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Insight and Psychosis

Published online by Cambridge University Press:  02 January 2018

Anthony S. David*
Affiliation:
Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF

Abstract

The concept of insight into psychosis has received scant attention in the psychiatric literature. Drawing on sources such as phenomenology, clinical research and experimental psychology, it is proposed that insight is not an ‘all-or-none’ phenomenon but is composed of three distinct, overlapping dimensions, namely, the recognition that one has a mental illness, compliance with treatment, and the ability to relabel unusual mental events (delusions and hallucinations) as pathological. A scheme is proposed to standardise the assessment of insight to assist further research.

Type
Research Article
Copyright
Copyright © Royal College of Psychiatrists, 1990 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn). Washington, DC: APA.Google Scholar
Appelbaum, P. S., Mirkin, S. A. & Bateman, A.L. (1981) Empirical assessment of competency to consent to psychiatric hospitalization. American Journal of Psychiatry, 138, 11701176.Google ScholarPubMed
Arieti, S. (1974) The Interpretation of Schizophrenia (2nd edn). London: Crosby Lockwood Staples.Google Scholar
Bartkó, G., Herczeg, I. & Zádor, G. (1988) Clinical symptomatology and drug compliance in schizophrenic patients. Acta Psychiatrica Scandinavica, 77, 7476.CrossRefGoogle ScholarPubMed
Bauer, R. M. (1984) Autonomic recognition of names and faces in prosopagnosia: a neuropsychological application of the guilty knowledge test. Neuropsychologic, 22, 457469.CrossRefGoogle ScholarPubMed
Bisiach, E. (1988) Language without thought. In Thought Without Language (ed. L. Weiskrantz). Oxford: Oxford University Press.Google Scholar
Bleuler, E. (1913) Autistic thinking. American Journal of Insanity, 69, 873886.Google Scholar
Bleuler, E. (1924) Textbook of Psychiatry (trans. Brill, A. A., 1951). New York: Dover Publications, Inc.Google Scholar
Brett-Jones, J. R., Garety, P. & Hemsley, D. (1987) Measuring delusional experiences: a method and its application. British Journal of Clinical Psychology, 26, 256257.CrossRefGoogle ScholarPubMed
Brooks, G. W., Deane, W. N. & Hugel, R. W. (1968) Some aspects of the subjective experience of schizophrenia. Diseases of the Nervous System, 29 (suppl. 5), 7882.Google Scholar
Brown, R. (1973) Schizophrenia, language and reality. American Psychologist, 28, 395403.CrossRefGoogle ScholarPubMed
Chapman, L. J. & Chapman, J. P. (1980) Scales for rating psychotic and psychotic-like experiences as continue Schizophrenia Bulletin, 6, 476489.CrossRefGoogle Scholar
Cotard, J. (1882) Nihilistic delusions. In Themes and Variations in European Psychiatry (1974) (eds S. R. Hirsch & M. Shepherd). Charlottesville: University Press of Virginia.Google Scholar
Cutting, J. (1985) The Psychology of Schizophrenia. London: Churchill Livingstone.Google Scholar
Cutting, J. & Murphy, D. (1988) Schizophrenic thought disorder: a psychological and organic interpretation. British Journal of Psychiatry, 152, 310319.CrossRefGoogle ScholarPubMed
David, A. S. & Nestadt, G. The assessment of insight (in preparation).Google Scholar
Eskey, A. (1958) Insight and prognosis. Journal of Clinical Psychology, 14, 426429.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
Fodor, J. A. (1983) The Modularity of Mind. Cambridge, Mass.: MIT Press.CrossRefGoogle Scholar
Freedman, A. M., Kaplan, H. I. & Sadock, B. J. (1975) Comprehensive Textbook of Psychiatry, vol. 1 (2nd edn). Baltimore: Williams & Wilkins.Google Scholar
Freud, S. (1913) On beginning the treatment (further recommendations on the technique of psychoanalysis I). Standard Edition (1958) vol. 12, pp. 123144. London: Hogarth Press.Google Scholar
Freud, S. (1933) The dissection of the psychical personality. Standard Edition (1964), vol. 22, pp. 5780. London: Hogarth Press.Google Scholar
Frith, C. D. (1987) The positive and negative symptoms of schizophrenia reflect impairments in the perception and initiation of action. Psychological Medicine, 17, 631648.CrossRefGoogle ScholarPubMed
Garety, P. A. (1985) Delusions: problems of definition and measurement. British Journal of Medical Psychology, 58, 2534.CrossRefGoogle ScholarPubMed
Garety, P. A. & Hemsley, D. R. (1987) Characteristics of delusional experience. European Archives of Psychiatry and Neurological Sciences, 236, 294298.CrossRefGoogle ScholarPubMed
