From 'Lack of Insight' to Being a Knower: A Personal Turning Point in Psychiatric Inpatient Care.

Abstract

Background: At times, the psychiatric inpatient system pathologizes patient perspectives as 'lack of insight', framing survival strategies as DSM symptoms. In these moments, power imbalances emerge that risk silencing patients' experiential knowledge.

Purpose: This autoethnography reflects on my journey from invalidated patient to 'knower' to underscore the need for curiosity-driven, person-centred practices that validate lived wisdom in mental health recovery.

Methods: A first-person autoethnographic narrative draws on lived experience of inpatient care, including periods of compulsory treatment during severe anorexia and post-ECT amnesia, combined with retrospective reflection and critical engagement with psychiatric literature and power dynamics.

Findings: When patients' voices are ignored, recovery stalls, risking internalized illness identities. Reclaiming narrative through writing enables 'double recovery'-from suffering and systemic marginalization. This fosters equality through questions like 'How do you understand your experience?'-a stark contrast to DSM's symptom-focused framing.

Relevance to mental health nursing: Drawing on my experience of inpatient care, mental health nursing can help shift psychiatric practice towards a more collaborative approach that actively incorporates patients' own explanations into assessment, documentation and care planning. This can begin by asking how patients understand what is happening, recording their own explanations alongside clinical observations and co-designing goals that align with patients' priorities. In doing so, staff can better recognize survival strategies as meaningful responses to distress and strengthen trust through more person-centred practice.