Benefits and burdens of insight

What is insight? I am thinking of it from a mental health/mental illness perspective, an internal insight of the workings of the own mind. In mental health care, insight is generally regarded as being a very good thing. It means that the patient has a good understanding of their illness, the symptoms and struggles they experience consequently and what helps them to manage these. It means they know when they are unwell or becoming unwell and when they need to seek more support. A patient’s insight is assessed as part of a mental state examination.

 

I would describe myself as having a very good insight into my mental illnesses. I have been living with them for about 12 years and in that time, I have learnt a lot about my relationship with them. Initially I had very little insight. The illnesses were new and confusing; I did not know why they were there, and I did not know what support I needed with them. At that stage I needed support and was reliant upon the expertise of others as opposed to my own insight and judgement.

 

I am going to discuss insight in relation to anorexia nervosa. Eating disorders are incredibly complex mental illnesses triggered by a combination of biopsychosocial factors. From the outside, it can appear as though the issue is purely about someone’s feelings about their body and the resulting anxieties around food. This could not be further from the truth. There will always be underlying insecurities, unexpressed emotion, trauma, emotional pain etc and the eating disorder often serves as a coping mechanism. For me, having insight into my anorexia means I have an understanding and awareness of the contributory factors and the function of it. I know what has helped me to overcome my eating disorder and I am aware of the signs that I am having a wobble and need some more support. Having insight has allowed me to make significant progress in my recovery journey although it has also proven to be a burden at times.

 

Having good insight does not often mean that the pain and distress is any less. It may be directed towards or because of something else, but it is just as intense. When I had limited insight in to my eating disorder I was experiencing lots of distress around food but as the years have gone on and my insight has developed, the distress isn’t because of my anxieties around food, it’s because the issues underlying the eating disorder are now being uncovered. They are raw, intense, powerful and painful because I have bottled them up for so long. In that respect, having insight made having an eating disorder even more distressing. I was still having to challenge negative thoughts and anxieties around food, and I was now having to tackle the difficult thoughts and emotions I was feeling about my identity and life in general.

 

I have moved a long way in regards to my journey towards recovery, overcoming many challenges and setbacks. I have very good insight, and this has been a huge advantage for me. It has enabled me to stop many of my disordered eating behaviours and I now have very little anxiety around food. The insight however can make me overthink and dwell on the past which is often very unhelpful. My recovery process became a mission to complete, an enigma to crack, a problem to solve. I had this idea that the only way I could ever make a full recovery from anorexia was if I worked out exactly what the trigger was. It made me look deep inside myself and start obsessing over my thoughts and behaviours, seeking the meaning behind them. This created stress and overthinking which led to more feelings of guilt and shame. I began to blame myself for developing an eating disorder and causing all the problems for myself and my family. I started to think, ‘if only I had been more honest about my feelings earlier, why didn’t I do that, I should have done that, why could I not have been more….’, you get the picture.  I wanted to put the eating disorder development down to one event or one repressed emotion which is obviously not the case. There were a multitude of factors which contributed to its development. I also began to blame myself for not making a full recovery yet. I would say to myself ‘you have so much insight now and have had a ridiculous amount of professional help, you should be fixed’.

 

I have moved a long way in my recovery, and I agree that I have very good insight however it can still feel overwhelming and burdensome. My insight must not be associated with less distress or not needing support. I just now may be in a better position to ask for it. I must also tell myself that I may still need extra support at times despite that insight and I must not blame myself for requiring that. Insight is one key but there are multiple doors with different locks to get through.