Psychosis patients ‘living in a metaphor,’ study suggests

People experiencing delusions during psychosis may be ‘living out’ deep emotions, research suggests, offering a new way to understand the condition.

The study sets out a “radically different perspective” on delusions, challenging older ideas that they are only a ‘glitched brain’.

About 2-3 per cent of people in the UK and Australia experience psychosis, often first between ages 16 and 30. Delusions are fixed false beliefs, often seen as bizarre.

The research, by the University of Birmingham, the University of Melbourne and the University of York with Orygen, offers the first known study of how delusions in psychosis are shaped by emotions and language.

The findings suggest delusions are not isolated ideas from ‘glitches in the brain’ but reflect body patterns responding to strong emotions or dissociation (feeling detached from oneself or surroundings).

Dr Rosa Ritunnano, consultant psychiatrist from the Institute for Mental Health at the University of Birmingham and author of the study, said: “Our research provides a radically different perspective on psychotic delusions, demonstrating how they emerge from the emotional, bodily, and linguistic fabric of people’s lives.

“For a long time, clinicians have struggled to understand where delusions come from and how they take shape.

“Our research offers new insight by showing how delusions are grounded in emotional experiences that involve great bodily turmoil.”

Before delusions began, people often experienced upsetting or traumatic events that triggered the same intense feelings later felt during delusions, especially shame.

Repeated negative experiences, such as being publicly mocked and shamed by bullies, could create a bodily sense of being watched when no one is there.

These can become persecutory beliefs that others are out to harm them.

A striking feature of participants’ accounts was figurative and metonymic language (one thing standing in for another), linking bodily sensations with complex emotions or abstract ideas.

This helps explain why delusional content can seem unusual. For instance, feeling ‘exposed’ or ‘tainted’ might be expressed as being watched by cameras or being contaminated.

Jeannette Littlemore is professor of linguistics and communication at the University of Birmingham and co-author of the paper.

She said: “We all use metaphors and narratives to understand our experiences and make sense of our lives. But psychosis patients do so more intensely.

“As a result of having endured strong (often negative) emotional experiences, which are then responded to by the body, and shaped by everyday language use, people experiencing psychotic delusions really are living in metaphor.

“People may feel delighted and say they are so happy they can ‘touch the sky’; this could lead them to experience the delusion of thinking they can fly.”

Importantly, delusional experiences were not always negative. Some involved awe, love and spiritual connection, supporting identity and hope.

Participants said there was little space to discuss the meaning of delusions in treatment and recovery, which increased shame and the feeling of being dismissed and marginalised.

The paper concludes that delusions are not simply beliefs gone wrong but embodied attempts to restore meaning and emotional balance when life becomes overwhelming.