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One of the obstacles to understanding the links between social inequality and mental health distress is the reliance on heterogeneous diagnostic categories. In this paper, it is argued that a solution to this problem is to explore more homogenous experiences of distress. This paper investigates one particular form of distress: paranoia. The relationship between social inequality and paranoia is then examined, focusing on two aspects. Firstly, it is argued that social inequality might affect the experience of paranoia itself since the experience of the surveillance encountered in the everyday use of public space may vary depending on one's location in social categories like gender, 'race' and culture and class (these social categories are, of course, themselves stratified by social inequality). Secondly, mental health service users' locations in these categories may influence the way that the plausibility of ostensibly paranoid claims are evaluated by mental health professionals. Within the discussion of each category, links are drawn between community and clinical samples to understand how the experience of paranoia may be influenced by these social categories. The paper concludes with implications for research and policy. [ABSTRACT FROM AUTHOR]