Mental Disorders, Addictions, and Insight: “There’s nothing wrong with me!”


Adapted from A Vision for Change: How to He;p Someone With Addiction or Mental Illness by Rich Whitman and Melissa Deuter

Mental Health and Insight

Why does a lack of insight affect so many people with mental health diagnoses? The disease processes themselves may be to blame. If your mental health condition causes false beliefs like delusions, it makes sense that one such false belief could be about the presence of the condition itself.

Some conditions affect trust in other people, and some affect intuitions or the ability to read facial expressions and emotions.

And, there are psychosocial factors that affect the ability to accept the illness. Mental illnesses frequently begin right around the time a young adult is attempting to break away from his or her parents. It may be the parents or other members of the family who step in and identify that something is wrong, and this may coincide with attempts to claim independence and separate from the family to start life on one’s own. When your primary goal in life is to claim independence and find yourself, it can be hard to accept anyone’s view that you’ve got a problem that might affect those goals. And it can be even harder to grab some control from parents just to give it back to them a short while later.

Whether it’s about parents or not, few would want to accept that there is something wrong with the way you perceive reality. The idea of having a mental illness that alters your perception of reality could be acceptable. What do you mean I’m not seeing reality? How can I trust you to be the judge of that, especially when my eyes and ears are telling me something different?

Having a mental illness means losing control. Not only does it mean being unable to control one’s mind, it may be giving over control of other factors too. Mental illness may require taking prescribed medication. What if there are side effects and problems? And what if mental illness claims individual freedom, by requiring short-term hospitalization or long-term supervision in a living situation where someone is around to oversee behavior and response to treatment. Believing that a mental illness is real could mean relinquishing the right to live alone or make decisions most of us take for granted each day.

Believing that an illness is real, despite personally experiencing a different reality, takes a leap of faith and trust in others. And that leap is even harder when treatments cause problematic side effects.


Addiction and Denial

Just like in cases of mental illness, the presence of an addiction can leave a person without insight. Some people with addictions fail to see that they need help. The processes are essentially the same. But in the world of addiction, the terminology is often different. Instead of “lack of insight,” insiders in the addiction world will often use the word “denial.”

Denial is just another way to say lack of insight, but addicts choose it because it connotes personal responsibility. “You’re in denial, and you need to wake up!” This approach is the preferred method in addiction, often because there is a belief in personal responsibility for healing addiction. Addicts have to stop using, and to do so, they have to wake up and admit that using is a problem.

It might seem that having an addiction would be pretty obvious, and that you’d have to twist reality dramatically to miss that you have it, but just like recognizing signs of a mental illness, it’s not always so simple to see signs of the disease of addiction.

Shame leads to some of the very unhealthy aspects of the disease of addiction. People lie, cheat, and steal to cover up a problem they don’t want anyone to know about. And they do it to protect a fragile sense that the truth is too dangerous or ugly to allow out. The secret is the only protection.

But it’s not always about something as awful as shame. Some people want to continue drinking or using drugs because drinking or drug use is the way they have grown accustomed to socializing. They want to participate. They want to be included. They want to be “normal.” For folks who want to continue to drink or use socially or normally, admitting that the drinking or drug use has gotten out of control would feel like a way of ostracizing oneself from friends and activities.

Alcoholics want to be able to crack open a beer and watch the game, even when experience has shown that a single beer is not realistic for an anlcoholic. They want to use willpower, when addiction has already changed their brain to the point that willpower is out of the question. They have lost the power to make a choice and they drink because they cannot stop, but the truth of the addiction is too hard to bear and the denial keeps the truth at bay.

Whatever the underlying cause of a lack of insight, people with addictions and mental health conditions run the risk of doubting their diagnosis. Whether the doubt stems from the biology of the disease process or from the psychosocial aspects of accepting the disease, the end product is the same: the mind doesn’t see its own limitations objectively.



Posted on June 3, 2019 .