may be swallowed up in the objects about him, so that he has, at the
time being, no consciousness of self at all" (Mead 1964:207).
From Schutz (1967) we learn that normally one's presence "here",
in a given sociophychological space, by definition makes a "there" for
others. The two perspectives are mutually recognized. There is then
a reciprocity of perspectives, an interchangeability of the "here" and
the "there" of different egos. This reciprocity is the necessary pre-
condition of a shared reality. But in the case of Donald, exchange
breaks down. It is obvious that neither the preconditions for the
shared reality, nor the shared reality itself are possible for him or
others like him. His a priori definition of world and his place in it
precludes his understanding of the perspective of others, and, hence
their understanding of his.
In the foregoing I have delineated certain characteristics of the
persecutory paranoid: a faulty perception and interpretation of lin-
guistic and verbal meanings, hypersensitivity to the actions of others
and insensitivity to his own actions, the use of tentative conclusions
as facts, watchfulness, lack of basic trust, lack of reciprocity of
perspectives and an unshared social reality. All of these characteris-
tics are crucial in affecting the paranoid's interaction.    Other impor-
tant aspects of the condition, such as the role of sexuality, and the
lack of self-esteem, have not been addressed here, since they are not
our primary concern.
I will now turn to Donald's interaction. The reader should keep
in mind the features of the condition from which the individual suffers,
especially those enumerated above. To Donald, his social world is full
of hostility and aggression which are focused on him. We should remain
aware that to Donald the delusions of the hostility, aggression and
malevolent intentions of others are not delusions: to him they are
social reality.
INTERACTION
Back Region and Back Reqion Behavior
The back region is defined by Goffman (1959:134) as that region
"where action occurs that is related to the performance but is inconsis-
tent with the appearance fostered by the performance." The back region
is private and concealed from front regions where public social inter-
actional encounters occur.
The back region behavior of Donald is characterized by extreme fear
and anxiety. Much aggressive hostility is shown, but only in selected
areas of the backstage area. Backstage, i.e., at home, Donald was at
the mercy of the pseudocommunity. By being in one place, Donald felt
the pseudocommunity could get him. He believed that the house was
bugged and the phone tapped. As a consequence, when on the phone or in
certain parts of the house (where the bugs were), Donald would talk only
r7 n1
of normal things in an effort to manage the impression (cf. Berreman
1962 on impression management) that he was unaware of what they were up
to. Donald then neither said nor did anything which would clearly ex-
hibit a discrepancy between the fostered impression of not knowing he
was being monitored and the reality of his knowing he was. While at
home, he would profane the plotters only when he thought he was not
being monitored.
The statement Donald made, "If they know that I know they are listen-
ing, they'll get me. But if they think I don't know, I'll be able to
get them'" exemplifies Goffman's concept of information control (1959:
141). Donald was trying to control all three types of destructive in-
formation delineated by Goffman (1959:141-145): "dark secrets" which
they could use to slander or blackmail him; "strategic secrets" which
would allow the plotters to adjust to the next interactional situation;
and "inside secrets", those things Donald did not want known by anyone.
("I don't want anyone to know anything about what I know or what I do.")
Because Donald felt that others were listening in on his backstage
life, he had to act at being normal. Thus, Donald came to perform for
himself. As Goffman writes, "A performer may be taken in by his own
act, convinced at the moment that the impression of reality which he
fosters is the one and only reality. In such cases a performer comes
to be his own audience; he comes to be a performer and observer of
the same show" (Goffman 1959:80). Ironically, because Donald performed
for himself, he came to interact with himself in a way which reinforced
his own beliefs of persecution.
Also observed in the back region behavior of Donald was ritual
profanation, the profanation of the audiences Donald might encounter
in the front regions on the "outside." Donald made critical and insulting
remarks about everyone he knew and many people he did not know, and
imputed the most malicious motives to their actions. These ritual pro-
fanations served to dehumanize them, a process which further justified
Donald's distrust of and contempt for everyone.
Donald's image of others was illustrated by another ritual act: he
carried his wallet in his hand at all times while in his home. Stating
the reason for this behavior he said if he were not to carry his wallet,
"They would steal something out of it or they might even steal the whole
thing"' I asked him how he thought someone could enter the house to
remove something from the wallet while both he and I were present. Don-
ald said, "Well, they have been doing it. Besides, you don't know how
devious they are, they can fool you anytime."
