Multiple posts, but still no discussion how this relates to Christian belief, salvation, or election. Ah well, it will come.
Symptoms and insight.
If you have Obsessive-Compulsive Disorder, you have full insight – overfull insight – into the fact that you have symptoms. I keep thinking I have hit someone with my car when I know I haven’t. It’s a crazy thought, but I can’t get it out of my mind. I know intellectually that my hands are clean. But the certainty that they are dangerously germ-ridden is sometimes overwhelming. If you have OCD, you know you have symptoms. People might have any of a hundred understandings of how the symptoms arose, but there is no doubt of their existence. Anxiety disorders in general are perceivable to the patient as symptoms. Yeah, I have phobias. That’s why I’m here, doctor.
Contrast this, as we have, with schizophrenia, where insight is always impaired when the illness is untreated, and may continue even after treatment. Plenty of schizophrenics take the medications because it makes other people happy, even though they don’t believe they need them; or will take them for other symptoms, such as getting more sleep, or take them because they are under court order or guardianship. Some never believe that the voices are not real.
There’s a full spectrum in between. People who are depressed may not have insight into that at first, they may just think that life sucks and everything is hopeless. But they can often, if the depression is not severe, accept the explanation from others, and be cued into it. Yeah, I’m depressed. People who are irritable don’t see it that way at first, they just think that a lot of other people are being jerks. Yet they can sometimes be cued into the understanding as well: Have you been more irritable lately? “Y’know, I have. Small stuff bothers me more than it usually does.” A patient’s understanding of mania is more varied, but generally, the more severe the symptoms, the less likely the patient will perceive them as symptoms. The sicker one is, the less insight, which is both infuriating and tragic. Hold that point in mind.
Borderline personality disorders can learn over time, whether by specific instruction or by hard-knocks trial and error, which feelings and responses should be classified as symptoms. Until then “feelings are facts” to them. Their present feeling of being nonsuicidal and safe trumps the fact that they tried to OD just two hours ago. They are not attempting to manipulate others with this. This triumph of current feeling over all fact is their reality. They can go to the other extreme in crisis as well, being unable to understand feelings of despair or anger as temporary phenomenon. They seem world-consuming. Similar uneven insight prevails in the other personality disorders as well.
There is another anosognosia we have not yet mentioned as well. Some people are unable to perceive their incompetence regardless of the outside cues. I saw a backstage American Idol segment a few years ago while in a lobby somewhere. The girl had sung and was terrible. The judges had told her she was terrible and to give it up. She refused to believe it. She just knew that she was a great, absolutely great entertainer, and she wasn’t going to give up her dreams on their say-so. (I have since learned that this happens on American Idol all the time. Or Bulgarian Idol. Or Serbian Idol. This is why people need to stop telling elementary school children to follow their dreams, they can be anything they want to be. Despair, Inc. has it better.*
There is the more general case, the Dunning Kruger effect Here’s the money quote:
poor performers do not learn from feedback suggesting a need to improve.The same as with the serious mental illness – the more intense the symptoms, the less the insight. Learning does not take place. Feedback has no effect. Here’s an irony from Dunning and Kruger’s work, BTW. They quote Bertrand Russell with approval on the subject. One of the painful things about our time is that those who feel certainty are stupid, and those with any imagination and understanding are filled with doubt and indecision. And as if to illustrate this, he became quite sure of several things he proved to be entirely wrong about over the course of his career. Perhaps no worse than other opinionated folk, though.
You know people like this - coworkers who who believe they are the most competent in the shop but are really a drag on the rest; choir members who cannot sing, but tell everyone else what they are getting wrong; 50% of all hockey fans calling in to sports shows; nightmarish parents who hold court on their philosophy of childrearing; all manner of showoffs and snobs. One keeps thinking that a spectacular failure will finally get the message through to them, that they will now just have to at least have a moment of doubt. But it doesn't. If anything, they get worse.
Next up, more Dunning-Kruger, this time with dictators, the confidence of prognosticators, and how in the world this foolishness can be adaptive.
*And while we’re at it, stop telling teenagers these are the best years of their lives. Great way to increase suicidality, I would think.