For many people, the word psychosis immediately brings to mind images of incomprehensible beliefs and broken reasoning. Delusions are often described as false ideas, stubbornly held and detached from reality. They are portrayed as strange mental errors, glitches in the brain that twist logic beyond recognition. But new research suggests something far more human is happening beneath the surface.
According to a study led by researchers from the University of Birmingham, the University of Melbourne, and the University of York, in collaboration with Orygen, delusions may not be meaningless mistakes at all. Instead, they may be deeply emotional experiences, lived through language and the body, shaped by powerful feelings that overwhelm a person’s sense of self.
Published in The Lancet Psychiatry, the research offers what its authors call a radically different perspective on one of the most puzzling aspects of psychosis. Rather than asking only what delusions get wrong, the study asks what they are trying to express.
A Common Experience, Often Misunderstood
Psychosis is not rare. Around 2–3% of people in the UK and Australia will experience it at some point in their lives, with first episodes commonly occurring between the ages of 16 and 30. For those who go through it, delusions are often central. These beliefs can feel absolutely real, even when others cannot share or understand them.
Traditionally, delusions have been framed as cognitive failures. They are described as fixed, false beliefs that persist despite evidence to the contrary. This framing has made them seem alien and inaccessible, both to clinicians and to the wider public. Yet the new research suggests that this view misses something crucial.
The researchers set out to understand not just the content of delusions, but how they are formed and lived. They focused on young adults receiving care from Early Intervention in Psychosis services, listening closely to how these individuals described their inner worlds.
Listening to Lives, Not Just Symptoms
The study combined clinical assessments, phenomenological interviews, and life-story narratives. This approach allowed the researchers to trace how people’s sense of reality and identity shifted during psychosis, moment by moment, feeling by feeling.
Dr. Rosa Ritunnano, a consultant psychiatrist at the University of Birmingham and lead author of the study, explained that delusions do not arise in a vacuum. They emerge from what she calls the emotional, bodily, and linguistic fabric of people’s lives.
She noted that clinicians have long struggled to understand where delusions come from and why they take the forms they do. The research suggests that delusions are grounded in intense emotional experiences, often accompanied by what participants described as profound bodily turmoil.
In other words, delusions are not just thoughts. They are lived experiences.
The Body Under Emotional Pressure
One of the most striking findings was how closely delusions were linked to the body’s response to strong emotions. Participants described swinging between intense embodiment and disembodiment.
At times, they felt overwhelmingly present in their bodies, with sensations of being exposed, powerful, or uniquely significant. Some described feeling deeply connected to God or infused with a sense of special purpose. At other times, they felt unreal, detached from their bodies, from other people, and from the world itself.
These shifts were not random. Before delusions took shape, many participants had lived through upsetting or traumatic experiences. These experiences triggered the same intense emotions that later reappeared within the delusions. Feelings of shame were especially prominent.
When Shame Turns Into Surveillance
For some participants, repeated negative experiences such as being mocked or shamed by bullies left a lasting imprint on how their bodies felt in the world. That imprint could transform into the sensation of being watched, even when no one was present.
This bodily feeling of exposure sometimes became what clinicians call reference delusions, where neutral events are experienced as personally significant. Over time, these could harden into persecutory beliefs, with people feeling that others were actively out to harm them.
In some cases, this sense of constant exposure went even further. Participants described believing that others could hear their thoughts or see everything they were doing at all times, a phenomenon known as thought broadcasting. There was no room for privacy, no safe internal space.
Seen through the lens of the study, these beliefs were not arbitrary. They echoed earlier experiences of shame, of being publicly seen and judged, now replayed and intensified through the body and the imagination.
Not All Delusions Are Dark
Importantly, the research also challenges the assumption that delusions are always distressing. For some participants, delusional experiences were filled with awe, love, and spiritual meaning.
Feelings of profound connection, purpose, and hope emerged alongside certain beliefs. These experiences could foster a positive sense of identity and a renewed vision of the future. Even when detached from shared reality, they carried emotional truth for the person living them.
This complexity is often lost when delusions are reduced to symptoms to be eliminated. The study highlights how varied and meaningful these experiences can be, even when they cause distress.
Living in Metaphor
A key insight from the research lies in language. Participants frequently used figurative and metonymic language, expressions that link bodily sensations with complex emotions or abstract ideas. This helps explain why delusions can sound so strange or bizarre to others.
For example, a feeling of being emotionally exposed or morally tainted might take shape as a belief that one is being watched by cameras or contaminated by parasites, as in delusions of parasitosis. These are not random images. They reflect how emotions are understood through physical sensation.
Human language is full of such links. Warmth is associated with love. Being seen is associated with shame. These connections shape how emotions are felt and described. In psychosis, the study suggests, this ordinary process becomes more intense.
Professor Jeannette Littlemore, a linguist at the University of Birmingham and co-author of the paper, explained that everyone uses metaphors and narratives to make sense of life. People experiencing psychosis do the same, but with greater intensity.
She offered a simple example. Someone might say they are so happy they can “touch the sky.” For a person in psychosis, that metaphor might be lived so fully that it becomes the belief that they can actually fly.
This is what the researchers mean when they say people experiencing delusions are living in metaphor.
The Cost of Not Being Heard
Many participants described feeling that there was no space within their treatment to talk about what their delusions meant to them. Their experiences were often dismissed or treated purely as symptoms to suppress.
This lack of dialogue increased feelings of shame and reinforced a sense of being marginalized. When the emotional meaning of delusions is ignored, the person’s suffering remains unacknowledged.
The study argues that attending to people’s emotional and bodily worlds, and to the language they use to express them, is essential for compassionate and effective care.
Why This Research Matters
At its core, the study challenges a deeply rooted idea. Delusions are not simply beliefs gone wrong. They are embodied attempts to restore meaning and emotional balance when life becomes overwhelming.
By reframing delusions as meaningful responses to intense emotional experiences, the research opens the door to a more humane understanding of psychosis. It suggests that the metaphors and narratives people use are not signs of irrationality, but clues to their inner worlds.
This perspective does not deny the distress that psychosis can bring. Instead, it offers a way to meet that distress with curiosity rather than dismissal. Understanding how delusions arise could help create care that listens, rather than merely corrects.
For the millions of people who experience psychosis, and for those who support them, this research matters because it restores something often lost in clinical conversations: the recognition that even the most bewildering experiences are deeply human, shaped by emotion, language, and the body’s attempt to survive overwhelming pain.
Study Details
Delusion as embodied emotion: a qualitatively driven, multimethod study of first-episode psychosis in the UK, The Lancet Psychiatry (2026). DOI: 10.1016/S2215-0366(25)00341-4
