Family and Caregiver Schizophrenia Discussion Forum

Is lack of insight permanant?


Hello, I know many of you are care givers for your family member with Schizophrenia. Do you know if they get insight once they start taking medication? I have read that even if one takes medication most times they will not have insight. Just wondering if anyone can help me understand this. I am sure many with diagnosis are on this forum. What is your experience ? What helped you to get through the difficult days in your life? If you didn’t believe you were sick, what made you take medication? Some of you are doing so well and I just want your answer. Thanks.


I was put in the Hospital a total of three times. All 3 times Police came to pick me up at my residence. The last time was 5 years ago, the problem I had with taking medication were the side-effects, which are hard to ignore, I was feeling really good at the time, studying, working, and keeping fit. That’s why I’m resentful because the hospitalization came at a phase in my life when I was truly happy, which leads me to believe there is more to it than just wanting us to fare better for ourselves. For example, why did I require to be put in the Hospital for two months while I was trying to obtain my degree, couldn’t they just put me back on medication and let me go on with my life. After that happened I understood there was just no way out and decided to keep compliant with treatment.


Hi Heather~
As a caretaker, Its hard for me to say-at least for my son. Sometimes, he seems to know exactly whats going on…and others, no.
A lot of people on this forum seem to be very self-aware…age doesnt seem to matter. Guess it could be permanent for some. Sorry...I really dont know.


I knew i was sick , eventually , and i arrived at this realisation , in the typical manner i realise anything else , and that is through a process of failing repeatedly , until i come to a solution eventually through a process of elimination.


Honestly I think it depends on the person. I did not develop any deeper level of insight until I was around 15 or 16, and I’ve had it my entire life, so it took…well, that many years. Even now I still frequently have moments where I slip back into surreality.

Medicine can certainly help bring a person back to reality, but it can only keep them there if they let it.

Also if it helps, what made me aware was an event with a close friend of mine who I involved in my delusions where she stopped believing me and told me I needed help after none of the things I said would happen happened. That made me question why none of my beliefs (mostly paranoid at the time) had come true. That’s when I started believing that something was funky with me.


there have been a few times that i have had no insight at all, usually in the midst of psychosis. looking back, it’s amazing to me how i seemed to fall for it each time to be honest. i don’t honestly know if it was the meds that got me out of it or just plain old experience and a sort of epiphany each time on my part. i still have a set of beliefs but not the same as when i was psychotic. i function, i look after my kids but i need help to run the house. but as for psychoses, i still don’t understand why i had no insight at all tbh. just can’t understand it.


Thanks for all your replies. I truly appreciate it. I know some have been on medication and are still hearing voices, also have no insight. My family member has no insight for 5 years now. Beliefs never changed no matter what the therapist and psychiatrist said. That is why I am worried how long it will take for the person to realize it. I wonder if the age matters. I read some where some might never get the insight and their beliefs will be there for the longest time. Thanks again. You all have been wonderful.


Some posts you may find interesting.


@BarbieBF , Thanks for the articles. I have read them in the past. I just want to know at what point do they get insight? OR if they don’t get it at all? I have known many patients on medication and then stop because they felt better. Then go through it again. I just wanted personal stories of people who didn’t have insight and at some point they got insight. OR what can help them to understand that what they believe is not real. Research continues to find out how they can correct this but so far there is no answer. Having my family member ill for a while, I am doing my own research and looking for any and every explanation. If a family member is not taking medication because the person believes that it’s not mental illness and We can’t do anything to help them being an adult unless they are dangerous. Thanks for your article.


From what I saw with my son it seemed to go up and down. My son acknowledged that he has schizophrenia however he only recognizes paranoia as a symptom. If you were to ask him if he has insight then his answer would be yes that he is not experiencing paranoia so his sz is under control. I would say no that he has anosognosia. He is unable to see the other symptoms as being a part of his sz because he has sz.


