People experiencing delusions during an episode of psychosis may be “living out” deeply held emotions, according to groundbreaking research that offers a radically different perspective on one of the most puzzling elements of psychosis. This study, published in The Lancet Psychiatry, challenges traditional views by suggesting that delusions are not merely cognitive deficits but are intricately linked to emotional and linguistic experiences.
Approximately 2–3% of the UK and Australian populations will experience psychosis at some point in their lives, with the first episodes commonly occurring between the ages of 16 and 30. Delusions, often described as fixed or false beliefs, have been traditionally understood as reasoning errors or cognitive deficits. However, this new research from the University of Birmingham, University of Melbourne, and the University of York, in collaboration with the Australian youth mental health research institute Orygen, explores how emotions and language shape delusions, leading individuals to “live in metaphor.”
Understanding Delusions Through Emotional and Linguistic Lenses
Conducted with young adults receiving care from Early Intervention in Psychosis services, the study combines clinical assessments, phenomenological interviews, and life-story narratives to explore changes in self-perception and reality during psychosis. Dr. Rosa Ritunnano, from the Institute for Mental Health at the University of Birmingham and a consultant psychiatrist, explains, “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.” — Dr. Rosa Ritunnano
The Role of Strong Emotions
The findings reveal that delusions are not isolated ideas produced by “glitches in the brain.” Instead, they reflect distinctive patterns of the body reacting to strong emotions or experiences of dissociation. Participants described alternating states of intense emotional embodiment, such as feeling exposed or powerful, and disembodiment, such as feeling unreal or detached from their bodies and the world.
Before the onset of delusions, individuals often endured upsetting or traumatic experiences that triggered intense feelings, particularly shame. Repeated negative experiences, such as being publicly mocked, could lead to “reference delusions,” where individuals feel surveilled by others despite being alone. These experiences can evolve into persecutory beliefs that others are out to get them, with no space for privacy, known as “thought broadcasting” delusions.
Interestingly, delusional experiences were not always negative. Some participants reported powerful feelings of awe, love, and spiritual connection, fostering a positive sense of identity and renewed hope for the future.
The Power of Figurative Language
A striking feature of participants’ accounts was their use of figurative and metonymic language, linking bodily sensations with complex emotions or abstract ideas. This linguistic pattern helps explain why delusional content can appear unusual or bizarre. For instance, feeling “exposed” might manifest as beliefs of being watched by cameras, while feeling “tainted” could lead to delusions of contamination.
“We all use metaphors and narratives to understand our experiences and make sense of our lives. But psychosis patients do so more intensely.” — Jeannette Littlemore, Professor of Linguistics and Communication
Professor Jeannette Littlemore, a co-author of the paper, highlights that the intense use of metaphor and narrative in psychosis is a response to enduring strong emotional experiences. These experiences are then responded to by the body and shaped by everyday language use, leading individuals to truly “live in metaphor.”
Implications for Psychosis Care
The study argues that a better understanding of how delusions arise can inform more effective care for individuals experiencing psychosis. Participants expressed a lack of space to discuss the meaning of their delusions within the context of treatment and recovery, leading to feelings of shame and marginalization. The researchers emphasize the importance of attending to individuals’ bodily and emotional worlds and how they express them when developing compassionate, effective approaches to psychosis care.
The research concludes that delusions are not simply “beliefs gone wrong,” but embodied attempts to restore meaning and emotional balance when life becomes overwhelming. The metaphors and narratives used by individuals are keys to understanding their suffering and should not be dismissed as irrationality.
This development in understanding psychosis represents a significant shift in how mental health professionals might approach treatment, potentially leading to more empathetic and personalized care strategies. As the field of mental health continues to evolve, studies like this highlight the importance of integrating emotional and linguistic insights into clinical practice.
