There are many systems of power. One of them is the healthcare system &, within that, the mental health system- interconnected with systems like social services, education, housing, & criminal justice.

We have to reckon with our power, as individuals & as a system.

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One example: the concept of "insight." How do we decide that we understand a patient's life- inner and outer -better than they do? How much time does it take to be sure? How much collateral information does it require?

More, or less, than we ask patients to provide?

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How deeply do we need to think about it, before we label a patient low insight?

How much weight do you give to that term-“low insight” -and what it means?

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Because:

To say that someone lacks insight is to use your professional credential to announce that a patient cannot be trusted when they talk about themselves.

And that *you* can be trusted to describe *them*. To call someone low insight is to take over someone's narrative. 4/

And when we do that, we decide a diagnosis even if the patient does not agree, which leads to treatment decisions even if the patient does not agree. and treatment decisions are not wholly separate from the rest of life. from housing & jobs & education & relationships & money.5/9

Sometimes when we call someone low insight, that leads to guardians- loss of ability to make decisions about medical care or finances. Difficulty working or building relationships. Poor healthcare due to stigma because of that line in the medical record.

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That one concept- insight -is a very powerful thing.

(think about all the power from all the processes in the mental health system)

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so: how sure do you need to be, before you use your credential to announce that someone cannot be trusted to know the truth about themselves?

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and: how can we use this space, this system, this power, so that it benefits people? so that it lives up to our ethical codes of doing no harm, of benefitting individuals in distress and society at large?

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