There also often problems with insight in the manic phase of Bipolar Disorder or Manic-Depression, whereas people who are depressed typically realize that they are depressed. I am not sure why mania is associated with lack of insight, but it often is.
Of course there is typically no insight during psychotic mania, but there is often no insight whatsoever during even hypomania. The lack of insight during hypomania is usually because the person is feeling so good that they don’t could possibly be ill, but I assure you that they are. The hypomanic typically says, “I have never felt better in my life!” It is hard to convince someone they are ill when they’re on top of the world and feel like a million bucks.
Another serious problem is society.
I have told you that I don’t like people much because they are stupid and this i+s one more example of that. Ordinary people are preposterously ignorant of mental illness of all kinds. There is no reason to be this way, and people have simply chosen to become ignorant about this issue out of their own free will.
Our society also stigmatizes mental illness, so that makes it so in general you can never discuss the subject in polite company without violating social rules and seeing people try to shut you down. People are ignorant of mental illness because of stigma which means that they are not even supposed to talk, read or think about it. So people have refused to educate themselves in part due to stigma.
Understanding and recognizing the symptoms of common mental illnesses is not particularly difficult, and I feel that anyone with a 100 IQ ought to be able to learn such things.
Tragically, Bipolar Disorder is one of the most misunderstood illnesses of all, and the vast majority of people, when presented with a person who is floridly manic or even hypomanic will typically not understand what is going on at all. Florid manics are often accused of being bad people, criminals, psychopaths, evil or on drugs.
I must admit that if you do not know what you are looking for, it is hard to figure out what is wrong with a floridly manic person. Instead of being high as a kite and happy, floridly manic people are often irritable, angry, aggressive, menacing, threatening, violent, paranoid and miserable. They often start using drugs or drinking with the onset of the episode, which makes diagnosis even trickier.
People seem to be even worse at recognizing hypomania. Hypomanics are often witty, charming, extroverted, ecstatically happy and full of wild plans. They can’t stop talking, they are full of wild confidence and they’re always ready for a party.
I have seen many people observe wildly hypomanic people and come away saying that they are the coolest around because they can be so effusive, engaging and spellbinding. I often try to tell these that the person is actually mentally ill, but they refuse to listen to me and shut me down.
So the problem in mania is not only that the manic usually has no clue that they are ill, but also 90% of the ignorant people in society refuse to believe they are mentally ill.
It’s a perfect storm for epidemic lack of insight, and it really doesn’t have to be that way.