This post is to describe some concepts I’ll be referencing in other posts & which I think are extremely important for the general public to understand.
They’re common knowledge in psychiatry/psychology but rarely show up in mental health discussions among the wider public. This includes many progressive & leftist spaces that promote discussions on mental health & mental illness but often lack an acknowledgment of these concepts & related issues. Please note I am not a medical person. I’m a patient who has read about these concepts & discussed with my psych health team & so am presenting what I understand these concepts to be along with examples from my personal experience.
The 2 concepts are: Insight, and Control
Let’s start with Insight. Insight is simply the awareness someone has about their thoughts, emotions and actions. For mental illness, it often refers to whether a patient is aware they’re experiencing a symptom or sometimes whether they even realize if they have a mental illness.
It could be as simple as someone who is depressed to be aware that they’re depressed or they’re having depressive feelings. Other examples include being aware of trauma & other triggers & that you’re having a response to triggers. In my own experience, during mixed bipolar episodes or dysphoric hypomania, Insight is very important for things like irritability or anger symptoms i.e. being aware when I’m starting to be irritable & angry at small things.
Insight is not a binary or a constant thing. Folks can have Insight about some symptoms & not others. Folks can have Insight one day & not another.
Why does Insight matter?
Because people’s actions often depend on mental states so having an awareness of your thoughts & emotions & when you’re feeling mental illness symptoms can be important to how you behave. This includes knowing that you need medical care for your mental illness. Without that knowledge, one may not seek care even when it is available. In some cases, lack of insight leads to interaction with the coercive “healthcare” system where ppl might get “treatment” against their will.
This leads to us to the next concept: Control. Control is simply referring to the ability of someone to control their actions or behavior which in turn can impact thoughts & emotions.
How is this related to Insight & how do the two interact?
Often Insight is needed to be able to, for example, control negative behaviour that may result from mental illness symptoms. This includes being able or not being able to use coping skills “in the moment” to reduce symptoms.
Conversely, Insight is not enough to impact actions. One can have Insight but not Control.
For example, when I experience a psychosis episode, I often get what I call “half delusions”. They’re delusions where I’m usually aware I’m experiencing a delusion i.e. I have good Insight. This is not an uncommon experience. It often manifests as varying degrees of belief in the delusion & feels like two halves of my brain are arguing about what’s real. But crucially, I often act like I fully believe the delusional thoughts. This is where Control becomes relevant. Even though I know I’m experiencing a delusion, the fear I might feel from the content of the delusion often means I will act as if the delusion is real “just in case”. As an example, once I had a delusion that the water from the taps in my apartment was poisoned. Even though I had Insight that this was a delusion, I spent almost a whole day not drinking any water because I didn’t have enough Control to not let it affect my actions.
Just like Insight, some days I have more Control than others. Some symptoms I may have more Control too because of coping skills I know or treatments I have access to etc.
The main point of this post was to describe the concepts of Insight and Control and that having Insight does not equal having Control.
This is important in public discussions about mental illness because there’s often an assumption that if someone is aware they have mental illness symptoms, they should be able to stop any unsavoury behaviour that happens due to the symptoms. But this is simply not how mental illness works.