People who suffer with delusions and believe they are being watched, contaminated or controlled are usually told that their minds are misfiring. But a new study offers a radically different and far more humane explanation: people with psychosis may be “living in a metaphor,” expressing overwhelming emotional experiences through symbolic states.

Researchers from the University of Birmingham, the University of Melbourne and the University of York conducted the study in collaboration with Orygen, Australia's Centre of Excellence in Youth Mental Health.

The research focused on young adults experiencing psychosis for the first time, typically between the ages of 16 and 30, and receiving care from Early Intervention in Psychosis services.

Delusions are not simply beliefs gone wrong. They are embodied attempts to restore meaning and emotional balance when life becomes overwhelming.

Using clinical assessment interviews that focused on patients' subjective perspectives on their symptoms and detailed narratives of their life stories, the researchers were able to get a view of how people experience delusions from the inside.

A powerful pattern emerged. Delusions were closely tied to intense emotional and bodily experiences, especially those involving shame, fear, trauma and a loss of connection to the present moment.

“Our research offers new insight by showing how delusions are grounded in emotional experiences that involve great bodily turmoil,” lead author, Rosa Ritunnano, a consultant psychiatrist at the Institute for Mental Health at the University of Birmingham, explained in a press release. “[It] provides a radically different perspective on psychotic delusions, demonstrating how they emerge from the emotional, bodily, and linguistic fabric of people's lives.”

Participants described moving between states of intense emotional embodiment including feeling exposed, powerful or even connected to God, as well as states of disembodiment when they felt unreal or detached from their bodies and the world.

Many patients had had enduring upsetting or traumatic experiences before their delusions began, particularly experiences of humiliation or being shamed.

Repeated bullying or public ridicule, for example, could produce a deep bodily sense of being watched. Over time, these feelings might turn into what clinicians call “reference delusions” in which a person believes they are being observed even when no one is there. These can evolve into persecutory beliefs or “thought broadcasting,” the frightening sense that others can hear one's private thoughts.

Not all delusions were negative. Some participants described feelings of awe, love and spiritual connection that gave them a renewed sense of purpose and hope. In those moments, delusions seemed to offer meaning in the face of emotional chaos.

Many patients had had enduring upsetting or traumatic experiences before their delusions began, particularly experiences of bullying, humiliation or being shamed.

Language turned out to be a crucial clue. People naturally use metaphor to describe emotion — we say we're are “on top of the world” or “burning with shame.” When a person is in a state of psychosis, the researchers suggest, those metaphors can become literal.

Feeling emotionally “exposed” may lead to the belief that cameras are watching. Feeling “tainted” may become the fear of being physically contaminated.

“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 Communications at the University of Birmingham and co-author, explained. “People experiencing psychotic delusions are really living in a metaphor.”

Littlemore offered the example of someone saying they are so happy they can “touch the sky.” For someone suffering psychosis, this feeling could lead them to explore the delusion that they can fly.

Participants said they rarely had space in treatment to talk about what their delusion meant, and this feeling of being dismissed increased their shame and isolation. The researchers argue that listening to patients' metaphors could lead to more compassionate and effective care.

The paper concludes that delusions are not simply beliefs gone wrong. They are embodied attempts to restore meaning and emotional balance when life becomes overwhelming. Understanding psychosis, the study suggests, begins by learning how to listen.

The study is published in The Lancet Psychiatry.