Delusional psychosis isn’t about being “out of touch with reality”. It’s more a matter of seeing multiple ‘realities’ and not being sure which ones everyone else thinks they’re inhabiting.
Human cultures are symbolic constructs. Most neurotypical people mistake the shadow for the prey, believing that the socially symbolic value of this or that element of their mindset and/or environment is “what matters”. This parallels ‘naive realism‘, though I’m not sure the two notions are entirely co-extensive.
In some forms of neurodivergence – ASPD, for instance – the shadow is pretty meaningless, and all that is real is the prey. In others – delusional disorder being a prime example – there are only shadows: nothing (save the individual themselves) is real.
Contemporary psychiatric taxonomics and diagnostics are conceptually primitive and – generally speaking – philosophically unsound. They’re established by neurotypicals for neurotypicals, and don’t take into account how the ‘disorder’ represents a coping mechanism with respect to perceived or apprehended characteristics of (neurotic) neurotypical culture. And the most salient characteristic is symbolic interaction – indeed, George Herbert Mead considered society to be symbolic interaction.
With respect to understanding neurodivergence, a recent trend is to reintegrate its various forms as valid – if sometimes antagonistic – ways of apprehending and experiencing the world. This has two corollaries, one metaphilosophical; the other, pragmatic:
1. While allowing the dialectal basis of social reality, criticism of Median symbolic interactionism points out its assumption of sophisticated realism as an underpinning metaphysical thesis. I’d contend that antirealist fictionalism provides a foundation that is more congenial to neurodivergence in all its forms.
2. As a phenomenal and pragmatic condition, neurodivergence provides society in general with high-end deviations that benefit the community as a whole (intelligence, rationality, creativity, audacity…). Ensuring congenial mental and emotional environments for such folk, thus ensuring their social and psychological comfort and freeing them to pursue the positive characteristics of their difference, promotes innovation and enriches humanity.