I'm Insane sounds like a noise collage more than a song. Bob Bert provides more steady pounding drums while Thurston and Lee make some crashing noises. A bass line can be heard under all the chaos. A song actually starts to form when Thurston begins his "speaking" vocal style. A melody from the lyrics carries the song from the chaos that it starts with to an actual structured peice.
Sonic Youth began trying to write more structured work, but I'm Insane is a good example of a track begins with a mess but slowly evolves into a more structured piece. Like some of Lee's songs, this song reads more like a poetry piece which requires more of a spoken word approach. On the Gila Monster Jamboree video, Thurston just reads the lyrics from a set of cards. Porbably too many to remember?
This video is from the The Gila Monster Jamboree VHS from 1-5-85.