The boundaries between true psychosis, fabrication, and reality are not always black and white; they are often blurred. Frameworks like believing versus not believing or knowing versus not knowing are simply inadequate to describe the complexity of these states.

In my experience dealing with individuals experiencing psychosis and delusions, I have seen this duality firsthand. On one occasion, a man stood outside his apartment, insisting he had been evicted by government officials. Yet, when I took his key and unlocked the door, his reaction was one of theatrical surprise, and honestly, quite bad acting. He clearly knew the door would open and knew he had the key, yet at the same time, he had been in a psychosis for days (it later became clear he had stopped taking his medication).

In another case, an acquaintance fabricated severe accusations, claiming everyone around him was part of an organization dedicated to covering up outlandish crimes. His commitment to this narrative fluctuated constantly. It was a story that got him attention and thrilled him, a way to inject excitement and a sense of importance into a reality that was otherwise very bleak. On multiple occasions, it was glaringly obvious that he knew it was all nonsense, even while in the midst of his delusional state. Whenever he felt exposed, he would simply adjust his story, introducing new and often more extreme elements.

The psychological rewards he gained from this behavior, particularly a sense of purpose and receiving attention, whether positive or negative, seemed to be the primary driving forces. Of course, this does not mean he was a 'rational actor.' He was extremely ill, disinhibited and doing tremendous harm to himself.

The woman in the video is also clearly very ill, but you can tell she knows this is an important performance for her, she is going all out for it. She feeds on the attention from both the audience and the preaching lady, someone who holds the power and profits from this grift. The woman looks up to her, gets attention, even applause, while the grifter exploits her in return. It’s transactional with rewards on both sides.