The First Obstacle to a Healthy Mind

Picture a retired old man, Carl, who spends all day every day taking care of his precious garden - his pride and joy.

One day, he notices that some of his plants are drooping and appear yellow. He’s confused, but puts it down to the cold weather.

Over the next week, the decay spreads to other plants and Carl becomes increasingly stressed. His neighbours suggest that he seeks the help of an expert. 

But Carl insists he can handle it alone, thinking that others may ruin all his hard work. Despite his best efforts, more of his plants die and Carl spirals into a deep depression.

Carl’s son becomes worried, and calls a soil inspector to figure out what’s going on. Carl resists, but his son explains that an assessment won’t hurt.

The soil inspector plants a tool in the ground to measure the acidity, and finds that the soil has been contaminated. After further investigation, the inspector discovers that Carl’s soil has been poisoned by a factory dumping their waste onto a field nearby.

With full awareness of what was harming his garden, Carl detoxified his soil and had the factory shut down - solving his problem for good.

With help from those around him, an objective reading from the acidity tool, and knowledge about the effects of contamination from waste nearby, Carl found the missing piece to this puzzle. 

Carl found insight.

Insight

In psychiatry, insight is defined as the ability to understand the objective reality about the health of one’s mind:

• Your awareness of whether you are well or unwell 

• Your capacity to understand what is contributing to the health of your mind

• Your recognition for your need for help

When we are unaware of the true state of our mind, we are unable to address the root cause of its problems - just as Carl couldn’t heal his garden without being aware of the poison that lurked beneath.

All too often, people who lack insight never seek help. Instead, their unresolved mental health issues build up over time - until a crisis happens.

Tragically, this can result in harm to themselves or harm to others, leading us to the age-old ethical question: should someone who lacks insight be found not guilty by reason of insanity?

The stakes are high with the issue of insight. It can determine whether someone walks free from committing a murder, or if they are detained in hospital against their will.

But beyond determining who is to blame, lacking insight leads to painfully poor outcomes in mental health care because those who lack insight struggle to engage with help they believe they don’t need.

Sadly, this creates a vicious cycle which presents possibly the greatest obstacle to a healthy mind:

If it’s so vital, why do people lack insight?

Think back to Carl - why did he refuse help when it could have prevented his suffering? Some possible explanations:

• Carl felt insecure and denied help to defend his gardening skills. 

• Carl feared being judged as not having control over his garden.

• Carl felt paranoid that others would only worsen the situation.

• Carl didn’t understand how polluted soil far away could affect his garden.

• Carl was suffering from an underlying mental illness, impairing his judgement.

We all suffer from insecurities, unconscious defence mechanisms, and not knowing what we do not know. To some degree, we all lack insight into certain parts of ourselves, particularly the most uncomfortable parts - but these are the most important parts to bring to awareness.

Tool:

How can we gain insight?

Everything we experience in our minds is subjective. Yet, we need to be as objective as possible when looking inwards to become aware of reality - as if we were looking at another person. This toolkit helps you do just that:

• Journal your thoughts, feelings, and actions. Tracking these can give you insight into your patterns in an objective way - just like the tool Carl’s soil inspector used to measure the acidity of the soil.

• Get feedback from those around you. This requires trust in others, but these strong social connections will play an important role in supporting you.

• Connect with others who have faced similar experiences. Openly discussing your experiences with others who can empathise from first-hand experience can make you feel less alone, more understood, and more hopeful that there is a path through.

• Learn about where your experiences could be coming from. Research, education and professional therapy may reveal what may have been previously unknown to you.

How can we help others gain insight?

Failing to understand the reality of our own minds can be painful later down the line. But bearing witness to a loved one lacking insight can be even more painful. 

Forcing your viewpoints on them can be met with resistance, suspicion and paranoia, leading to your loved one alienating themselves. 

Following the framework for motivational interviewing, here’s what you can do:

1. Engage your loved one in a supportive environment and take their lead by asking them how they feel and what they think. 

2. Focus your loved one onto the specifics by asking them to identify the exact issues and clarify their goals.

3. Evoke their motivation to change by demonstrating empathy and drawing out their reasons to get better.

4. Plan collaboratively by exploring their ideas and supporting their strategies.

Enabling your loved one to lead the discussion gives them greater control over their recovery, but it’s important to remember that:

Prompt:

From the toolkit above, consider implementing one of these tools:

If you want to journal, ask yourself: 

If you want the perspective of someone else, find someone you trust to tell you the honest truth, coming from a place of love. Ask them:

Becoming aware of the nature of your mind is the first step in gaining mastery over your mind. After all, that is what you’re here for.

Written by Dr Manu Sidhu 🩺

Feel free to email back with any thoughts, questions, or ideas for us to explore.

If this article resonated with you, the best way for you to support is by sharing it with others who may be interested.

You can also tweet me or connect on LinkedIn.

Disclaimer:
The Mind, Explored. is for informational purposes only and does not constitute the practice of professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information in this newsletter or materials linked from this newsletter is at the user’s own risk. The content of this newsletter is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of health care professionals for any such conditions.