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Despite our efforts to build a more liberatory mental healthcare system, psychosis remains one of the most stigmatised psychological experiences. Even people who are otherwise sceptical of psychiatry often see psychosis as different, as more severe and inherently pathological, where social explanations no longer apply and medical authority, including non-consensual interventions, are seen as unavoidable. Psychosis is framed as something that cannot be understood in relation to the world a person lives in, only managed or contained.
This assumption carries weight: it not only shapes how psychotic people are treated, but it also acts as a barrier to meaningful change in our mental healthcare system. When we make exceptions for some people or experiences, we suggest that our stated aims are not fit for purpose – that the social model is insufficient, and that psychiatric abolition, or even substantive reform, is utopian rather than realistic. My aim is to challenge these assumptions, exploring how psychosis can be understood using the social model and supported outside of the psychiatric system.
When I share my critiques of psychiatry with others, a common rebuttal is “what if you had a loved one that was psychotic — would you still think the same?” My answer to that is, undoubtedly, yes. My understanding of psychosis is shaped partly by watching people close to me struggle with beliefs that caused them real fear, yet were judged in completely different ways depending on their cultural fit. Some of these beliefs were immediately pathologised as symptoms of psychosis, while others — despite having the same structure, certainty, and distress — were accepted as normal because they aligned with dominant social anxieties around culture, religion and politics. Seeing this double standard up close made it impossible for me to view ‘psychosis’ or ‘delusion’ as a discrete and purely clinical category. It felt less like a measure of innate disorder and more like a reflection of the specific fears society is willing to legitimise, and those it will not.
The medical model presents psychosis as a combination of delusions (fixed, false beliefs) and hallucinations (sensory experiences that others don’t also experience) that cause distress or impairment in daily life. In psychiatry’s own terms, most delusions are ‘non-bizarre’, meaning the content involves situations possible in real life, like being followed or being in trouble with the police. Hallucinations are usually related to the delusion’s content, such as seeing the person you believe is following you. This means even when a person’s beliefs do not reflect their circumstances, the content usually draws on recognisable, real-world events. They are not random or incomprehensible, but shaped by the social and material environment in which the person lives.
Not only does the genuine plausibility of most psychotic beliefs allow them to take hold, but so does the atomised and precarious nature of our society. It is far easier to become paranoid about people around you when you don’t know them, and when you are living with real, unresolved stress and injustice. In these conditions, people naturally try to make sense of their distress by locating its source, especially in a society that offers few collective explanations or avenues for change. As a result, the experience of psychosis is often far more distressing and debilitating for those living in urban areas and in neoliberal countries. A study found that London and Paris had the highest rates of psychosis in the world, with the strongest predictor of psychosis being a low rate of owner-occupied housing — the metric used to measure housing instability, and by extension inequality. A separate study found that the experience of psychosis varied wildly around the world: while paranoid and distressing symptoms are common in individualistic societies, psychosis is viewed neutrally or even positively in more community-oriented societies. The paranoid, persecutory beliefs we associate with psychosis are not inherent to it; they don’t prove a disordered mind, but rather a disordered society.
This becomes clearer when we consider the prevalence of ‘delusion-like beliefs‘ in the general population, and how analogous these are — both in content and impact on the individual — to those that are pathologised as psychotic. Fixed, false, and distressing beliefs are common, often relating to victimisation: there are far more social media stories of “stalking” and “almost abduction” than are statistically credible. These anxieties are distressing, and often disrupt people’s lives, but they’re also understandable. In a patriarchal society where crime is common and its fearmongered media coverage even more so, “stranger danger” takes precedence over community. In such a society, it is common, natural, and certainly not ‘crazy’ to distrust others.
Crucially, this pattern isn’t limited to beliefs commonly labeled as ‘delusional’. Many culturally accepted beliefs operate in much the same way: they draw on shared narratives, become deeply personal, and shape people’s daily lives, even resulting in sensory experiences that are analogous to hallucinations. For example, religious or spiritual frameworks may involve beliefs about divine punishment, demonic forces, or apocalyptic futures; while political conspiracies may centre on shadowy elites, impending wars, or secret plots. These beliefs can be intensely distressing, all-consuming, and resistant to counter-evidence, yet they are rarely medicalised when they align with dominant cultural or ideological norms. My point is not to pathologise religion or conspiracy, but to highlight the absurdity of pathologising beliefs at all. If distressing, unprovable beliefs are ubiquitous across society, then the act of singling some out as symptoms of illness appears less like science and more like a social judgement about whose interpretations of the world are permitted.