Another aspect of Donald's back region behavior was his interaction
with what Goffman calls service specialists who are a group if "indivi-
duals who specialize in the construction, repair, and maintenance of the
show their clients maintain before other people" (Goffman 1959:153).
A repairman came to Donald's house to repair a gas heater. Donald
hovered over him, watching his every move. The repairman said that
31
if he could not fix the heater, it would have to be replaced because
it had a leak. Donald interpreted this to mean that the repairman was
warning him that the heater, with its escaping gas, was only one of the
many methods that they could use to get him. The heater was repaired
quickly and the repairman departed. But Donald checked it to make sure
that no destructive device had been left behind by the repairman in or
around the heater.
Donald, however, was still worried about the visit of the service
person. He reasoned that even if it were possible that the repairman
was not in the plot, he would probably divulge to the plotters informa-
tion gleaned during his visit to the house. The plotters could use
this new information against him at some future time.
Donald's fear illustrates a point made by Goffman. "It would seem
that service specialists can hardly attend to the needs of an individual
performer without acquiring as much or more destructive information about
some aspects of the individual's performance as the individual himself
possesses" (Goffman 1951:153).
Front Re2ion and Front Region Behavior
I will now consider Donald's behavioral transitions from back to
front regions. "One of the most interesting times to observe impression
management is the moment when a performer leaves the back region and
enters the place where the audience is to be found, or when he returns
therefrom, for at these moments one can detect a wonderful putting on
and taking off of character" (Goffman 1959:121).
The back region performance of Donald, which fostered the appearance
of unawareness and sought to conceal his anxiety, was carried over into
the front region with important additions, watchfulness and readiness
to attack. The front region is defined as the location "where a parti-
cular performance is or may be in progress" (Goffman 1959:107).
We will digress here to discuss some characteristics of Donald in
particular and of paranoids in general to clarify some of Donald's prob-
lems in interaction. These difficulties in interaction will be dis-
cussed shortly.
The paranoid comes to interaction with preconceived notions and
definitions, i.e., his own reality which is not shared by others. In-
teraction, then, involves more than communication about a given face
engagement. It is an opportunity to confront a suspected plotter.
Donald, prior to an engagement, had defined the kinds of information
which he could get during interaction. He proceeded with a single
intent, that of gleaning confirmation of his preconceived notions of
persecution. For Donald, any given interactional situation was not
defined in terms of its actual unique setting(s), participants, and
communicated information (both expressive and linguistic), but rather
in terms of a nonadjusting projected system of persecutory beliefs.
To protect himself, and to catch the plotters, Donald tried to manage
an impression of being unaware. This act of impression management
82
was, however, extremely poor and not infrequently led to interactional
problems.
As we have seen, the paranoid is extremely sensitive to others'
conscious and unconscious motives and equally insensitive to his own.
Just so with Donald: he was totally unaware of his own behavior and
appearance, as his attention was focused elsewhere. Because of his
diverted attention, Donald manifested "a typical sign . . . of psychosis
(which is), the individual's neglect of his appearance and hygiene"
(Goffman 1963:27). Goffman's dual components of personal front are
manner and appearance and their impression management counterparts
politeness and decorum (Goffman 1959:108). Considering these dual com-
ponents of personal front in relation to Donald (or any other psychotic),
we can see why Donald's impression management will fail and, further,
why paranoids' delusional systems are often self-fulfilling.
Unfocused Interaction
"In this realm of unfocused interaction, no one participant can be
officially 'given the floor'; there is no official center of attention;
. . , such a performance tends to be presented as if it were primarily
for the benefit of everyone in the vicinity" (Goffman 1963:34). As we
have seen, Donald did not perform in the usual, socially acceptable
manner, He is a performer (in a show of unawareness) but the perform-
ance is conspicuously transparent.
Therefore, persons present in an unfocused interactional setting
become acutely aware of Donald. He was clearly a person who did not
adhere to the "obligation to convey certain information when in the
presence of others and an obligation not to convey other impressions"
(Goffman 1963:35). Donald became a focal point of scrutiny even before
he had a chance to act.
In an unfocused interactional situation, body idiom, "an idiom of
individual appearance and gestures that tends to call forth in the actor
what it calls forth in the others, the others drawn from those and only
those who are present" (Goffman 1963:34), plays a significant part.
