Lack of Insight: The Story of Psychiatry


From Human Givens: “John Read tells Denise Winn about his work showing adverse life events explain most types of emotional distress, and how the medical model ignores it.

READ: . . . One large study found that 90–95 per cent of people with a [schizophrenia] ‘diagnosis’ do not believe, at least at the beginning of their treatment, that there is anything biologically wrong with them. This, unfortunately is mispresented by psychiatrists as a lack of insight which, miraculously, becomes a symptom of the illness – i.e. trying to explain to the psychiatrist that there is nothing biologically wrong with you. This is a very effective power play and double bind – you can’t talk your way out of it. And if you get very upset, as a consequence, the more that confirms that you are crazy.

WINN: I thought that lack of insight referred to people thinking hallucinations or delusions they may have are actually real.

READ: That is one form of lack of insight, but, overall, it is a misuse of the term originally used by psychodynamic therapists. They used it to mean that someone wasn’t aware of something that had gone on in their life that was still affecting them, because they were repressing it. But psychiatry has co-opted it and one of the meanings now is that the person doesn’t have insight into the fact that they are ill – and that they need medication. One of the criteria for psychiatry’s version of lack of insight is not agreeing to have medication, which is quite astonishing. Then they turn it into an actual symptom of the illness, which is also strange. They call it anosognosia, which makes it sound like a real medical thing.

WINN: Apparently French neurologist Joseph Babinski created the term in 1914 to describe someone who had lost the ability to use or feel the left side of their body – but clearly it has been widened out to encompass ‘schizophrenia,’ too.

READ: Surveys show that most people with a ‘diagnosis of schizophrenia’ think that the voices they hear mean something about what is going on in their lives, but usually they aren’t asked about that.

WINN: . . . even when it is accepted that circumstances can play a part in mental distress, the medical profession often talks about a predisposition to vulnerability. In other words, they claim, it is genetic. You would say otherwise.

READ: Yes, because it is absolutely a mistake. In the 1970s, the stress vulnerability model was invented. It is in every textbook, taught to every mental health professional, that you inherit a predisposition to various things, and the strength of that predisposition determines how much stress is required to push you over the edge into whatever diagnosis you end up with. What biological psychiatry never tells people, and they have probably forgotten themselves, is that the original model was very clear that the predisposition could be trauma based.

The researchers included trauma itself as the predisposition to subsequent traumas and stresses, pushing someone over the cliff. And that is absolutely obvious. If, say, you have been physically abused as a child, you are going to be more sensitive to and more damaged by physical abuse later. So both aspects of the stress vulnerability model can be adversity based – or trauma based, to use the word they did. You don’t need a genetic predisposition.

Also, they haven’t found these genetic predispositions! They are still at it, after 50 or 60 years, saying, ‘Please give us another £50 million and we will find it one day.’ The genetic research has gone nowhere. Researchers have given up looking for specific depression or schizophrenia genes and now they are looking for combinations of hundreds of genes. It is a huge waste of money. I was at a conference with my colleague, Professor Richard Bentall, probably our best clinical psychology researcher, when he asked the geneticists, ‘Can you identify a single patient who has ever benefited in any way whatsoever from any of your research?’ And there was silence.”

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  1. It wouldn’t matter if statistics on antidepressant-related suicides were gathered. The moment they’re compiled they’d be confiscated by some local official at the behest of the federal government’s pharmaceutical donors.

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  2. A DIFFERENT Lack of Insight : Psychiatry has a lack of Insight in it’s own behaviour on who they treat.
    from the drgrumpyinthehouse blog (still online) Saturday, May 7, 2011
    “Psycho Home Repairman”.
    My first rotation as a 3rd year medical student (determined randomly at my school) was psychiatry.

    Your first day on clinical rotations you never know what to expect. I was assigned to evaluate Mr. Binford, who’d been picked up by police (for vandalism) the night before.

    I sat down and nervously spoke to Mr. Binford. He was a bit disheveled, but seemed intelligent and reasonable. He owned a home improvement company. He employed several handymen (including himself) and had a central dispatch office. They did all ranges of home and yard work.

    It all sounded pretty reasonable to me. So, being young and naive, I presented the case to my attending psychiatrist. When he asked me what I thought, I told him that this person didn’t seem to need psychiatric care.

    Then he asked me if I’d read through his past chart. Sheepishly I admitted I hadn’t, because I’d been in a hurry to interview the patient early on my first day.

    So he handed me the chart.


    The patient owned no such business. He had a remarkably intricate delusional system.

    He owned a truck full of power tools, paint, and various other home repair supplies. Of which he had some knowledge about using them.

    He drove around the city, day and night, and would randomly stop at houses where he thought they’d called him for work.

    People would come home (or be woken up at night) to find him doing unneeded work on their houses. Cutting down trees. Painting their outside walls. Knocking holes for windows in their homes. Taking apart pool filters. In one case he’d actually painted a guy’s car with house paint.

