One of the biggest challenges for diagnosing, evaluating and treating mental illness comes from a lack of awareness or insight. Typically in these patients, there is a lack of motivation for change which leads to them rejecting the reality of their situation.
When patients reject their reality, it not only delays correct diagnosis but also delays effective treatment. It has been proven that mental illness awareness is directly linked to sticking to treatment and positive motivation for change.
This is significant for mental illnesses including dissociative disorders, psychotic disorders (schizophrenia) or eating disorders (anorexia and bulimia). In fact, lack of awareness of illness makes them more susceptible to relapses, in addition to elongating the time of hospital visits, which not only effects the individual but also other relationships, families and work.
Although the term has multiple meanings, some professionals use the term “insight” to refer to an individual’s ability for introspection, self-awareness and self-evaluation depending on the theoretical perspective.
What does it mean to be aware or have insight into mental illness?
- Have the ability to recognise illness.
- Attribute the symptoms that they are aware of to the illness whether at the time or retrospectively.
- Ability to appreciate the social implications of the illness.
- Ability to recognise the effectiveness of treatment.
In other words, a lack of illness awareness leads patients to adjust poorly to treatment as they believe they do not need it. This ultimately adds to them being unmotivated to change the things that require a large effort on their part.
To manage certain mental illnesses, the support of families and health professionals is crucial. For this reason they should prioritise having good insight.
For situations where there is a lack of or very little awareness or insight, it is important to refer to a series of factors or general guidelines:
- The discomfort or suffering that many people feel simply thinking about the idea of putting themselves through psychological or psychiatric treatment is very difficult to take in and they prefer to try other methods beforehand. Illnesses are still seen today as disabilities, especially when referring to mental illness.
- In some cases, action needs to be taken before the tolerable limit is reached; this means that when there is a real problem that affects a relationship with a partner, family member, or peer, etc. that is the time to start self-evaluation before the situation becomes worse. Intervention should be done by the family and professional team before some of the essential personal circles are affected badly. This is especially important for cases of anorexia where people do not normally ask for help until they have reached their limit.
- Respect each individual’s time for adjustment. It is important to understand that it is not easy for anyone to go from being ignorant or not knowing of their illness to immerse themselves in their mind where they feel uncomfortable, without sharing it with anyone and having to manage it alone.
- Accompany them; In many cases, illness awareness can be accomplished through the help of family members, professionals, peers and associations or foundations.
- Rather than going deeper into the overall illness, it is important to start by recognising symptoms. The overall idea of an illness can do more harm than good for encouraging illness awareness. So, mental illnesses like schizophrenia carry lots of prejudices and clichés with them that are more difficult to assimilate than just the symptoms themselves. It is more probable that someone starts to become aware of their symptoms before thinking that they have an illness as it is easier to accept that they have symptoms rather than a larger problem (“no one will love me if I’m schizophrenic”).
- Do not constantly question the reality that a person experiences. During the assimilation process, an ill person may associate some of their symptoms with factors outside of their illness. In this situation, their denial is not constructive, however it would be helpful to normalise their experience as something that is just part of the process for example, “I would feel the same” helps to normalise the situation and helps them to keep an open mind.
- Symptoms are part of suffering but can also be seen as signs of improvement. It is much more difficult to assume that symptoms only reference suffering, inability, and assume that the illness is always a negative thing. Accepting that symptoms are signs of alert and not signs that all hope is lost may help to move forward toward improvements.
In professional environments, insight is generally based on the patient’s use of emotional arguments more than rational, focusing on the importance of their adherence to treatment whether they are fully aware of the illness or not. So, current multidisciplinary perspectives focus on improving insight through active and reflexive listening as well as empathy as tools that help to promote change in behaviour towards improvement.
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