“Insight” into “Mental Illness” Associated with Depression, Poorer Life Satisfaction

Rob Wipond
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Many people being treated for mental illnesses feel slightly more depressed and much less satisfied with their lives if they have greater “insight” into their illnesses, according to a study in Schizophrenia Research. “Insight” was defined by the authors as being related to acknowledgement of one’s illness along with “treatment adherence” and “treatment engagement.”

The researchers noted that previous research has been contradictory as to whether having “insight” into one’s “mental illness” along with “treatment adherence” and “treatment engagement” are actually helpful to people or not. “A frequently proposed key condition for recovery is insight into the illness, defined as awareness of the phenomena and consequences derived from having a mental disorder,” wrote the researchers. Lack of such insight or denial that one actually has a mental illness, they added, “is one of the major defining characteristics of psychosis and a frequently observed aspect in persons suffering from schizophrenia spectrum disorders.”

The researchers noted that some studies have found “lower levels of insight” related to increased symptomatology and severity, poor psychosocial adjustment, poor social and vocational functioning, low treatment adherence and negative prognosis. Other studies, however, have found that “higher levels” of such “insight” are connected with increased hopelessness and emotional distress, depressed mood and lower self-esteem, lower subjective quality of life, higher suicide risk, lower physical health and vitality, lower vocational status and less economic satisfaction.

Led by researchers from the University of Madrid in Spain, the 47 participants in this study were a convenience sample of inpatients of psychiatric units in two university hospitals who were currently suffering from “persecutory beliefs” and had diagnoses related to schizophrenia, psychosis and delusional disorders. All of them were currently involved in psychiatric treatment, and were interviewed by the researchers.

The researchers found that as “insight” into one’s “mental illness” decreased, the patients experienced less anxiety. “This could suggest that accepting the illness was associated with uneasiness and not to relieve (sic) in these cases,” the researchers wrote. They also found a “positive and significant association” between “poor insight” and satisfaction with life, “suggesting that acceptance of the illness is associated with dissatisfaction.” They further found that, “The presence of insight was associated with more depression when there were high levels of self-stigma.”

Valiente, Carmen, Maria Provencio, Regina Espinosa, Almudena Duque, and Franziska Everts. “Insight in Paranoia: The Role of Experiential Avoidance and Internalized Stigma.” Schizophrenia Research 0, no. 0. Accessed April 12, 2015. doi:10.1016/j.schres.2015.03.010. (Abstract)

10 COMMENTS

  1. If “insight” means “agreement with the professionals,” then “insight” means accepting that your brain is broken, that you won’t ever be able to do anything about it, and that you should adjust your expectations in life to being partially to totally disabled and to be dependent on drugs to manage your emotional states for the rest of your life.

    With that kind of “insight,” it is small wonder that people feel more depressed and hopeless! Other than a diagnosis of a terminal disease, it’s hard to imagine a more disheartening message than what most people are told about the nature of their “mental illness.”

    —- Steve

    • …and forced, often against their will to take drugs which make them physically sick and mentally disabled (often 1000 times more than any “mental illness” causes them to be) with unpredictable and devastating long-term effect and perspective of 25yrs shorter life.

      Psychiatry – we turn short term problems into long-term clusterf*** since XIXth century.

  2. Silly me, ha ha, when I read this title I thought they actually meant real insight into people’s conditions, like understanding that living in a capitalist cesspool understandably makes people crazy — which doesn’t really make anything better, other than to confirm that our perceptions of being oppressed and persecuted are valid, so having that insight with no apparent answers in sight could make one even more crazy.

    But no, with a straight face the article actually means “insight” as in the longest-running catch-22, the oldest and tiredest canard in the mental patient experience — the notion that “insight” equals acceptance of the label “mentally ill,” and that rejection of the label is proof that it is accurate. But no sense of irony is apparent. It would certainly follow that if insight is equated with accepting a false and disempowering self-identification then one’s emotional state is quite understandably likely to deteriorate as a result. But I don’t think that’s what they mean either…

  3. I would hesitate to generalize this to the population of people with the same symptoms and diagnoses who are not in psychiatric units, just on principle.

    Being in a locked ward with forced-drugging is profoundly different from being at home. It would affect my answer to anything I was asked about myself.

    • There are more studies that show that believing in “Chemical imbalance” theory is associated with higher levels of depressive symptoms (reverse of what was expected by people who conducted the studies). I don’t have time to search now but you can put “chemical imbalance” in PubMed.

  4. “Many people being treated for mental illnesses feel slightly more depressed and much less satisfied with their lives if they have greater “insight” into their illnesses, according to a study in Schizophrenia Research. “Insight” was defined by the authors as being related to acknowledgement of one’s illness along with “treatment adherence” and “treatment engagement.” ”

    This is so awesome… Another proof that psychiatry does more harm than good.