    I learned that old charts were useful.

    I also learned that even the incredibly delusional could make a lot of sense when you didn’t know their background.

    We called him “Psycho Home Repairman”.

    And to this day, if one of our neighbors turns on a lawnmower or other loud equipment after dark, I go to the window… Just to make sure.
    “he thought they’d called him for work.”

    PSYCHIATRY IS THE “Psycho Home Repairman” to those people who do not ask for HELP with forced drugging and such “treatment. Doing unneeded and unwanted work on their victim/patients healthy BRAIN.

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  3. “Lack of Insight: The Story of Psychiatry,” lol, great title. From one who has done her psychopharmacological research, and understands the psychiatric, et al, DSM “bible” is a scientific joke, and totally scientifically “invalid.”

    “We need to be grateful to the indefatigable critical psychia- trists, psychologists and others, who put their careers [and from the independent psychopharmacological researchers’ perspective, our entire lives] on the line in what, as Read terms it, is a struggle for hu- man rights.”

    So I do have many thanks to the ethical and outspoken “professionals,” who are honestly speaking out against the highly delusional DSM “bible” billers, who still believe in the DSM.

    But there is a relatively easy solution to psychiatry’s and psychology’s systemic human rights violations … make forced drug treatment, of any kind, illegal.

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  4. So let’s say at some point (late onset in my case) I “(over)heard voices” while at home, alone, that appeared to be the neighbors. Fairly quickly that idea didn’t make sense, but I had no idea how to make sense of it because they were so convincing (‘real’). Soon, with a story attached… I began to hear them on the street. This made even less sense since had no idea at all how that was possible. But still, I heard them. And they became threatening, then cruel, then downright vindictive and I had no f.. clue what was going on… and panicked, and asked a friend for help. The friend could not see what had happened in my mind… and helped in all the ways they could. … and then:

    – Option 1 |
    On the advice of friends I saw a doctor who referred me to a psychiatrist… who:
    – Asked me questions that made even less sense and bore no relation to what I had experienced, not in ANY way that I could see
    – Did not (could not, I later discovered) explain to me why the voices had been so convincing (real)
    – Had NO IDEA that what I needed most was to know how to respond to these voices, which by now were purporting to be demons, in spite of the fact that I TOTALLY reject the concept of such a thing existing (My rejection simply made the ‘thing’ more determined… did the psychiatrist know that? Why not? Did s/he know how to address that secondary effect?)
    – Fairly quickly AVH developed into a diagnosis Sz… with a dire outlook
    – An Rx was prescribed… without so much as a mention of the fact that I was very likely to gain 25kg (55 lbs) over 3 months. How is that for self image, how others see me, and for my wardrobe, a practical consideration that cost mega bucks)
    – I became dull… the light in my eyes dimmed, I participated less, I cared less…
    – All this led friends and family to question my common sense, my thoughts, my needs, what I could do, what I should/ shouldn’t do…
    – And many to ask friends and family… is he dangerous, are you safe… shouldn’t you ‘put him in an institution’ where you can be sure that ‘x’ doesn’t happen
    – Can he look after himself? is the question at the top of mind of others, on whom you now have a greater reliance… soon to become dependence… adding even more distress, all day, every day, month in, month out… stretching to how long exactly?
    – What will he do they ask? Will he be able to support himself? (I wonder where THESE answers come from – psychiatry maybe?)
    – What will I do? I ask myself… what answers does psychiatry have here? How is the Rx helping?

    All this is HIGHLY predictable… it is a prognosis consistent with the course of the ‘treatment’. Where is that ‘insight’ problem now? In my mind… or in the profession psychiatry?

    Option 2 |
    I am able to find a psychologist… who says… “I understand what you are experiencing” and maybe can demonstrate that with some knowledge of the experience of other hearers. Let’s analyze the situation… and see if we can together figure out a way to make the problem less traumatic. How about we…

    Mmmm… here, my friends and family are supportive, hopeful, ready to help (instead of to police meds)… and find ways to INclude me in social activity… instead of exclude me, or make excuses for me.

    Why is the social response so different based on the profession I turn to for help?

    Option 3 |
    I am lucky enough to live in a city where there are Hearing Voices Network (HVN) support groups. I go along. I see that others are experiencing similar weirdnesses (I made that word up, lol). I hear about the things they have tried, the struggles with family and friends that they have had. The difficulties experienced at work, or how they went about getting a job, or housing, or making new friends… and socializing… and the tactics tactics discovered and applied to make tolerating lived experience easier to do.

    Friends and family see me seeking out the help I NEED. They see me understanding the problem differently (is this insight? Yes, say I) and finding a way to forge my own path, to make my own story.

    Option 4 |
    The default for too many… find your own way.
    Each of us learning from scratch… because psychiatry lacks insight.

    Psychiatry may have pin point solutions that can help… it’s hard to see how they they are still able to think they have thought leadership.
    Darn, that lack of insight again, pesky, isnt it?

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