**2. History of the concept**

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 about the need for an investigation of this concept were:


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

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 the context of coercion and legal responsibility.

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 concepts like that of a person's self.

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.
