The social consequences of "insight" and rumination

I've made lots of mistakes along the way with Chris, and one of them, in the early stages, at least, of his "officially diagnosed illness," was getting caught up in negative thinking patterns. I attribute this to the dismal diagnosis, being counseled by mainstream to see the "illness" in medical terms, and interaction with dismal doctors. All of these factors influenced me to dwell negatively on Chris's future. The purely medicalized view of this "illness" has huge impact on the patient and how s/he is treated by family members.  If I was influenced to adopt negative thought patterns, consider what happened to Chris. People do much better where families behave as if they are not particularly concerned/worried about them. It's a skill one can learn. Also, think about the message given out by families who are convinced that their relative lacks "insight" into his own condition. "If only they were as worried as I am, they would know they are mentally ill."  This is called "insight" from the point of view of the relative. The relative assumes that, armed with this "insight," the patient will learn to take better care of himself, to avoid future relapse.

This research article suggests that "insight" (believing you are mentally ill) and rumination is associated with depression and negative self-appraisal in people with chronic schizophrenia.

Abstract
Rumination, Depression, and Awareness of Illness in Schizophrenia
Neil Thomasa1 c1, Darryl Ribauxa2 and Lisa J. Phillipsa2
a1 Monash Alfred Psychiatry Research Centre and Swinburne University, Melbourne, Australia
a2 University of Melbourne, Australia

Background: Depressive symptoms are common in schizophrenia. Previous studies have observed that depressive symptoms are associated with both insight and negative appraisals of illness, suggesting that the way in which the person thinks about their illness may influence the occurrence of depressive responses. In affective disorders, one of the most well-established cognitive processes associated with depressive symptoms is rumination, a pattern of perseverative, self-focused negative thinking. Aims: This study examined whether rumination focused on mental illness was predictive of depressive symptoms during the subacute phase of schizophrenia. Method: Forty participants with a diagnosis of schizophrenia and in a stable phase of illness completed measures of rumination, depressive symptoms, awareness of illness, and positive and negative symptoms. Results: Depressive symptoms were correlated with rumination, including when controlling for positive and negative symptoms. The content of rumination frequently focused on mental illness and its causes and consequences, in particular social disability and disadvantage. Depressive symptoms were predicted by awareness of the social consequences of mental illness, an effect that was mediated by rumination. Conclusions: Results suggest that a process of perseveratively dwelling upon mental illness and its social consequences may be a factor contributing to depressive symptoms in people with chronic schizophrenia.

Keywords:

schizophrenia; psychosis; rumination; post-psychotic depression; insight