Insight in psychosis: A critical review of the contemporary confusion

• Published in: Asian journal of psychiatry Vol. 48; p. 101921
• Main Author: Jacob, K.S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2020
• Subjects: Assessment; Awareness - physiology; Culture; Diagnostic Self Evaluation; Humans; Insight; Psychosis; Psychotic Disorders - diagnosis; Psychotic Disorders - physiopathology; Psychotic Disorders - psychology; Schizophrenia; Schizophrenia - diagnosis; Schizophrenia - physiopathology; Schizophrenic Psychology; Psychosis; Schizophrenia; Insight; Culture; Assessment
• ISSN: 1876-2018; 1876-2026
• DOI: 10.1016/j.ajp.2019.101921

This commentary highlights the context, complexity, conflicting claims and the contemporary confusion related to insight in people with psychosis. Traditional psychiatric precepts suggests that good insight is inversely related to the severity of psychotic symptoms and directly related to depression scores, better clinical outcome, and treatment adherence. However, recent studies have recognised that insight does not predict outcomes, changes over time, and is dependent on the trajectory of the individual’s illness and the social and cultural context arguing that “insight” is an explanatory model and a coping strategy. Methodological issues related to the assessment of insight, the limitations of psychiatric classification and complex interaction between biology and the environment make simplistic explanations of the concept of insight less than useful. The paper argues that the biomedical model should be presented without dismissing or devaluing patient beliefs and explanations. Psychiatry needs to embrace the complexity of mental illness and value diverse attempts at restoring homeostasis.