What is insight ?

Insight

This is a modified version of a letter written to an individual patient who asked me to explain what I meant by developing insight.

I am sorry it has taken me so long to get round to writing this letter to you as promised. We agreed that I would write to you to explain my views about your illness, the treatment you are getting, and the process of rehabilitating you into the community.

You suffer from a mental illness that is probably caused by an imbalance of brain chemicals. These chemicals are called neurotransmitters and allow the brain to communicate with the body and with other parts of the brain. One of the features of the illness is what we call "psychosis ", which means having thoughts, beliefs and experiences that are real to you, but to everyone else are unusual and inexplicable. Another characteristic of psychosis is the experiencing of sounds, sights, tastes or feelings that aren't apparent to everyone else. And alongside all of those symptoms is what we call a lack of insight. The person who is suffering from the illness has unusual sensations and beliefs that are real to them. If they have insight, they can see that these things are not happening; if they lack insight, they do not understand that their experiences are "a trick of the mind ". To put it another way, someone who is ill cannot see that it is their illness that makes them see, hear, taste or believe certain things. Part of getting better involves developing insight, which means understanding the reality of the situation.

Medication hopefully will improve your symptoms so that you stop feeling paranoid and irritable, reduce or stop altogether hearing things or seeing things and generally means you relate better to other people. It is when you achieve a level of understanding and knowledge about the circumstances that we will know when you are developing insight.

It is extremely important for you to be well before you can live in the community. If you were discharged from hospital too soon, things are more likely to break down, requiring you to be re- admitted to hospital. To ensure that we can discharge you safely into the community without you posing a risk of harming yourself or harming others, you and we all need to understand your illness. This means being extremely honest and sharing information so that we can establish when you have developed insight and when you are well. Also we jointly need to make a list of early warning signs of your illness so that we can take steps to stop you from becoming very unwell and needing hospital. We call this making a list of relapse indicators.

It is hard for you to know that you are suffering from an illness that cannot be cured. Medication will help treat the symptoms but sometimes people with that kind of illness relapse either because they stop taking their medication or because they use non-prescribed drugs or alcohol or because something stressful happens in their life. In some cases when individuals are ill they have had certain beliefs and experiences that result in them posing a risk to themselves and/or to others. It is important that if you are to live successfully in the community you are well so that you are not a risk to yourself or anyone else. That is why it is very important to make sure we give you every possible help to get you as well as you can be. I cannot put a time limit on how long this will take, but we are all working to improve your mental health so that you can safely live in the community

I hope this letter is understandable and answers some of your queries. I would be happy to discuss any of the points further if you have any questions.