You're leaving out a key aspect, which is "while it's happening". My mentally ill friends are some of the most introspective, self-aware people I know. They understand exactly what happens to them and how it affects them. They just don't have the ability to do a lot about it while it's happening.

Psychosis is not always like that. You can have an episode and then retrospectively, like days or weeks after the delusion, realize it was not "real" (tm). An example is people on the bipolar spectrum but this can also happen if you are on the autism spectrum and had an overstimulation episode or some other kind of break.

bipolar and autism are orthogonal.

it's perfecly possible to be on both

Lack of insight to varying degrees is a well-known feature, but not always the case.

Having insight doesn't imply at all a lack of symptoms. It's possible to be aware, but not be able to correct errors in real time.

Someone with paranoia is highly sensitive to coincidences, and may have great difficulty blocking out elaborate theories regarding them which seem to spontaneously arise, as well as an intense fear reaction to the possibilities.

Some people can suppress that sort of thing fairly well. The problem is, that's not a solution to impairment, because suppressing patterns will suppress the ones that normal people consider important as well, sometimes.

I suspect that (knowing how paranoid delusions work as I observe in my daughter - and also, how I process anxiety); that the anxiety is often triggered as a physiological reaction, a hormonal signal that physically jacks up your heart-rate, and adrenaline. This sensation is often processed as fear. And our intellectual coping mechanism for fear, is to try to UNDERSTAND it, to figure out if there's any action that should be taken to prevent harm. And in the absence of any apparent rational explanation for the fear, the mind MANUFACTURES a rationalization. Sometimes it's a completely silly nonsense rationalization. But if it relieves the fear somewhat, (not the anxiety), it becomes an adequate coping mechanism. A healthier coping mechanism is when something triggers inside that helps you to realize that what's happening is a physiological reaction, and there's no actual real reason to be anxious. You can still come up with a silly rationalization, but you will realize that it's not real. I think that's the hairline that separates insanity from a person who's just having a hard time coping with an anxiety attack.

>that's the hairline that separates insanity from a person who's just having a hard time coping with an anxiety attack

Ultimately, it's not entirely intrinsic, it depends on extrinsic factors as well.

When someone is intensely fearful, and interacting with someone else, they're susceptible to spiraling feedback loops and misunderstandings.

I have always wondered why if someone with good logical reasoning skills got schizophrenia they clould not reason their way to seeing their delusions for what they are. For example (real example I heard) if I think everyone who looks at my eyes is from the government and tracking me on my walk to the park- there simply is no agency that could field and coordinate that many undercover agents nor surreptitiously replace all normal people on my route. It seems to me dellusions must involve both imagination and somehow disable logical reasoning for an intelligent person.

That's me. I had all the paranoid delusions mentioned in this thread and logically walked myself out of them. I sometimes have snaps where I let my guard down and get paranoid again but they have been easier and easier to avoid with age and responsibility.

Reading your comments, I can relate. I never found an answer but ptsd, derealisation and schizophrenia all feel like they overlap or fit on a spectrum. Perhaps some of us don't quite have the ingredients to completely detach from reality and can manage our way around symptoms. A lot of the time I think I'm just too imaginative.

If I'm quite upbeat and have good happy mood (not so common) then symptoms are much less likely to occur, so it could also be a depressive state of sorts.

In my own experience, reality and imagination merged.

Any logical reasoning I had was dealing with massively corrupted input. I was overwhelmed trying to separate want was real and what was not real.

The only way I could tell what was real and what wasn’t was by going off what I remembered to be true about the world. Well, part of memory retrieval got compromised too.

There are things I knew to be “true” about the world that didn’t match my mental model of how the world actually worked. That model was all that was left in the end. The only reason I came back was the episode ended. Even then, I thought the experience was a normal human response to stress.

>there simply is no agency that could field and coordinate that many undercover agents nor surreptitiously replace all normal people on my route

It's entirely possible that a person can reason like that and reject some theories, and it may even be comforting to see and feel things that are easily dismissed.

However, paranoia does not necessarily involve things that are so clearly absurd, even to a healthy observer. You're talking about one end of a distribution, even for a given person, and an almost infinite number of possibilities are in a gray area.

It's possible to observe patterns of coincidence without a particular theory, and rejecting a theory or switching to a different one doesn't make observations go away.

Those observations can be mistaken or selective, but that's a separate issue.

I agree, two famous mathematicians who had severe mental illnesses come to mind, Kurt Gödel and John Nash. In fact there seems to be a link between the two (intelligence and predisposition to mental illnesses), see: https://www.psychologytoday.com/us/articles/201707/the-mad-g...

>In fact there seems to be a link between the two (intelligence and predisposition to mental illnesses)

I don't think it's real. I attribute it to a selection effect.

Of all the people with mental illnesses it's necessarily the particularly smart or talented ones that you hear about.

The more of a handicap something is, the more extreme other abilities have to be to cancel out and produce a notable accomplishment or even an average, comfortable life.

People who aren't brilliant in some way, aren't going to be noticed, and have little to gain by sharing their experiences.

I used to volunteer for a mental health advocacy non-profit, and they had a poster listing all the famous people that supposedly had some sort of mental illness. I didn't find it inspirational, because I suspected on the one hand it was kind of reaching for many of them, and on the other, it had the unintentional implication to me, that if you aren't Einstein you can only pretend to be, or be nothing.

Society fixates on geniuses with mental illness for another reason - they are likely to be able to describe their inner life much better than the average person. But they might not be representative.

I’ve had psychosis and knew I was completely out of reality. The problem was my rational brain wasn’t in the driver’s seat. So I got to watch myself believe and do things I didn’t want.

I had a friend who had a few psychotic episodes in her teens and early 20s. She fully knew there were no aliens, but that didn't stop the sensation that they were real and hiding in her apartment, or the actually real fright that came along with experiencing it.

My understanding is that the clinical definition of a delusion is a concrete, false belief. There's no insight, by definition.

People can have hallucinations that aren't delusions (in that they recognize them for what they are).