Wednesday, November 21, 2012

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.

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.


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


  1. I agree but I also hope that my son will come to have some insight to be able to try to find out how he can help himself. I don't want him to dwell on it endlessly - but I'm sure in his quiet moments away from the voices he must wonder what is going on... The people I have met that have really recovered - are taking ownership of their mental illness and taking the appropriate steps - medication or BCT or other treatments - to help themselves. Kit only admits to have SZ when he wants government support. Otherwise he is happy to just sit back and do absolutely nothing as he believes that is what 'the controller' wants him to do...

    1. "The people I have met that have really recovered - are taking ownership of their mental illness..." is a self-contradictory statement. You either have an illness, or you're recovered. You can't have your cake and eat it.

      The people I know who've really recovered haven't taken ownership of a thing called "mental illness", but rather of their life story, and their reactions to it, understood as perfectly natural, healthy, indeed life-saving reactions, hearing voices included. The concept of "mental illness" allows people to own, i.e. identify with, this thing, the "mental illness", which on its part alienates them from themselves. While people take ownership of any "mental illness", at the same time they disown themselves.

      "The controller" will remain in control as long as he's not listened to respectfully, but declared a meaningless symptom of meaningless madness, ignored, and tried to be silenced at any cost. Voices are messengers. Don't shoot the messenger! If you really want to help your son, you help him explore the meaning of the message his voices have for him, and to take ownership of himself, not of a thing called a "mental illness".

  2. Hi, Lesley,
    For what it's worth, my son could do absolutely nothing for years. Let me see, six years at least, from the time he dropped out of U. of T. until two years ago. It was a struggle for him to interact socially (peaks and troughs), he couldn't stick with courses (college level or otherwise)and he failed to show up for lots of volunteer work. He knows he had problems, and he can talk about them now quite articulately. I have deliberately tried to educate him to not identify with the schizophrenia label. Is not defining oneself as "schizophrenic" a lack of insight? Chris's crisis has really forced me to take a long term view. It's hard to watch a young man in his twenties hang around the house all day. But, with sustained positive thinking, these young men can eventually thrive.

  3. My son did ruminate a lot when he came out of hospital and he was deeply depressed. He ruminated a lot about what had happened to him: somehow it helped him to understand and to come to terms with his experience. I was very keen for him to move on but he couldn't: he went round and round in circles and his psychiatrist warned me to be patient and not to push him too fast: he needed to heal first, she said, and rebuild his physical health and confidence otherwise it could lead to relapse. It took two years before he tried to regain his independence. He has moved out but Sadly getting a job now is very difficult because there are just no suitable jobs around.

    1. It is great that he is trying to regain his independence, but really tough that he is having trouble finding a job. The psychiatrist is doing her job by urging patience. Healing takes patience and time.

  4. Insight?

    The "professionals" in the psychopharmacological paradigm of "care" are the ones who lack "insight!"

    Overcoming adversity; embracing challenges as gifts; learning to thrive... These are the better parts of our human nature... *All* of us... *Each* of us!

    Homeostasis, balance, centering, thriving...
    These things *happen*.
    As long as "professionals" get out of the way!

    Happy Thansgiving.


    1. Ooops,

      Re: Thanksgiving...
      I forgot you're not in the U.S.,where we celebrate this holiday.



    2. I'll be tucking into turkey tonight at church. Thanks for the kind words.


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