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

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

The concept of Insight in psychosis or the lack of it, did not receive much attention till mid nineteenth century due to its close association with the concept of delusion, so much so that loss of insight was part of the definition of insanity. Two empirical factors [1] that brought

**2.** incomplete insanity or monomania, in which there was the impairment of specific faculties

Both these factors lead to the assumption that there might be some forms of insanity which can be called Partial Insanity. The idea of Incomplete Insanity in the eighteenth and early nineteenth centuries had to fight the prevalent idea put forward by John Locke of an indivisible or simple mind. This idea was challenged with the help of Gall's Phrenology which divided the brain according to anatomical parts with specific functions and Thomas Reid's Common sense theory of mind which suggested that mind has separable components like will, emotion, etc. After this there was a significant change in the discourse of Insanity with

Partial insanity and the related ideas about specific faculties of the mind therefore led to the birth of an idea of insight as something to be studied and understood in its own right, separate from the concept of mental illness. There was understandable resistance for such a concept because of its far reaching implications on legal responsibility of the people with mental illness. In 1869, an important conference was convened by the Société Médico-Psychologique to inquire into the legal questions raised by the partial insanity and the nature of a person's awareness about his mental illness. Some of the important observations in that conference and subsequent scientific debates were: (1) fair reasoning capacity in an ill person does not always mean that he is aware of his illness; (2) some people who were aware of their illness suggested that they were powerless to prevent few behaviors related to their illness; (3) awareness of mental illness or its symptoms does not mean that the ill person has freedom of choice with regard to the resultant behavior. These issues will be important when insight is discussed in

From then on the discussion went in two different streams of thought. On the one hand alienists and prominent biological psychiatrists of the late nineteenth and early twentieth century like Kraepelin, Maudsley, Despine and Lewis spearheaded the view that the insane cannot have insight or judgment about their illness. On the other hand, Dilthey's concept of Human Sciences and Husserl's phenomenology, which later influenced Karl Jaspers, fostered another view that insight or patient's judgment about their illness is dynamic and is related to deeper

from further study.

**2. History of the concept**

92 Psychosis - Biopsychosocial and Relational Perspectives

about the need for an investigation of this concept were:

talk of "emotional" insanities and "volitional" insanities.

the context of coercion and legal responsibility.

concepts like that of a person's self.

**1.** episodic nature of certain forms of insanity, and

of the mind and not a global impairment.

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

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 and mental illness.
