One morning, a few years ago my heart thudded against the tight metal bands strapped around it. Adrenalin ping ponged through my system. I was out on a run, and the air hummed with a kind of malevolent electricity. I sensed something terrible was about to happen. And it did. I was heading down the hill when I saw them. Severed limbs, pale and bloated – tossed carelessly in the gutter.
My breath lurched in and out of me as I stood and stared in horror. Should I call the police?
Then insight broke through and with it a reality more terrifying than the severed limbs. I didn’t need the police. The limbs were sandbags. I sprinted inside, hit the call button next to my bed and clenched my eyes shut while I waited for a nurse.
When he popped his head in the door, I opened my eyes and said:
‘Can you please page my doctor. I’m starting to have visual hallucinations and delusional thoughts.’
He went and, having paged my psychiatrist, returned very quickly with a cupful of antipsychotic medication. I gulped it down and waited for the jumbled sharpness inside my head to soften and slow.
If this had been my first experience of psychosis I may have been terrorised by the severed limbs (and worse) for longer. I may have tried to tell other people about what lay in the gutter at the bottom of the hill. But it wasn’t my first experience.
I had admitted myself to hospital several days before with precursor symptoms. Speeding thoughts, pathological irritability, non existent concentration and short term memory. I was in hospital waiting, the potential for psychosis hovering darkly over me. So, when it descended I knew what was happening. And that insight got me treatment quickly and saved me from the embarrassment of a family member, nurse or doctor having to convince me I was delusional.
Developing insight usually requires multiple episodes of illness and hard, proactive, psychological work. You have to dig around inside yourself to learn what are normal feelings and behaviours for you and which ones herald the onset of illness. The hard work of gaining insight is even more challenging for anyone who hasn’t had access to effective early management of their illness.
And no one ever has insight into their first episode of illness because that first episode hijacks you. It catapults you from being someone who could always trust the contents of your head to those contents not only being unreliable versions of the truth, but sometimes your worst enemy.
And unlike experiencing symptoms of a physical illness you can’t just lie back and expect others to know you are sick. If you are vomiting or have a nasty cough your suffering is obvious to everyone. You don’t need insight to tell your family or your doctor about what is going on with you in order to get the help you need.
With a mental illness, painful symptoms are often expressed as behaviours. They can mercilessly present you to the world as:
negative, unmotivated, slow, shuttered, insecure, nervous, scattered, indecisive, irritable, unfocussed, unintelligible, uninhibited, nonsensical, lost, delusional, racing, jittery, and more.
In part insight means learning to recognise that what can feel like personal failings are just symptoms of an illness. You have to internalise this before you can translate what is going on with you for the people around you.
But regardless of how someone manages their mental illness, they won’t do so successfully in the long term without insight. Or they will rely heavily on others to tell them when to seek help.
I absolutely loathe anyone else speaking for me in any area of my life, but particularly when it comes to my Bipolar Disorder. So, doing the work to gain the insight was and continues to be non negotiable for me.
My psychiatrist and I now communicate very efficiently. He doesn’t waste time asking about how my family think I’m going because he knows he will get the most accurate answer directly from me. I can recognise and name the symptoms I’ve gotten to know so well over the last 14 years.
I am practiced at translating overwhelming feelings into symptoms. For example, I know now that when my life feels as though I am running through chest high water with concrete boots on that is depressive symptoms setting in, and if I ignore them, the water will continue to rise.
My symptoms will always affect me, and they will always hurt when they flare into life. But recognising and naming them shrinks the overwhelming into the manageable. Insight has built a safety barrier between me and this illness. It ensures I can see that even though I may live with its symptoms, those symptoms have nothing to do with who I am.
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