What Is Impaired Judgment in Mania and Hypomania?
One of the most confusing and painful things for families is this question:
“If they are educated and intelligent, why can’t they see they are unwell?”
The answer is impaired judgment.
This is not stubbornness, ego, or denial on purpose.
It is a core medical symptom of mania and hypomania.
What Does “Impaired Judgment” Actually Mean?
Judgment is the brain’s ability to:
- Evaluate reality
- Understand consequences
- Make safe decisions
- Accept feedback
- Recognize illness
In mania and hypomania, this system becomes biologically impaired.
So the patient:
- Thinks differently
- Feels extremely confident
- Loses the ability to self-correct
What Happens in the Brain
Two important brain areas are involved:
1. Prefrontal Cortex (Thinking & Control Center)
This part normally:
- Applies brakes to impulses
- Helps us reflect
- Accept mistakes
During mania:
- This area becomes underactive
2. Limbic System (Emotion & Drive Center)
This part controls:
- Energy
- Confidence
- Motivation
During mania:
- This area becomes overactive
👉 Result:
Emotions overpower logic
Why Patients Feel “Better Than Ever”
In mania:
- Dopamine levels are high
- Confidence feels extreme
- Thoughts feel fast and powerful
Example:
Patient says, “My brain is finally working properly.”
So when family says:
“You are unwell”
Patient hears:
“You are trying to stop me”
Why They Cannot Differentiate Illness From Normality
Because the illness itself changes perception.
Think of it like:
- Fever causing confusion
- Low sugar causing irrational behavior
Mania changes insight, so the patient truly believes:
- Their behavior is correct
- Others are slow or wrong
- Doctors are unnecessary
This is called lack of insight, and it is not voluntary.
Real-Life Example 1: Impaired Financial Judgment
A 38-year-old man invests his entire savings into a business idea within one week. When questioned, he says, “You people don’t understand vision.”
Later, after recovery, he says:
“I don’t know why I did that.”
This is impaired judgment.
Real-Life Example 2: Social Judgment Failure
A woman starts calling relatives at midnight to give advice, scolds elders openly, and posts impulsive messages.
She feels:
- Confident
- Righteous
Family sees:
- Disinhibition
- Risk
Real-Life Example 3: Medical Judgment Impairment
Patient stops mood stabilizers saying, “I don’t need medicines anymore. Doctors overdiagnose.”
This is illness-driven reasoning, not logical decision-making.
Why Logical Explanation Does NOT Work
Families often try:
- Reasoning
- Showing evidence
- Reminding past episodes
But logic requires a functioning prefrontal cortex—which is temporarily offline.
So:
- Arguments escalate
- Patient becomes defensive
- Relationship suffers
Why Insight Returns After Treatment
Once:
- Sleep is restored
- Dopamine stabilizes
- Brain circuits normalize
Patient often says:
“Doctor, now I realize something was wrong.”
Insight comes after treatment, not before.
Important Message for Families
If a patient could recognize mania on their own, they wouldn’t need treatment.
Expecting insight during mania is like:
- Expecting clarity during intoxication
- Expecting calm during severe pain
What Families SHOULD Do Instead
✔️ Stop debating illness
✔️ Focus on behavior and safety
✔️ Seek medical help early
✔️ Visit psychiatrist even without patient
At Mind & Mood Clinic, Nagpur, families are guided on:
- Crisis prevention
- Communication strategies
- Legal and ethical aspects when insight is absent
When Impaired Judgment Becomes Dangerous
🚨 Emergency if:
- Reckless spending escalates
- Aggression appears
- Risk-taking increases
- Sleep disappears completely
Early intervention prevents:
- Hospital admission
- Legal trouble
- Financial loss
Psychiatrist’s Closing Note
“Impaired judgment is not refusal to understand.
It is the brain’s inability to evaluate reality during illness.”
Treatment restores judgment.
Delay worsens damage.
Medical Disclaimer
This information is for educational purposes only and does not replace professional psychiatric consultation.
Dr. Rameez Shaikh (MBBS, MD, MIPS) is a consultant Psychiatrist, Sexologist & Psychotherapist in Nagpur and works at Mind & Mood Clinic. He believes that science-based treatment, encompassing spiritual, physical, and mental health, will provide you with the long-lasting knowledge and tool to find happiness and wholeness again.
Dr. Rameez Shaikh, a dedicated psychiatrist , is a beacon of compassion and understanding in the realm of mental health. With a genuine passion for helping others, he combines his extensive knowledge and empathetic approach to create a supportive space for his patients.
