I got a lot of stuff going on off Hive ever since I started working in the Psychiatry Department. Let me tell you one of the items we check for each patient under the Mental Status Examination (MSE) is insight. It’s the capacity to gain an understanding of something, in the patient’s that we handle, their capacity to recognize their predicament. I think I’ve only reached my 3rd encounter with the divine spirit and one of them was a child of Zeus that hears songs sung by Bruno Mars like a mental playlist. Insight is a gauge whether the patient understands the situation they are in and why they think they are confined.
Usually, if the patient recognizes that they have a mental problem and needs the hospitalization, the path to recovery gets smoother. But for cases when they are still convinced that their eyes can shoot laser, it can take a few more days before the medications and psychotherapy interventions kick in. It goes back to the first steps in problem solving, if they can’t recognize they have a problem by insight into their situation, they’ll often be resistant. In some cases, just compliant to whatever you tell them to do without learning anything from the experience.
What insight does is get the person to recognize they have a problem and we hope once that realization kicks in, they start thinking ways to work with us. But here’s the thing, it’s not enough that a person recognizes they got a problem that needs solving. They also need to accept the hard parts about going through recovery like lifelong compliance to the medications and other lifestyle adjustments that come long with it. Insight isn’t enough to move a person to do the right thing. Don’t believe me? Try convincing a chronic chainsmoker or alcoholic to just cutdown their addiction. There’s a good chance these people recognize that their addiction is bad but they just can’t find it in themselves to quit the habit.
Bad insight is failing to recognized why people are mad at you for gambling so much and stealing from others during a manic episode. Bad insight is failing to recognize you’re not the son of some deity. Bad insight is labeling your self harm habits as healthy means to cope with your stresses.
It’s almost the same thing with people who have moments when they lost touch with reality. Sometimes there are moments when they are lucid and can think for themselves but feel powerless about their situation and resign to their fates to permanently comply to the regimen. This isn’t ideal because as soon as you set them free, they’ll come back to old habits like denying they have a problem and fail to take their meds and come back to us again. It’s not the case for everyone but it happens often. Sometimes, it’s not the patient who lacks insight, but the folks that we have to work with that refuses to accept their situation. A proud mom who has a valedictorian kid that succumb to psychosis may be in denial of the situation and that impedes their kid’s path to recovery. Mental health problems aren’t just the patient’s problem, it’s everyone’s problem, all those included in society.
It’s a case to case basis and not everyone recover the same way. Some patients have already been cognitively impaired that your only best outcome is they become compliant with the treatment regimen long term and are well supported by their guardians. I say guardians because sometimes it’s no longer the family that takes care of them but social workers. In the institution I work for, cases when the only person the patient relies on is themselves to do the follow ups or having a legal guardian assigned to them by social service, because their folks have abandoned them. It’s not enough that they have insight, they or their guardian must exercise good judgment as to when to seek further help and make the necessary lifestyle changes.
Thanks for your time.