**1. Introduction**

Psychosis can be a devastating personal experience due to its ability to rob a person of his self determination and control on his behavior. In the interpersonal context it can damage trust in the relationship and diminish the familiarity between the healthy and the affected person, giving rise to interpersonal negative criticism and can even lead to a complete loss in a relationship. In this background how a person suffering with psychotic disorders reflects on his illness and how he interacts with treating team or the legal system with that self-understanding becomes important. The ability of a person to reflect upon his illness is called Insight into illness (psychotic illness in this case).

In this chapter we will chart a historical and conceptual development of the concept of insight in psychosis and how brilliant people throughout history interacted with this concept and its implications. Later we will look at the current neurobiological and socio-cultural perspectives

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

and outline the need for an integrated view of the concept especially in the background of the nature of human person. We will end the chapter with an attempt to see how far we understand this concept, as well as what the unanswered questions are which would benefit from further study.

Another important aspect in the development of the idea of insight into psychosis was the use of different terms in different European countries. For example, Germanic languages like German and English used terms like Einsicht, Insight or Introspection which encouraged a narrow view that the concept of insight is a circumscribed notion and is separable from the larger concepts of mind, consciousness or the self. The French, by contrast, lack a specific term and so used the word "Conscience," which had a wider meaning encompassing consciousness, self-knowledge and introspection. This led to differences in the way the concept of insight was discussed in the French scientific literature compared to that in the Anglophone or German scientific literature.

Insight in Psychosis: An Integrated Perspective http://dx.doi.org/10.5772/intechopen.79368 93

Over the past two decades, there is a resurgence of interest in the concept of Insight in psychosis. This might be due to its relevance with regards to treatment adherence, long term prognosis, psychological management of psychotic symptoms, as well as use of coercion in treatment and legal responsibility of people with psychotic disorders. The understanding of the concept has greatly evolved from the initial categorical yes or no assessment in studies like International Pilot Study of Schizophrenia [2] and assessment schedules like Present State

The initial multidimensional construct by David [4] was characterized by three aspects of awareness of being mentally ill, awareness of pathological nature of symptoms and acceptance of treatment. Though this approach was lauded by various researchers who further expanded it, many others from the anthropological perspective have deemed it as a biomedical approach which favors a reductionist biological understanding of the concept of Insight

Insight in psychosis is a difficult concept to define within a biomedical model due to various

**1.** Insight, like the concept of Time, is a higher level concept which is easier to use than to

**2.** Insight is related with particular features of mental illness like delusions, hallucinations

When we consider the usage of the concept of insight we find that the distinction between psychotic and nonpsychotic has wide clinical use and is legally important. Within the symptoms of psychosis, it is delusions which are perhaps most closely associated with insight and therefore the understanding of insight has similar conceptual limitations as the understand-

**3.** Delusion is a psycho-pathologically and ethically central feature in mental illness.

**4.** Delusion has a conceptual range of forms comparable to normal human reason.

Examination [3] to a multidimensional construct covering various aspects of Insight.

**3. Current perspectives on insight in psychosis**

**4. Problems with the concept of insight in psychosis**

and thought alienation phenomena and not to other features.

factors which are listed by Fulford [5] as:

ing and definition of delusion.

and mental illness.

define.
