Interestingly my delusions were based on self improvement for the most part...I'm not saying there weren't some scary horrible ones but the majority were about writing a grant for my job...I had a nutritionist who was a voice and helping me eat a better diet...I also had a voice who was an IT guy...he did everything from helping me enhance my computer security to helping me play strategy based video games more efficiently. The ones that weren't constructive told me I was psychic and possibly a shaman but I felt I could heal the world with just my thoughts and it was incredibly pleasant. So I had work and play and everything was exciting much more so than ever before so I don't think all these concepts are mutually exclusive. So I think you can be deluded but also have real aspirations...albeit this could be because I'm a scientist and part of my job is creation and seeing patterns in data so relaxing my normally rigid thresholds actually opened up more possibilities.