Donald attributed meaning to all bodily gestures that he observed. He
did not ceparate the gestures of others into classes of significant and
nonsignificant (Mead 1964).   Further, these gestures were not, as Goffman
states, "Something less than significant symbolism" which fosters "an
impression (that) must be maintained (which shows) that a margin of un-
calculating spontaneous involvement has been retained in the act"
(Goffman 1963:33-34), for Goffman speaks of normal interaction's symbol-
ic behavior.
All of this is understandable from Donald's point of view: "every-
one is out to get me." In his psychotic condition, the actors in the
world were all acting in direct relation to him. That being the case,
even appropriate involvement shields (Goffman 1963:33-34) or absences
were interpreted by Donald as secretive behavior. Meaningful absences
included the withdrawal of generalized others to back region areas for
the repair of a setting, or their persons, which were later to be
O3
employed in front regions. An example of this can be seen in an unfocused
situation where a hospital waiting room provided the setting.
As Donald and I approached the waiting room, numbers of people could
be observed situationally involved in waiting. Several of their number
were also engaging in subordinate involvements, e.g., reading.    Just
after our entrance, a man got up and left the room. Donald's interpre-
tation was this: "He was waiting here for us. He knew I was coming.
He thinks I didn't see him behind that paper: He's probably calling
the others now to let them know I am here." And when the man returned
from the rest room, Donald said as he glared at him, "He thinks I don't
know he just reported in. I know they have phones in the rest rooms."
I later went to the rest room myself. Upon returning, I told Donald that
there were no phones there. Donald retorted, "Oh, don't be stupid.
He's got one of those small transmitters that he used in there."
It is also important to note that Donald made definite distinctions
as to the appropriateness of involvement shields. Donald himself did
not use any such shields in public as he would have missed some of the
activities of the plotters. In one instance, a man was reading a news-
paper while standing on a street corner. Donald and I were across the
street from him; we were waiting for the light to change so we could
cross and continue on our errand. After observing the man for a few
moments, Donald remarked,, "There is nothing important or interesting
in the paper today (because)I read it." So it was obvious to Donald,
"He's just acting like he's reading it. He's really following us and
watching us."
There were other occasions where Donald passed judgment on the
validity of involvement shields,   On each occasion, Donald was able to
recognize his enemies by the fact that their shields against interaction-
al involvement were inappropriate in his judgment. In this way, symbolic
statements made in public places by people indicating that they did not
wish to be engaged in conversation were construed by Donald as aggressive,
hostile acts. By use of this interpretive procedure, Donald converted
passive symbolic statements about non-involvement into aggressive, hos-
tile acts of surveillance.
Even in unfocused interaction, Donald's systematization of motives
and intentions of actors created "situational insolence" (Goffman 1963:
42) because of Donald's acute awareness of the unfocused interactional
behavior of others. Donald sensed, and rightly so, that the people
around him were presenting a face which masked some of their real in-
tentions. Donald recognized that even in unfocused interactions others
were not being themselves; they were playing roles. Donald, however,
misinterpreted the reality and intent of what it was others were trying
to conceal.
Focused Interaction
Focused interaction is that which pertains to organized, directed
and focused social interaction. This is interaction in which the actors
84
have their attention focused on one another and this focused attention
is legitimatized by the underlying assumptions of such interactional
encounters. Focused interaction of Donald was in part influenced
back region behavior.
Earlier we mentioned, as an act of ritual profanation of a non-
present audience, Donald constantly carrying his wallet. When Donald
extended this behavior into front region areas, it became an "occult
involvement where the offender can supply a lively statement of the
object of his special engrossment, which, however, persons present cannot
credit. This retrospective aspect of the offense is often followed by
the feeling that all of the offender's oncoming conduct is suspect.
The kind of trust-in-the-other that is necessary if persons are to be
in each other's presence and go on with their separate affairs can then
be lost, and the offender ruined as a candidate for social intercourse.
In a sense, then, a paranoid person is someone who has acted in such a
way as to cause others to be suspicious and watchful of everything that
he does; the persecutory feelings that result may be quite justified"
(Goffman 1963:78).
The occult involvement of Donald, the carrying of his wallet, also
had other consequences. These consequences grew out of the fact that
all of Donald's subsequent conduct was considered suspect. The suspicions
of others were manifested in ways similar to those of Donald. That is,
their suspicions were expressed by staring. Thus, another component of
focused interaction, civil inattention, was consistently broken.
"By according civil inattention, the individual implies that he has
no reason to suspect the intentions of the others, be hostile to them,
or wish to avoid them. (At the same time, in extending this courtesy
he automatically opens himself up to a like treatment from others present.)