Gelder, M., Gath, D. & Mayou, R. (1983) Oxford Textbook of Psychiatry. Oxford: Oxford University Press.Google Scholar
Greer, S. (1983) Cancer and the mind. British Journal of Psychiatry, 143, 535543.CrossRefGoogle ScholarPubMed
Hamilton, M. (1974) Fish's Clinical Psychopathology. Bristol: John Wright.Google Scholar
Harré, R. & Lamb, R. (eds) (1983) Encyclopaedic Dictionary of Psychology. Oxford: Basil Black well.Google Scholar
Heinrichs, D. W., Cohen, B. P. & Carpenter, W. T. (1985) Early insight and the management of schizophrenic decompensation. Journal of Nervous and Mental Disease, 173, 133138.CrossRefGoogle ScholarPubMed
Hemsley, D. R. & Garety, P. A. (1986) The formation of delusions: a Bayesian analysis. British Journal of Psychiatry, 149, 5156.CrossRefGoogle ScholarPubMed
Hunter, R. & Macalpine, I. (1963) 300 years of Psychiatry 1535–1860. Oxford: Oxford University Press.Google Scholar
Huq, S. F., Garety, P. A. & Hemsley, D. R. (1988) Probabilistic judgements in deluded and non-deluded subjects. Quarterly Journal of Experimental Psychology, 40A, 801812.CrossRefGoogle Scholar
Jaspers, K. (1913) General Psychopathology (trans. Hoenig, J. & Hamilton, M. W., 1963). Manchester: Manchester University Press.Google Scholar
Junginger, J. & Frame, C. L. (1985) Self-report of the frequency and phenomenology of verbal hallucinations. Journal of Nervous and Mental Disease, 173, 149155.CrossRefGoogle ScholarPubMed
Kendler, K. S., Glazer, W. M. & Morgenstern, H. (1983) Dimensions of delusional experience. American Journal of Psychiatry, 140, 466469.Google Scholar
Kraepelin, E. (1913) Lectures on Clinical Psychiatry (2nd edn) (trans. Johnstone, T.). London: Baillière Tindall.Google Scholar
Kräupl Taylor, F. (1981) On pseudo-hallucinations. Psychological Medicine, 11, 265271.CrossRefGoogle Scholar
Landis, C. (1964) Insight. In Varieties of Psychopathological Experience. New York: Holt, Rinehart & Winston.Google Scholar
Lewis, A. (1934a) The psychopathology of insight. British Journal of Medical Psychology, 14, 332348.CrossRefGoogle Scholar
Lewis, A. (1934b) Melancholia: a clinical survey of depressive states. Journal of Mental Science, 80, 277378.CrossRefGoogle Scholar
Lin, I. F., Spiga, R. & Fortsch, W. (1979) Insight and adherence to medication in chronic schizophrenics. Journal of Clinical Psychiatry, 40, 430432.Google ScholarPubMed
Lishman, W. A. (1987) Organic Psychiatry, Oxford: Blackwell Scientific.Google Scholar
Lord, C. G., Ross, L. & Lepper, M. R. (1979) Biased assimilation and attitude polarization: the effects of prior theories on subsequently considered evidence. Journal of Personality and Social Psychology, 37, 20982109.Google Scholar
Maher, B. & Ross, J. S. (1984) Delusions. In Comprehensive Handbook of Psychopathology (eds H. E. Adams & P. B. Sutker), pp. 383409. New York: Plenum Press.Google Scholar
Marcel, A. J. (1983) Conscious and unconscious perception: experiments on visual masking and word recognition. Cognitive Psychology, 15, 197237.CrossRefGoogle ScholarPubMed
Markovits, H. (1988) Conditional reasoning, representation and empirical evidence on a concrete task. Quarterly Journal of Experimental Psychology, 40A, 483495.CrossRefGoogle Scholar
Marks, I. M. & Mishan, J. (1988) Dysmorphophobic avoidance from disturbed bodily perception: a pilot study of exposure therapy. British Journal of Psychiatry, 152, 674678.CrossRefGoogle ScholarPubMed
Mayer-Gross, W., Slater, E. & Roth, M. (1960) Clinical Psychiatry (2nd edn). London: Cassell.Google Scholar
McEvoy, J. P., Aland, J., Wilson, W. H., et al (1981) Measuring chronic schizophrenic patients' attitudes toward their illness and treatment. Hospital and Community Psychiatry, 32, 856858.Google Scholar
McEvoy, J. P., Apperson, L. J., Applebaum, P. S., et al (1989a) Insight into schizophrenia. Its relationship to acute psychopathology. Journal of Nervous and Mental Disease, 177, 4347.CrossRefGoogle ScholarPubMed
McEvoy, J. P., Freter, S., Everett, G., et al (1989b) Insight and the clinical outcome of schizophrenic patients. Journal of Nervous and Mental Disease, 177, 4851.CrossRefGoogle ScholarPubMed
McGlashan, T. H. & Carpenter, W. T. (1981) Does attitude towards psychosis relate to outcome? American Journal of Psychiatry, 138, 797801.Google Scholar
McGlynn, S. M. & Schacter, D. L. (1989) Unawareness of deficits in neuropsychological syndromes. Journal of Experimental and Clinical Neuropsychology, 11, 143205.Google Scholar
