Delusions Are Often Not-So-Delusional After All

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I I feel like I’m being sent on some sort of mission,” says Adam, “…like I’m receiving messages through television.” Adam doesn’t know what his mission is, he clarifies, but it doesn’t seem like a good mission. He feels like TV wants him to do something bad. His mission seems to be linked to murderous thoughts, he explains, and gives off a “dominant atmosphere”.

Adam participated in a recent study on clinical psychosis and delusions published in Lancet psychiatrywhere his story was recorded. Psychotic delusions affect only a small percentage of the world’s population, about 1 percent. But they are very annoying for those who carry them and very difficult to dislodge. How do these strange beliefs arise, particularly during a person’s first episode of psychosis, and how can clinicians help those suffering from them return to a more grounded reality?

A team of psychologists from the United Kingdom and Australia have proposed that these psychotic episodes are more than just thinking problems: they represent a larger change in the way a person experiences the lived and embodied world, shaped in part by life events, personal history and emotions. To test this hypothesis, they conducted a qualitative study with a small group of 10 young adults in the UK who were receiving early intervention for psychosis care. Participants had a median age of approximately 25 years. All had suffered a first episode of psychosis and were suffering from or had experienced clinically significant delusions in the past. Individuals whose delusions were related to substance use were excluded.

“Our research offers a radically different perspective on psychotic delusions, demonstrating how they emerge from the emotional, bodily and linguistic fabric of people’s lives,” explained Rosa Ritunnano, of the Institute for Mental Health at the University of Birmingham, consultant psychiatrist and author of the study, in a statement. “For a long time, clinicians have struggled to understand where delusions come from and how they take shape. Our research offers new insights by showing how delusions are rooted in emotional experiences that involve large bodily disturbances.”

Read more: “Wrong meteorologists of the mind”

Over a six-month period in 2023, the researchers conducted 33 interview sessions in total with the 10 participants. Participants also completed a number of standardized psychological questionnaires on anxiety, insight, purpose, and abnormal experiences. Next, the team analyzed the collected material from three perspectives. First, they reviewed clinical records to classify delusional themes using a standardized clinical framework. Next, they performed a phenomenological analysis to capture the first-person lived texture of the experience, mapping changes in space, time, language, mood, and existential orientation, among others. In the final narrative analysis, they collected each individual’s life story, with the goal of understanding delusions in the context of childhood experiences, relational turning points, and coping strategies. They paid particular attention to figurative language.

What the researchers found was that each participant’s delusions were driven by overlapping themes. Three major themes were most common among the delusions examined: all delusions were of persecution, while 9 out of 10 had delusions with so-called “reference” themes (the feeling that everything carries special messages for you) and grandiose or religious themes. These delusions also coincided with a larger shift in the way participants understood reality: their experiences of time, other people, the atmosphere, and their place in the world all changed significantly.

The most common distortions included unusually intense or sticky perception, time distortion, blurred boundaries between self and other, pervasive revealing mood, and existential changes, such as feeling unique or cosmologically different. Taken together, these findings suggest that delusions are not just random beliefs, but rather a story that the mind begins to tell itself to make sense of systemic change in one’s lived and embodied experience.

The researchers also discovered certain patterns in the participants’ life stories: early and repeated painful interpersonal experiences that presented powerful emotions, particularly shame, but also fear, anger, and a sense of control. Later, during major life upheavals, such as breakups, abusive relationships, rejection, loneliness, or major stress, this pattern was reactivated and participants faced a series of strategies including an obsessive search for meaning, immersion in spiritual or fictional narratives, and absorption spirals. In other words, delusions often come at the end of a long emotional journey, and not out of nowhere.

Three common upheavals often precede the emergence of delusions. The first was feeling in the spotlight, exposed or judged, a feeling often rooted in shame. This heightened self-awareness might later develop into feelings of persecution or morph into feelings of grandeur (e.g., that one is a god). The second involved moving from an emotional void to a feeling of meaning or connection, which could be experienced as fear, hope, a feeling of protection, and a feeling of being chosen or connected to a cosmic mission. The third was that individuals lived in a simulation, marked by disembodiment, detachment, and numbness, which could coincide with a feeling of being watched, everything seeming false, and performative emotions.

The authors argue that their findings suggest that delusions may be difficult to correct not because of poor reasoning, but because they are so powerfully rooted in bodily feelings, in deep instinctive desires to hide, fight, connect, or obey, in transformations in one’s understanding of the social world, and in identity-level meaning. As such, they believe that treating the delusion will require engaging not only with the false belief itself, but also with a person’s embodied emotional states, history, and coping styles and by providing emotionally calming environments. They also suggest that clinicians pay special attention to figurative language.

Jeannette Littlemore, professor of linguistics and communications at the University of Birmingham and co-author of the paper, said: “We all use metaphors and narratives to understand our experiences and make sense of our lives. But psychotic patients do this more intensely. After enduring strong (often negative) emotional experiences, to which the body then responds and are shaped by everyday use of language, people suffering from psychotic delusions actually live in metaphor. People can feel delighted and saying that they are so happy that they can “touch the sky”; this could lead them to experience the illusion of thinking that they can fly.

If the results are confirmed in larger-scale studies, they suggest that delusions are not simply strange beliefs. These are visible signs of a deeper emotional shift on a global scale, rooted in the lived body, shaped by personal history, and expressed through stories.

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Main image: missSIRI / Shutterstock

• Kristen French

  Published on January 13, 2026

  Kristen French is an associate editor at Nautilus. She has worked in science journalism since 2013, reporting and writing articles and news for publications such as Wired, Backchannel, The Verge, And New York Review. She holds a master’s degree in science journalism from Columbia University.