The Price of Insight


I'm OK A prominent feature of  schizophrenia and bipolar disorder is anosognosia, a sick person’s unawareness that he is sick. — Algis Valiunas, New Atlantis, Winter 2009.

No one really understands why those of us with serious mental illness struggle with insight.  Current medical theory holds that it’s actually a core feature of our neurobiology.  It’s not that we’re in denial or stubborn—we simply can’t see.

This seems ridiculous to those observing from the outside as our behavior becomes more risky and disjointed.  But those are the times when our insight is most impaired, because anosognosia is also a symptom. We lose insight just when we need it most.

Lack of insight is relative.  It fluctuates as the illness fluctuates.  When we are in remission or in a more stable state, we can often see that we were ill.

Lack of insight is listed as the leading cause of non-compliance with medication (I’m not sick, so why should I take these drugs that make me feel lousy), and in another paradox, compliance with one’s medication regime can improve insight in some cases.

Aggression and violent behavior are also linked to lack of insight.

So, if insight is important to recovery and functionality, what can we do to foster it?  Unfortunately (and not really a surprise), the mental health delivery system has little to offer:  Take your meds.  Go to therapy.

I’ve been told by most of the professionals I’ve worked with that I have a high level of insight.  Even when my symptoms are at their worst, I retain some awareness, though it becomes harder to access and trust.  But very few of those therapists and psychiatrists ever asked me if I do anything to strengthen my awareness.  The fact is I work very hard at it.

I started meditating and working on mindfulness years before I was diagnosed with bipolar disorder, and those practices continue to help me “wake up” in the middle of an episode.  Meditation is the only “exercise” I know that builds the muscle of insight.  And like any muscle, the more it’s worked, the stronger it becomes.  We can build insight by using insight.

It’s not for weenies, this practice.  Ask any neuro-normal who sits meditation or suddenly realizes he’s projecting his fears into the future instead of living in the Now.  Most people are asleep.  To be anything else requires dedication, courage and sweat.  It also requires forgiveness, tenderness and a willingness to observe rigid beliefs with gentle curiosity.  Even then, moments of awareness are fleeting.

Insight is a Big Ticket item, and most people would rather spend their hard-earned psychic cash elsewhere.  I get that.  I’ve taught meditation for fifteen years with many online groups like Askyourguide and BeHere. Most people don’t stick with it.  Sitting with oneself can be uncomfortable.  It can be frightening.  Why not practice golf instead?  At least that’s fun.

That’s been my experience with neuro-normals.  Now I’ve been asked to teach meditation to folks like me with serious mental illness.  I’ll introduce it gently next week, then see if anyone wants to continue.

Because these are people who will recognize the price tag.  And they might decide it’s worth it.

16 Comments (+add yours?)

  1. Brenda Knowles
    May 16, 2015 @ 16:03:40

    I learned a few things SandySue. Thank you! I believe in meditation but admit it’s hard for me (a neuro normal) to commit to consistency. I’ll be curious to hear how your new classes go.


  2. Moss Piglet
    May 16, 2015 @ 16:04:08

    Reblogged this on abelmoir.


  3. Cheryl LaVille
    May 16, 2015 @ 16:22:05

    This was a great insight for those who don’t have a bi-polar diagnosis. I appreciate it when you give information about the illness and then break it down so that I can understand the illness better. I would, however, question your statement that golf is fun! 🙂 Love the card–gorgeous. Love the words on it, too. A visual delight!


  4. Kitt O'Malley
    May 16, 2015 @ 19:12:13

    Thank you, Sandy Sue. Back when I was a suicidal 18 year old, I underwent cognitive therapy in which I learned to distance myself from destructive thoughts. Even years before that I learned some mindfulness techniques via yoga learned in physical education at school and used as a warm up exercise in drama class. Now that I read your post, I realize to what extent those skills enabled me to develop insight. Not that my insight was developed overnight. I still wasn’t diagnosed bipolar until I was 39. But, the mind is a complicated thing, not easily defined or put into a simple diagnostic box. That said, years of psychotherapy for depression, taking medication for depression and later for bipolar disorder, and maintaining a certain distance from unhealthy thought processes, has helped me, has kept me alive, in fact.


  5. Penny
    May 16, 2015 @ 19:20:52

    You’re no weenie.


  6. cabrogal
    May 16, 2015 @ 20:49:57

    Anosognosia is just another term of abuse psychiatry applies to those it labels mentally ill. Specifically it’s used against anyone who disagrees with their diagnosis or with the treatment regime applied against them.

    Those designated neurotypical have lots of areas in which they lack insight. For example they tend to have an inflated and deluded idea of their ability to control their own lives. The more accurate view is called depressive realism. Yet strangely enough psychiatry has yet to coin a derogatory term for the lack of insight shown by those without a diagnosis (note how even when they have a firmer grip on reality it’s the patient who wears the label, not the deluded majority).

    Anosognosia is yet another of psychiatry’s pseudo-illnesses made up in order to justify the ridiculous amount of power psychiatrists have over those they pathologise.

    Aggression and violent behavior are also linked to lack of insight.

    Overall, those with a psychiatric diagnosis are less likely to commit violent acts than the general population (despite being violently victimised at much higher than average levels) but they are much more likely to be claimed to be suffering from anosognosia – which is typically applied to someone who argues with a shrink, not someone who punches one.

    The small sub-group of mentally ill people who suffer from psychosis have a very slightly raised risk of violence (most studies put it at around 2% over five years, compared to the general population risk of around 1.8%). There are demographics with much more associated risk of violence (e.g. young men, binge drinkers, those who play contact sports …) yet they typically do not have their entire existences pathologised with derogatory terms that deny them not only agency over their actions but even the capacity to monitor their own thoughts.

    BTW, notice how E Fuller Torrey’s Treatment Advocacy Center – major promoters of “Kendra’s Law” type legislation as well as anosognosia and the dishonest claim that mentally ill people are at elevated risk of violence – publish figures showing the mentally ill are under-represented among violent offenders in the US. However as they don’t contextualise their raw numbers by comparing them with overall rates of mental illness, the ignorant and statistically illiterate (a majority unfortunately) will come away from their website with the impression mentally ill people are dangerous.


  7. cabrogal
    May 16, 2015 @ 21:09:32

    Oh, I forgot to mention.

    Anosognosia was originally a valid label applied by neurologists to those who are clearly and objectively unable to recognise a disability. A relatively common manifestation is stroke victims unable to acknowledge they are partially paralysed and so keep coming up with rationalisations as to why, say, they drop everything they try to carry with their affected hand. It is closely associated with specific damage to the right parietal area of the brain.

    Psychiatry didn’t invent the term. It appropriated and distorted it to it’s own purpose.


  8. pegoleg
    May 17, 2015 @ 10:11:08

    I’m not familiar with the terminology, but it doesn’t sound derogatory the way you explain it, just descriptive. It’s interesting. A friend’s significant other has been inpatient for threatening suicide twice in the last year. This is something to keep in mind since my knee-jerk reaction is to say, “well why doesn’t he stay on his meds?”


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

Blog Stats

  • 184,335 hits
%d bloggers like this: