How much insight do you generally have during an episode?

Hi everyone,

This is something I've been wondering about... When I was talking to my dad the other day, he commented that it's unusual for bipolar patients to retain insight in the midst of episodes, as I often do. He's a doctor himself (kind of ironically, a consultant psychiatrist, but for the elderly), so I'm sure he knows what he's talking about. But I wanted to know if this corresponds to your experience?

As for me, my insight during episodes is certainly not great, but I do seem to retain some, even when psychotic. When I was last manic in 2011, I knew during brief flashes of insight that I wasn't 'right' and took myself to their version of Accident and Emergency, from where I was hospitalised.

When depressed or mixed, I definitely know I'm unwell. With hypomania, it's more difficult, as I feel so great, energetic and self-confident etc. My manias usually make me intensely anxious, paranoid, aggressive and often full of rage- so that gives me a clue as to me being unwell.

I was the first one to recognise that I had some form of MI when I was about 14, before my family realised. Also, I knew it was severe, but my family didn't allow me to get treatment until I was full-blown manic and psychotic, as they had no choice by that point. (Their reasoning was they didn't want me to have a MI diagnosis recorded in my notes, and my dad tried to treat me unofficially- with little success).

Anyway, I'm curious to hear your experiences on this topic. Thank you in advance.

Like you, I typically have a lot of "insight." I'm very rigorous about examining my emotions and mental state, and my perception of others' in general; this does not subside when I'm manic or depressed. When I'm psychotic, I know that what I'm experiencing isn't "real" even thought it "feels real." I use this distinction to ground me.

I use writing to help order my thoughts, and I find this tool especially useful when I'm experiencing psychosis.

During my first manic episode, I had a complete break from reality that lasted several hours. It was akin to an alcoholic blackout. That has not happened since (that was 5 years ago.)

I always have blackouts, but usually not for the whole episode. When I've been hypomanic, I usually have pretty big holes in my memory. Big enough that I occasionally discover I've done some pretty messed up stuff that I had no idea I'd done.

The few times I've had full on manic episodes, though, I remember very, very little from. Like, scattered 5 minute memories with no context, that make no sense what so ever afterwards. And the fragments I do remember are not necessarily real at all.

Thank you both for your replies. They're very interesting, particularly as you seem to have had quite different experiences over the level of insight you usually manage to hold on to during an episode.

I had a feeling that the issue probably isn't quite as 'black and white' as my dad claims (for example, he said that most bipolar patients usually present to him while involuntarily hospitalised). That's obviously his professional experience (and I'm sure stands up to evidence), but it's good to hear from some people with bipolar themselves.

Maehem- I think it's intriguing you tend to examine your and others' emotional state closely. I'd say I'm similar in that I'm quite analytical and an over-thinker when it comes to my emotions. I also write daily and there might be some connection to insight in that.

Sung- I can relate to having some holes in my memory from higher mood states. Though these are fairly rare, they can be very scary and disorientating. For example, I have no memory whatsoever of being taken in an ambulance from Accident and Emergency to hospital, and I'm sometimes reminded by family members of particularly 'out-of-character' things I've said or done but can't remember. That in itself is probably for the best, though!

Thanks again and if anyone else would like to share their experiences, you're more than welcome to x