In many ways, schizophrenia and paranoia are the extremes of the experience of madness. The first develops (often abruptly) at a relatively young age: the subject suffers delirious confusion, bizarre dissociative and cognitive impairment, as a result of the disease. It is to be said however, that today, thanks to new neuroleptic drugs, the illness is less debilitating than in the past. Typical of schizophrenic psychosis is the autistic closure with which the subject attempts to cope with the feeling of losing his personal characteristics, the feeling of the splitting of his ego or the hallucinatory experiences that reinforce his distress experienced in relation to the ‘outside world’, of others and to what is different. Schizophrenics, thus, tend to live their delusional reality, entrenching themselves in defense of what remains of the central conceptual core of themselves. Paranoia, on the other hand, begins to manifest itself instead (after a long period of ‘incubation’) in middle age. It is expressed with morbid yet lucid ideation that borders on the plausible, and resisting all forms of treatment, almost always ends up with the patient in the darkness of a cell. Contrary to schizophrenic psychosis, in paranoic psychosis, the patient in experiencing the ominous presence of the persecutor sees no other way to protect himself other than that of attacking with all the means to him available (verbally, physically, etc.). In short, in schizophrenia there seems to be a necessary opposition to otherness, in paranoia, instead, the need or search for the presence of the other. We can therefore say, that behind the usual psychiatric definition of psychosis, there are very different ontological and psychopathological developments. Besides the delusional continuum that characterizes psychopathological states, forms of madness assume different and specific emotional, cognitive and social aspects. In this paper we will outline the ontological distance between psychopathology and the existential modalities of madness, that of schizophrenia and paranoia, that while portraying two aspects of one single delusion, however, seem distant enough to make the kraepelinian distinction between dementia praecox and madness still relevant. This gap can be investigated on the grounds of the personal drive to live emotional experiences, on the recognition of the object (internal) or subject (external) of morbid ideation, or by analyzing the communicative and relational needs of the delusional patient. In other words, the tendency to experience feelings of empathy, the need to consider others and their beliefs in the sense of obtaining a theory of mind (ToM) or get to the point of understanding and sharing the content of an morbid idea with another delirious subject can constitute a phenomenological complex that can be used to establish the difference between the various forms of psychosis? But, above all, what is the role that language plays in all this?