Delusions, obsessive fantasizing gone too far, or both?

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Despite the fact that raising my antipsychotic Zyprexa to at least the maximum dose (20 mg/day) cleared out the preoccupations, my current psychiatrist says he is not sure if I was suffering from delusions, or was just obsessively fantasizing a little too much and got in over my head. I wonder, though, if it can't be both.

My preoccupations formed in June 1998 and were that I was Sephiroth, I was destined to conquer the world, I had to train to survive Y2K, a meteor was a portent of all this, etc., and I acted on them in bizarre and dangerous ways in late July 1998, resulting in 6 months of hospitalization. This actually wasn't too different from my very common fantasizing habits, in which I always imagine I am a chosen one destined to bring greatness to the world. This fantasizing has died out in the past 5 years or so since I joined the skeptic movement and began my gender transition, and I experience the loss of fantasy as a deadening of my world experience. Since it has died out, the world has come to seem more dead, more limited, more uninteresting to me.

There's an interesting article on schizophrenia that goes into why patients have such poor insight and it says that it is the manner in which the symptoms are presented to the patient that is the main cause: "3 interrelated aspects of the emergence of psychosis." One of these 3 aspects is given as follows, in which the psychotic experiences do not seem very different from the more common non-psychotic experiences, so the development of an illness when psychosis finally forms is not apparent to the patient (bold emphasis added; italic emphasis in original):

I think it was both but it also seems hard to make the distinction. I think the distinction is subjective and the person making the diagnosis has too much power of interpretation. Culturally appropriate beliefs that would otherwise be considered delusions are excluded because they are taught. False beliefs that aren't subjectively outrageous enough aren't given the status of delusions. If I believe destiny is making my life miserable and that bad things just happen to me that might get me diagnosed with severe depression rather than psychosis. That would be a false belief and there are a lot of false beliefs and cognitive fallacies involved in depression which is why we have Cognitive Behavioural therapy. I was basically told in the hospital that I have false beliefs that aren't delusions. They're normal false beliefs that depressed people get such as "I'm a failure", "I'm stupid", "everybody thinks I'm annoying" and that type of stuff. Also I think they're more malleable than what we consider delusions. Conviction is another thing that a psychiatrist has the power to subjectively evaluate. I don't know how we can have a concrete distinction between delusions and fantasies.

For some reason I personally look at what you wrote and I think there's no way it could've been just obsessing/fantasizing on its own. You believed you were a fictional character. If you were just fantasizing about saving the world I could see that being a fantasy and nothing more.

Then there's something that's also subjective in that how do you differentiate between a half-belief or suspicion and a strongly held belief. You could suspect that you're destined to save the world while being open to the possibility of being wrong but still hope you're right. You could believe with 100% that you are destined to save the world like it's something you know rather than something you suspect might be the case. Are both of those examples of delusions? Is only the second example a true delusion?

I don't know anymore than you do about protection. I would think that if you don't fantasize as much you might be less vulnerable but I don't know.

Good questions. My conviction was never tested, because I never gave anyone the opportunity to test it. Typically, in cases of delusions, the person states what their delusion is and the interlocutor (like a family member or doctor) tries to reason with them, but the person sticks to their delusional belief. This proves that the person is delusional; this shows the patient's 100% conviction. As for me, I refused to state fully my delusional belief and so my conviction could never be tested in that way. Before I was hospitalized, I thought I had stumbled upon something supernatural, strange, and secret and kept it a secret. After the incident for which I got hospitalized and when I was questioned, I was embarrassed that my ideas came from a video game and I didn't want the video game makers to get the blame for it, so I described my experiences using fragmented hints and misdirection, to get them to stop asking questions, frustrating my doctors who couldn't tell if I was psychotic or not.

Nevertheless, there is that one scene in Final Fantasy VII which was the inspiration for what I did when I acted on my delusions and I have believed since then that if anybody close to me who had been involved in the incident were to see that scene, they would fully understand my delusional system: It would all come together for them. When my sister played through that game once years after my psychotic episode, I kept a close eye on her progress so that when she neared that scene, I then sneaked in and played through the scene in question, saving her progress, and offered no explanation for doing so. My purpose was to prevent her from seeing that scene and fully understanding where my inspiration came from. That was my fear and embarrassment.

Anyway, back to the issue of conviction. As I understand it, in the real world, conviction tends to vary over the course of a psychotic episode, and this is especially true of schizophrenia, partly due to the phenomenon of double bookkeeping (see the OP which quotes the article on this). Like how I thought I was Sephiroth and destined to take over the world but at the same time still worked to get into a regular school to avoid being in special ed any longer: I was working in two different worlds at once, my private, psychotic world and the real world (as mentioned in the article in the OP). A classic example is the man who has the delusion that he is the Pope, but still does his janitorial work: he's living in two worlds at the same time, as well. Nevertheless, as the article in the OP mentions, worlds can collide. That's what happened when I acted on my delusions.

If there is any time where one can say I had 100% conviction in my delusions, it was when I acted on them. The actions that I took were shocking, bizarre, dangerous, and not ones you can typically take back. To go so far with my delusions like this surely showed complete conviction during that time, and I was very blessed by how it ended up turning out.

Outside of that, my conviction was not tested, so I am not sure of how strong my conviction was most of the time.

BTW, here is a reliable source showing that conviction levels vary over time:

seems like it sure wuold suck if ended up geting put on an antipsychotic if you were just "suffering from obsessive fantasy." least when i think of fantasy, i think of a game, and if you get obsesed with that, then you might get litle too into it but with onlly little help can remember that its a game after all. least thats the only difference i can distinguish between that and delusion, where delusion isnt game so much as a false perception or belief about yuorsellf. guess you can get delusional while being obsessed in a fantasy/game. but anyways, i say it would suck if it was just geting obsessed with fantasy because from what i knnow, antipsychotic use has long term physical and mental tolls that, if you were realy just trapped in a game for while, really shoulldnt have been deployed at all.

ive always seen and heard things since long as i can remember and when i was a kid i used to thinkk that i was destined to rule the world. didnt really conflict with reality as far as i was concrned because i didnt believe i already ruled it, but i was going to, so didnt matter i was dirt poor and abused everyday in present, i woulld find a way eventualy. then i eventualy gave that up because i didnt want power and responsibllity anymore for awhile until i decided to start training to becom a priest. now i think im most likely a god (im not certain yet). do i think these are delusions and fantasy? nope. i tried getting help for these things once and modern psychiatry wasnt able to help me so that only further strengthened conviction that what i was experiencing is real, but more than that what right does anyone have to tell what in my world is true or false? for all i know, they dont even actuallly exist (i dont believe that but its pretty much the ultimate argument of why someone else outside of me saying what is and isnt real is absurd/irrelevant). thoughts and feelings always become ones own reality, and as i am the only one in possesion of my thoughts and feelings, im the only one who can determine what is and isnt real for myself - least that's what got me to point today, sanely insane and mostly at peace with what i experience, no mental meds, insted of undermining my own reality by declaring parts of it fantasy or delusion because others say so and ultimatelly destroying my own sanity. the only thing that ultimately determines whats delusion and whatts reality is how eloquently you express it and how popular it is, and ive determined not to let popular opinion deter my quest for wisdom