When I was delusional and deep in psychosis I had zero insight - this went on for years. As soon an an antipsychotic was introduced into my system - for me the awakening was almost immediate - I had insight.
It is not like this for everyone, but anosognosia does not have to be a permanent condition - antipsychotics can help tremendously and can make a difference


for me it took months, even on high doses of anti psychotics. i don’t know why. but i know they can take up to a month or two to get into your system, but i’m talking like, 6 months or more, it took me to calm down and see through it for what it was and this has happened at least 3 times. all apart from one episode were lead by voices but it’s the belief in it that got me. some of them were so ridiculous that they couldn’t possibly be true yet i fell for them, hook, line and sinker and i find it all so odd looking back. very odd indeed that i culd be so…uneducated? gullible? willing to believe? i don’t know how to explain it but but i am just shaken that i could’ve fallen for any of it i think.


I have at various times been described as having good or bad insight depending on my relationship with the pdoc.
I think the term anosognosia can be mis/over used. To describe someone who doesn’t realise they have an illness- fine. To describe someone who accepts they have problems but doesn’t agree with the pdoc’s approach or is on bad terms with the pdoc- both stupid and wrong.


I usually have good insight, it’s what has kept me out of the hospital so far. Though being able to tell yourself it’s not real is of limited help when the hallucinations are there, bright and loud and just as real as anything, or when you’re absolutely certain your whole circle of friends are plotting against you. Some of the paranoia I don’t have as good insight on, except in retrospect. I can look back at a delusion once it’s done and identify it as false, but while it’s happening, even if I tell myself it’s not real, I still believe it fully. Being on meds hasn’t really changed my insight, though it’s lessened the symptoms enough that what insight I have is usually enough to keep me stable.


I was undiagnosed for many years and had zero insight. It took me about three years after my diagnosis before I started to get some real insight. It took a lot of interest and reading up on sz before I got some insight. I didn’t even know what sz was when I was diagnosed. This forum also helped me a lot since one can read up on people with the same struggles. I’d say AP drugs also helped to do the trick for me as it gave me some realisation into my illness since I was very ill when I got diagnosed and was desperate for help and then the meds did the trick to relieve me from the positive symptoms.


So in other words if someone doesn’t take medication and has no insight, do things remain the same? As far as I remember John Nash wasn’t taking medication and still won Nobel prize.


I’d say it varies from person to person. Some people might be able to manage their symptoms without medication, but some may be completely incapable of functioning without meds. Sometimes things will get better on their own, but usually that doesn’t last without medical intervention. I functioned for over a decade with no medication, but now I feel a lot more stable with the meds than I ever did before I was on them.


There are some people on this forum who don’t use meds and they have very good insight. I’d say it’s different for each one.


My insight has come and gone. There are some things that I still need help with. I’ve got some false memories and some things that have stuck in my head and never let go.

But I think my insight is pretty good for now. It’s hard to keep hold of. But for me… not for everyone… but for me… insight came with acceptance. I had to just finally accept that I have this illness.

When I fought it… I was on the same negative loop over and over. But when I just got too tired to fight… and I opened up to acceptance… insight grew. (also, it would be a bit of a cheat not to mention that I also gave up street drugs and alcohol and that made a huge difference too.)

I just had to let go and trust my family and sort of accept that I really do have this illness and sometimes my perceptions are vastly different from them and I have to trust that some of my perceptions haven’t happened.

I am very pro-med. My meds have found a balance and given me my life back. But I’ve met some people who are med free and doing well.

Again… they have a good safety net/ support system in place. They have some sort of therapy that helps…

Be it ECT or hypnotherapy or talk therapy… something to keep them grounded.

I feel that for me when it comes… I work hard to keep a hold of it. But at times I need help to do so.


I decided to trust the nurse in hospital. She said there are no ghosts or trolls. It was just misfires in my brain. I started writing on a piece of paper “there are no ghosts!” " there are no trolls". But it took time to believe it in my heart. I was in hospital for 6 months. It took me two years from my episode before I was thinking somewhat normal again.

I have meds. Abilify 20 mg and Quetiapine 300 mg. I still hear voices. I usually can ignore them. I recognize them as voices using logic. If I’m in bed and hear chatter, every one else is sleeping, they are voices. I don’t react on silly stuff ppl say when I’m outside. Some might talk to me for real but some are voices. I ignore everything until someone adresses me and I can see them talking to me.