This demonstrates that he has nothing to fear or avoid in being seen
and being seen seeing, and that he is not ashamed of himself or of the
place and company in which he finds himself" (Goffman 1963:84). Donald
did not accord such polite inattention and so did not receive it.
Also, when Donald stared at people for no apparent reason, the
other people were aware that an "individual's gaze ought not to be
guarded or averted or absent or defensively dramatic, as if 'something
were going on"' (Goffman 1963:85). So the others observed by Donald
were forced to make furtive glances at Donald to see if he was still
staring at them. Donald took these glances to be proof that the other
people are watching him.
Goffman suggests proximity of interactants also influences inter-
actional license. "The further they are from him, the more license they
will feel to stare at him a little" (Goffman 1963:85). Donald recognized
only that people were staring at him and, thus, regardless of the dis-
tance between them, the staring represented spying to Donald.
Often when people realized that Donald was staring at them, they
took it to mean that a face engagement was expected because ". . . mutual
glances ordinarily must be withheld if an encounter is to be avoided,
for eye contact opens one up for face engagement" (Goffman 1963:95).
I observed a good example of this interactional code being broken. This
occurred while driving with Donald. We came to an intersection and at
the red light I braked to a stop. In the adjacent lane, on the right
of my car, was another car with a woman driver. While I was waiting
for the light to change, I heard the woman in the other car say, "Do
I know you?" Donald, who had been staring at the woman, retorted
loudly, "I'm not stupid. I know you are following me' I ought to
teach you a lesson." Needless to say, the woman was shocked. As tge
light turned green, I sped away, leaving her to ponder what had happened.
By making eye contact, Donald appears to be accessible (Goffman
1963:104) for interaction. But"cognitive and social recognition" (Goff-
man 1963:113) are interpreted by Donald to have but one meaning; he is
known because all the members of the plotting group "have been told to
watch" for him. Often I observed Donald misconstrue the glances of
others. And often, as in the example above, others looked at Donald
because he looked or, more accurately, stared at them.
CONCLUSIONS
These few examples of interactional behavior provide insight into
the kinds of interpretations and conclusions formed by a persecutory
paranoid in social interactional performances. Since persecutory para-
noid thinking is actually different only in degree and not in kind from
normal thinking, one can easily visualize the paranoid in hypothetical
situations.
The paranoid's inability to be reflexive (reciprocity of egos),
his inability to "correctly" interpret what he sees, his hypersensitivity
to unintended meanings coupled with his insensitivity to his own appear-
ance and behavior, his mistrust, suspicion, fear, and his unique reality,
all play a part in preventing the paranoid from interacting "properly."
It was the inability to interact in a "normal" way which made the
subject of this paper a "proper" candidate for institutionalization and
not the underlying psychological causes of his illness. His behavior
was only symptomatic. It can be said, then, that a community's desire
to institutionalize such a person is more a reaponse to symptomatology
than a concern for the underlying causes of the mental condition.
Donald's mode of interaction was quite justified given his world
view. Through all of Donald's interactional difficulties, it became
clear that what disturbed others most and what led to Donald's receipt of
the label of madness was in large part his violation of the defenses of
others' concepts of self as they were presented in interaction.
Donald's condition was, in fact, seen as a threat to others only
because he saw them as cruel, hostile, and persecuting; not because he
actually threatened to do anyone physical harm. Donald was considered
sick really because he could not accept as valid and at face value the
managed impression of others. Our subject did not and could not proper-
ly perform the interaction rituals which serve to foster others'
86
presentation of self in everyday life. For his failure, Donald was
institutionalized for a period of several months. Fortunately, he was
clearly in remission upon his release.
The major failure of Donald was his obliviousness to the problematic
character of social interactional encounters. Interaction is made pos-
sible by the underlying assumption of a willingness to negotiate situa-
tional definitions, a willingness to create them by a give and take, an
exchange of meanings. For Donald, negotiation and, hence, exchange, was
impossible. Donald developed and used a pre-existing definition which
covered all social situations. Hence, his interaction became not only
problematic, but-impossible.
Perhaps other studies of social interaction do not so clearly show
the consequences of an individual's failure in the social games of a
given society. As Bailey's work (1971) and this study suggest, the
acquisition and successful implementation of the assumptions which pro-
vide the basis for interaction are not just matters of manipulating an
inconsequential set of ideas regarding an ephemeral social etiquette.
Rather, these are matters of knowing how to live in a society and how to
remain a part of it.
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