Insight and Psychosis

Psychosis is a feature of a mental illness involving a loss of touch with reality accompanied by symptoms like hallucinations, delusions or paranoia. I have had these symptoms.

People may say things like, “if you think you are psychotic, you aren’t, because if you were, you wouldn’t know.” There is some truth to this, when you lose contact with reality, often you are unaware. But, there is something called “insight”. Insight is when you can perceive you are experiencing psychotic symptoms. You know you are hallucinating, having delusions etc. It doesn’t stop them, but you know they are not real

Doctors have asked me if I was hearing voices and about other symptoms. They wouldn’t bother if I wouldn’t be able to answer.

Having insight is most of the battle. If you can see that these things are not real, you can work on getting well. It can be the hardest point, too.

When I was severely psychotic I was in my own world and it made sense to me. When I started to realize my thoughts were not real, I was frightened. How could I have believed such things? What is/was real? Can I trust my own thoughts?

I had been receiving “messages” from the media. I would hear things on TV and think it meant something about me. When the voices and messages stopped, I felt lost. They had entertained me, guided me, kept me company. Now I had to make decisions on my own.

It must have been frustrating for my therapist. The messages had gone away with medicine changes, therapy and time. But, I would question why they stopped. I thought maybe they were mad at me
She would use cognitive behavioral therapy techniques to challenge my irrational thoughts with more rational ones. Once I started to recognize that some thoughts couldn’t make sense, others unraveled. Some thoughts, I still believed, but I could act as if they weren’t real. Eventually, I would doubt it more and more. And, others, I still am unsure of what is real, but I set them aside and go about my day.

One of my thoughts was that I had a special skill to receive these messages. That I was being studied. I was even hospitalized at one point. I believed it was a research project. I thought I would receive a lot of money for this skill and was disappointed.

I am extremely fortunate. My medications control the psychotic symptoms now.

Insight and Psychosis

Lori Bernstein

Lori has been married over 20 years and is the mother of two teenagers. She has the diagnosis of schizoaffective disorder, bipolar type, along with recovering from alcoholism. She works as a Peer Mentor and volunteers for the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA)

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APA Reference
Bernstein, L. (2017). Insight and Psychosis. Psych Central. Retrieved on March 23, 2019, from


Last updated: 16 Apr 2017
Last reviewed: By John M. Grohol, Psy.D. on 16 Apr 2017
Published on All rights reserved.