How does one know if he is insane? I used to joke that the main symptom of insanity was insisting on one’s own sanity—it turns out that psychiatrists don’t disagree. Traditionally, “insight” into one’s own mental illness is considered an important step on the way to recovery. Regardless of the merits and flaws of this view, there obviously have to be other markers (unless we want to conclude that the only truly sane people are those who admit their insanity); whether its effects are helpful or detrimental, insight does not erase a disorder.
(Note, here, I will avoid politically correct terms such as “mental illness” for multiple reasons. The root causes of different disorders remain unknown; additionally, it is unclear if “mental illness” includes “temporary insanity” or mind disturbances associated with an identifiably physical illness, such as the delirium of fever).
So how do we distinguish a “sane” from a disordered mind? It seems the answer is so difficult to identify that we may begin to question whether “sanity” as a concept is meaningful.
Even well-defined symptoms like hallucinations occur in the “healthy” population—occasionally to a greater extent than those associated with psychosis. Other symptoms are even more vague, harder to define. When does introversion become indicative of depression? Where does a “good mood” fall on the spectrum from mere cheerfulness to full-blown mania?
Some psychologists only consider a trait pathological if it significantly affects the sufferer’s ability to function. But here too, the line between normal and impaired function is often blurred. Everyone has different coping mechanisms—likely some work better than others; some are more societally acceptable, whereas others carry stigma. One person may reach for a cigarette, another for a razor blade. Which of the two has the “greater ability to function”? Should we base diagnosis on the shape of someone’s crutch?
And what about self-analysis? How useful is it really to dissect one’s own feelings and reactions, to scrutinize the mind? Perhaps if we suspect that our excitement and restlessness might be symptomatic of hypomania, we may be more careful to ensure that our actions arise from rational decision-making, rather than from impulse. On the other hand, why waste the excess energy self-analyzing? If the urge to paint strikes in the middle of a sleepless night, why brush it off as a symptom of disorder, when you can just do it.