Insight (Elle)

John’s last post about signs has me smiling. Sometimes when you’re deluded the signs are massive and neon with flashing lights and the whole universe pours into that moment and makes complete sense of everything. You’re probably quite unwell at this point. Any feeling of omnipotence, or feeling like you have a divine purpose in life is obviously far from reality.

John was also talking about religion, and holding it lightly. This often weaves its way into delusional states. The first psychiatrist I saw treated me with anti-depressants for ‘major depression and generalised anxiety disorder’. This wasn’t entirely successful because the diagnosis was wrong, and I was cranking up through the bipolar gears towards my first psychotic episode. One morning I woke up wired and highly strung; my thoughts were racing. I remember being very confused by what I was thinking. On the one hand I was convinced I had some divine role to play in the universe (I was seeing myself in divine terms), and on the other I was confused, but didn’t think I was very well. I was high and racing, and needed to take action. So I set off from the flat with no idea what I was going to do next. The 50% bet was to walk straight ahead to the cathedral and find a priest to discuss my earthly mission with – no-one else could possible understand my calling. The alternative 50% bet was to turn right and speak to a GP. I walked for 15 minutes in a strange state – completely divided and torn between these two possible actions. And then turned right.

Insight is fascinating. To have insight into our condition is a human endeavor for self-reflective people. We are self-reflective creatures, more than any other creature. We can turn our attention on ourself, and learn from that, and grow. Insight into our actions can protect us from ill-considered and destructive actions. Insight makes us more alive to our life. Insight into our mental state and our mental illness can help us engage better with help. Part of the general psychiatric examination that psychiatrists carry out involves an assessment of insight. But insight isn’t an either/or state. It comes in degrees. Someone who is convinced of the fact that they are Jesus, unshaken by any evidence to the contrary, has no insight. But that morning I walked across the meadows holding two entirely conflicting possibilities in my mind, I was in a state of partial insight. I’ve never experienced it so convincingly since. It’s a bizarre state to be in. I was convinced that I was divine, AND I was also equally convinced I needed a doctor. The challenge for psychiatrists and psychiatric nurses is to work with these varying degrees of insight, and I can’t imagine it’s easy.