The insightful writings of Pam Wagner

We often check in with Pam Wagner's thoughtful blog. Pam and her sister co-authored Divided Minds: Twin Sisters and their Journey through Schizophrenia, and she has in the past compellingly weighed her feelings about outpatient commitment.

Pam's latest blog entries are a chilling recounting of her 4-week hospital stay, and the delusions and hallucinations that plagued her.

The voices are my brain, me, telling myself I’m a lazy fat sh--. That I should die, that I should maim and disfigure myself, that I deserve to put cigarettes out on my own face (which I did, several times) and so forth.

Pam's thoughts into insight are prompted by a "reality test" that made her realize things she thought were real were actually not. That test, she writes ...

... consisted of challenging a delusion or hallucination by asking someone a question like “Did you say such and such?” or “Did xyz actually happen?” or “Is xyz doing such and such in the walls?” etc then listening to the answer and trusting that the answer is the truth. Until I learned it, and could do it fully, including the trust part, I had had no idea that I was living in something other than consensual reality. Even though people told me again and again I was paranoid and delusional, I figured they were using such words just to insult me because they didn’t like me, because they had hated me from the minute they met me anyway. But at the instant that that horrendously frightening delusion dissolved in the light of reality, it became clear to me how much time I’d been spending in a wholly fictional world and how often I’d need to use that reality test: in three words -- all the time.

Lack of insight. That was the fundamental difficulty. I didn’t know that I had a problem. The reality test gave me insight, but it took me a four-week hospitalization to understand how to use it and why. Some people with schizophrenia are fortunate enough never to lack insight; others like me seem to have it, then lose it; have it, then lose it. But we all know some who remain unaware of being ill all their
ives. If there were a magic wand I could wave to change this, I would tell you where to find it. I only found insight by using it.