McKenna, P. J. (1984) Disorders with overvalued ideas. British Journal of Psychiatry, 145, 579585.CrossRefGoogle ScholarPubMed
Milton, F., Patwa, V. K. & Hafner, R. J. (1978) Confrontation vs belief-modification in persistently deluded patients. British Journal of Medical Psychology, 51, 127130.CrossRefGoogle ScholarPubMed
Mullen, P. (1979) Phenomenology of disordered mental function. In Essentials of Postgraduate Psychiatry (eds P. Hill, R. Murray & G. Thorley). London: Academic Press.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The brief psychiatric rating scale. Psychological Reports, 10, 799812.CrossRefGoogle Scholar
Pilowsky, I. (1978) A general classification of abnormal illness behaviour. British Journal of Medical Psychology, 51, 131137.CrossRefGoogle Scholar
Post, F. (1983) Clinical assessment of mental disorders. In Handbook of Psychiatry, vol. 1 (eds M. Shepherd & O. L. Zangwill), p. 219. Cambridge: Cambridge University Press.Google Scholar
Rachman, S. (1983) Irrational thinking, with special reference to cognitive therapy. Advances in Behavioural Therapy, 5, 6388.CrossRefGoogle Scholar
Reid, J. R. & Finesinger, J. E. (1952) The role of insight in psychotherapy. American Journal of Psychiatry, 108, 726734.Google Scholar
Richfield, J. (1954) Analysis of the concept of insight. Psychoanalytic Quarterly, 23, 390408.Google Scholar
Roback, H. B. & Abramowitz, S. I. (1979) Insight and hospital adjustment. Canadian Journal of Psychiatry, 24, 233236.Google Scholar
Robinson, M. F. & Freeman, W. (1954) Psychosurgery and the Self. New York: Grune & Stratton.Google Scholar
Rudden, M., Gilmore, M. & Frances, A. (1982) Delusions: When to confront the facts of life. American Journal of Psychiatry, 139, 929932.Google Scholar
Russell, B. (1912) The Problems of Philosophy (reprinted 1973). Oxford: Oxford University Press.Google Scholar
Ryle, G. (1949) The Concept of the Mind. Harmondsworth: Penguin.Google Scholar
Sacks, M. H., Carpenter, W. T. & Strauss, J. S. (1974) Recovery from delusions. Archives of General Psychiatry, 30, 117120.Google Scholar
Sandler, J., Dare, C. & Holder, A. (1973) The Patient and the Analyst. London: Maresfield Reprints.Google Scholar
Slade, P. D. & Bentall, R. (1988) Sensory Deception: The Scientific Study of Hallucinations. London: Croom & Helm.Google Scholar
Soskis, D. A. & Bowers, M. B. (1969) The schizophrenic experience: a follow-up study of attitude and posthospital adjustment. Journal of Nervous and Mental Disease, 149, 443449.CrossRefGoogle ScholarPubMed
Sperry, R. W. (1968) Hemisphere disconnection and the unity of conscious awareness. American Psychologist, 23, 723733.Google Scholar
Strachey, J. (1934) The nature of the therapeutic action of psychoanalysis. International Journal of Psychoanalysis, 15, 127159.Google Scholar
Strauss, J. S. (1969) Hallucinations and delusions as points on continua function. Archives of General Psychiatry, 21, 581586.CrossRefGoogle ScholarPubMed
Szasz, T. S. (1974) The Age of Madness. London: Routledge & Kegan Paul.Google Scholar
Taylor, P. J. (1985) Motives for offending among violent and psychotic men. British Journal of Psychiatry, 147, 491498.Google Scholar
Van Putten, T., Crumpton, E. & Yale, C. (1976) Drug refusal in schizophrenia and the wish to be crazy. Archives of General Psychiatry, 33, 14431446.Google Scholar
Weinstein, E. A. & Kahn, R. L. (1955) Denial of Illness. Illinois: Charles C. Thomas.Google Scholar
Wellman, H. M. & Bartsch, K. (1988) Young children's reasoning about beliefs. Cognition, 30, 239277.Google Scholar
Wing, J. K. (ed.) (1975) Schizophrenia from Within. Surbiton, Surrey: National Schizophrenia Fellowship.Google Scholar
Wing, J. K., Monck, E., Brown, G. W., et al (1964) Morbidity in the community of schizophrenic patients discharged from London mental hospitals in 1959. British Journal of Psychiatry, 110, 1021.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
Winters, K. C. & Neale, J. M. (1983) Delusions and delusional thinking in psychotics: a review of the literature. Clinical Psychology Review, 3, 227253.CrossRefGoogle Scholar
World Health Organization (1973) Report of the International Pilot Study of Schizophrenia, vol. 1. Geneva: WHO.Google Scholar
Zilboorg, G. (1952) The emotional problem and the therapeutic role of insight. Psychoanalytic Quarterly, 21, 124.Google Scholar
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