Delusion and adaptiveness

In this chapter, we discuss the adaptiveness of delusions as a relevant factor in the explanation of the phenomenon of the insight paradox. When people start acknowledging that they have mental health problems, they gain insight. This is supposed to be a good outcome as insight facilitates help-seeking and access to treatment. However, with insight, often severe depression and demoralisation ensue and people experience low mood, poor self-esteem, and a sense of hopelessness. This applies to the case of delusions as well. Why? Unusual beliefs that are considered as symptomatic of schizophrenia can play an important role by responding to the person’s psychological and epistemic needs at a critical time. When such beliefs are recognised as delusions by the person and gradually abandoned, they leave a gap which the person needs to fill by other means. Considering and assessing the potential adaptiveness of delusions help us explain the insight paradox and motivates the need to offer adequate support to people gaining insight into their delusion. This can reduce or prevent adverse effects on their mood and self-esteem.