Development of Insight

One of the most fascinating aspects of MDI is the patients’ lack of awareness of the illness. The medical term for this ‘deficit’ is anosognosia (from the Greek, lack of awareness of one’s illness).

The inability to recognize that changes of mood and behavior are due to an illness is an obstacle to seeking or continuing treatment.

This blind spot is often the cause of confusion and anger among relatives and friends, as it appears to be willful denial of the obvious. In a letter to a patient, a relative wrote:
“It’s all so predictable that it seems impossible you can’t see it. When you’re depressed you insist you’ll never feel better and when you’re manic you insist you’ll never feel depressed again. When you’re depressed, you insist you never had any real friends and when you’re manic you feel that everyone you know is a good friend. When you’re depressed you believe you’re utterly worthless and without redemption. And, when you’re manic you believe you’re God’s gift to mortals.
Why are you unwilling to accept the fact that it is your body, perhaps exacerbated by real events in your life, that throws you into highs and lows? When you’re in a manic phase you persistently condemn Lithium as something totally artificial and hypocritical, yet you eagerly smoke grass.
The reason I feel so utterly convinced that this is biochemical is because your patterns have been so predictable and you live your life swinging from high to low.”

A powerful tool in developing insight is observation and recording of mood and behavior over time. See Observation.