This means that the harm lies less in what people believe than in how those beliefs are responded to. Regardless of content, the best way to approach distressing beliefs is with honesty and respect. For example, a person I know talked to me recently about their fear of stranger abductions, and how they believe a trafficking ring will abduct them if they leave the house. I discussed this belief with them like I would with anyone, regardless of diagnosis. I affirmed their right to be afraid but explained why I thought the belief was not credible; I showed them the true statistics for stranger abductions and stated my opinion as to why it’s such a prevalent yet irrational fear. That it’s the moral panic of “stranger danger”, similar to other moral panics in that it keeps people fearful of, and so separate from, their communities, stifling attempts to organise and shifting blame for social problems onto some ‘other’ rather than addressing their structural causes. This explanation reflects my real view, and it starts a discussion rather than shutting one down. In contrast, responding to psychotic people with lies, such as by disingenuously affirming the content of distressing beliefs, or misleading someone into compliance with a narrow model of ‘recovery’, strip those interactions of honesty and agency. Whether the aim is to reduce disruption, secure cooperation, or facilitate treatment, deception denies people their autonomy. Being repeatedly lied to, managed, or misled in this way is often noticed, and it understandably reinforces paranoia.
The harm deepens with the involvement of carceral systems like psychiatry and the police. Interventions such as forced medication, involuntary detention, welfare checks, and surveillance are justified as neutral or therapeutic responses to psychosis, but they are often unwanted and distressing. Many common psychiatric practices have been recognised by the UN as “forms of torture and ill-treatment” when they rely on coercion, confinement, or the removal of legal capacity. When a person’s distress is met with force, and when those around them collaborate with systems that deny their account of reality or conceal decisions being made about their body and freedom, trust is damaged. What is presented as care becomes indistinguishable from punishment. When a person is forcibly medicated, detained, or surveilled, is it really irrational for them to feel persecuted? And when you are persecuted, is the paranoid response to blame distant powers, or to look to the people, services, and systems that you trust, that are meant to care?
If we take the social model seriously, then psychosis cannot remain the exception that proves psychiatry’s authority. The social model asks us to locate distress not in defective minds, but in unequal, violent, and isolating conditions; to understand impairment as something produced through the interaction between people and their environments. It requires us to recognise that what is called ‘psychosis’ is often an attempt to make sense of real insecurity, injustice, and harm in a society that offers few collective explanations and even fewer routes to safety.
From this perspective, the harm associated with psychosis is not inevitable. The question then is not how to correct or contain psychotic beliefs, but how our responses either compound or relieve distress. Coercion, deception, and surveillance don’t restore trust or clarity; they deepen fear and confirm a sense of persecution. Likewise, drawing rigid boundaries between “sane” and “delusional” beliefs doesn’t protect people from distress, it simply determines whose interpretations of the world are taken seriously and whose are punished. A truly liberatory approach to psychosis is not force disguised as care. It asks that we build our communities, and create trust rather than dismissing distrust as madness, and in doing so strengthening the distrust and isolation felt. A truly liberatory approach to psychosis demands honesty, solidarity, and material change.
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Giant Wasp — By Odeith
Nerd Fact: Black-and-yellow striping is one of nature’s clearest warning posters. Biologists call it aposematism, and the signal is so effective that harmless insects like hoverflies evolved to imitate wasps in classic Batesian mimicry.
Classic Day — By Odeith
Bite My Lips — By Odeith in Lisbon, Portugal 
Giant Rooster — By Odeith in Lisbon, Portugal 
Turquoise ODEITH — By Odeith
Burnt-Out Bus — By Odeith
Porcelain Bowl and Swallow — By Odeith in Portugal 
Giant Beetle — By Odeith
Silver Pair — By Odeith in Lisbon, Portugal 
Truck Cab — By Odeith
Giant Blue Frog — By Odeith in Portugal 
LISBOA — By Odeith in Lisbon, Portugal 
Be Careful When You Drink — By Odeith
Rooftop Kangaroo — By Odeith in Darwin, Australia 
Caravan Corner — By Odeith
Mossy Wall Wasp — By Odeith
Chrome Corner — By Odeith
Giant Bird Visit — By Odeith
Skull on Concrete — By Odeith
Ghost Train — By Odeith in Portugal 
Yellow-Black Lizard — By Odeith
Blue Letter Burst — By Odeith
Magic Angle Frog — By Odeith
Shadow Skull — By Odeith
Pillar Piece — By Odeith
Merge at Druidstone
Carved Void at Lindsway Bay
Clustermoon at Freshwater West 
Grown Stone
Stone Ribbon at 
Moons Motion at Freshwater West
Incline Spiral
Leaveshroom Void at 
Ascending Red at Colby Woods
Twisting Tree at Waddesdon Manor
THÉMIS & ORION — By AKHINE in Pleyber-Christ, France 
Still Life of Belonging — By Fintan Magee in Bitola, North Macedonia 
Digging Toward the Light — By Sipion in Callao, Lima, Peru 
Crashing Tennis Ball — By Jan Is De Man in Utrecht, Netherlands 
Phone Home — Artist Unknown in Europe
Stainless Steel Souls — By Jean Martin in Saint Barth
