Great post! I actually wanted to add that about people staying on them because of paradoxical effects from withdrawal. It is definitely used by some/many doctors and patients alike to promote submission to lifelong use, acceptance of lifelong dependence and to view med use as somehow normal or desired.

However, I think a small majority sees it as something necessarily associated with some medications and therefore they see it as being something only negative.

This forum is (most likely) not representative of everyone treated or untreated but diagnosed with a psychotic disorder (or having all symptoms). Per se, many, and possibly many more, are either in denial or have found other, some completely positive, ways to cope and see us as mere sheep.

Paradoxical effects from withdrawal of meds in perfectly normal. It is like taking the train to work or cycling to work: you will quite possibly feel better after some time of cycling, but at first you may feel really bad. The train, however, is not to blame for you feeling bad.

It is not particularly bad either, if you have asthma, for example. Loss of oxygen can be very unhealthy. Med withdrawal problems can be very much eliminated by slow, gradual withdrawal. Asthma may become manageable when you are exercise despite great problems at first. Just take it (very) slowly.

This analogy might not be perfect, but the takeaway is simple: of course you do worse after you lose something that helped you before. It might be better to be less dependent, but that doesn't make it easy, just worthwhile.

The antipsychotics work (maybe purely: it just is very hard to tell exactly what they, indirectly, do) by treating symptoms, sometimes called the endophenotype, but by doing so they cause a relief of a few forms of toxicity. In as far as they may cause brain atrophy this is of course working against that. However, the positives can (and tend to certainly for chronic forms of (pre-)psychosis/mania) outweigh the negatives.

Even just feeling slowed down can relieve stress on the brain, just by your behaviour alone. By slowing down specific activity in the brain it can (and does if they are needed) relieve your brain of further stress and other forms of toxicity, for example by stimulating (or, more directly, increasing) detoxification.

Mood stabilisers (including anticonvulsants) tend to work on symptoms as well as directly on detoxification.

If I were to choose between antipsychotics or mood stabilisers for long-term, prophylactic treatment, having only problems when unstable/manic/depressed, I would choose a mood stabiliser monotherapy any day. If it were just the case that I got called delusional all the time, without any problems in functioning: a mood stabiliser only. Only some "background" hallucinations: no antipsychotic.

But my chronic delusions really make it hard to function, so I use an antipsychotic in polytherapy. Hopefully sooner rather than later, I use none of the usual meds. Mileages vary. Conditions apply. As you often like to point out yourself.

Edit:
About calling someone delusional if you disagree: harmful. Then some caveats. Nor really important: thinking out loud. Or rather, it is about whether you should tell someone who is delusional that she or he is. I think not (or, again, gradually). Tell them they could just as well take an antipsychotic, since they are not delusional. And later tell them they (probably) were delusional. Again: thinking out loud. Not a response as such, really.

Another edit:
Basically, when considering atrophy versus toxicity: don't underuse and don't overuse. Psychosis may lead to underuse of key cortical brain areas, lack of excitation, fear or anxiety may lead to underuse of subcortical areas. Psychosis may lead to overuse in subcortical areas, anxiety (etc.) lead to overuse of cortical areas.

Another caveat, in similar vein: hepatic and renal toxicity can result from med use.

You can't win without some losses. It's all balancing probabilities and looking for more certainty. There is so much we don't know.

Some supplements, nicotine and caffeine, fish or other sources of good fatty acids, however, can be rather safe bets. Though there renal issues may arise as well by overuse.

Too much neuroprotection may lead to mutated/cancerous cell proliferation... and the list goes on.