**5. Neurobiology and metacognition research**

Metacognition is the ability of the human mind to reflect, look upon and influence itself. In the fourth century AD, Saint Augustine in his popular Confessions [6] ponders about the metamemory, a concept akin to metacognition that, "When, therefore, I remember memory, then memory is present to itself by itself, but when I remember forgetfulness then both memory and forgetfulness are present together – the memory by which I remember the forgetfulness which I remember." And in his Allgemeine Psychopathologie [7] Karl Jaspers also similarly writes, "I am not only conscious in the sense of having certain inner experiences, but I am turned back on myself – reflected back – in the consciousness of self. In the course of this reflection, I not only come to know myself, but I also influence myself." Though, as shown, this faculty of human mind was known from ancient times, it was not neuro-biologically investigated.

needs to be employed in view of limitations of above mentioned research and also due to the fact that this studies only the brain correlates which may be down-stream events and their interpretation as to whether they are causes or effects depends on the worldview espoused,

Insight in Psychosis: An Integrated Perspective http://dx.doi.org/10.5772/intechopen.79368 95

Markova and Berrios [17, 18] have suggested three broad ways that the field of mental health

(1) Insight as impaired awareness, i.e., a neurobiological deficit in awareness due to the psychotic

(2) Insight as self-deception, i.e., a psychodynamic defense mechanism that needs to be overcome in therapy. This view is a broad understanding not limited to psychosis, and is more

Socio-cultural critics of the concept of insight take the third position, and argue that a person who is suffering with psychotic illness may attribute problems to different causes. However as long as the person is able to construct a meaningful explanation of his symptom experience and integrate the psychotic experience into his life, he should be considered to have insight into illness [18]. Insight should not be restricted to just a biomedical explanation, as that explanation itself is argued to be a socially- constructed model among those who subscribe to a

A few workers have suggested socio-cultural modifications to the multidimensional model of insight [19], for example accepting any kind of help including nonmedical help should qualify as presence of certain form of insight. As the causal explanations of mental illness are contested across cultures, anthropological critics argue for a wider and an inclusive under-

One other aspect of the cultural critique of insight in psychosis is the consistent observation that the prognosis of schizophrenia is demonstrably better in developing countries [2]. These cultures are also often less likely to espouse the biomedical models of causation and treatment by default. The role of strong family systems has long been postulated to be a contributor to the better prognosis in developing countries, and it is worth considering the role of family

The nature of Human being has been discussed since antiquity. Mind–body relationship and nature of the human mind has given rise to numerous debates. All the research discussed till now from a biomedical viewpoint has presented empirical facts as opposed to the evaluative

disease process. This is biological psychiatry's position on the concept of insight.

(3) Insight as misattribution, i.e., cognitively attributing symptoms to different causes.

relevant in the neurotic conditions and those requiring psychotherapy.

western, individualist, post-enlightenment and biologically reductionist position.

standing of the concept of mental illness and a suffering person's judgment about it.

beliefs in impacting the patient's insight into his illness.

**7. Nature of the human person**

biomedical or any other.

**6. Cultural critique of insight**

conceptualizes problems with insight:

Over the last decade, interesting research into the neuroscience of self and self-reflection has opened new avenues for the understanding of the human mind and perception of changes within the self. In the study of the concept of insight in psychosis these are relevant findings as they pertain to normal and abnormal self-reflection. We will point out few prominent and replicated functional MRI findings using the Beck Cognitive Insight Scale [8], though these were done on small sample sizes and did not account for the effects of duration of illness and use of antipsychotic medication.


Unlike the earlier research which made multiple unsuccessful attempts at finding a specific executive deficit associated with the whole concept of insight as was suggested by Aubrey Lewis at the beginning of the twentieth century [16], the above mentioned research correlates more with specific components of insight rather than a unitary whole. However, caution needs to be employed in view of limitations of above mentioned research and also due to the fact that this studies only the brain correlates which may be down-stream events and their interpretation as to whether they are causes or effects depends on the worldview espoused, biomedical or any other.
