Insight & Capacity (History)

The History of Insight

The concept of insight has a long history in psychiatry, psychoanalysis and cognitive neuropsychology.  In General Psychopathology (1913), Karl Jaspers understood insight to be something more than simply ‘awareness of illness,’ requiring in addition an “objectively correct estimate of the severity of the illness [and an] objectively correct judgment of its particular type.”  In the 1930s, psychiatrist Aubrey Lewis defined insight as “a correct attitude toward a morbid change in oneself.”  At one time, insight was regarded by psychiatrists as the hallmark of psychosis and a distinguishing feature of psychosis.  For example, in his 1967 textbook, Clinical Psychopathology, Frank Fish wrote:  “The neurotic has insight into his illness … . The psychotic, on the other hand, lacks insight.”  These views are now widely seen as outdated.

In the 1995 edition of a later textbook, (Symptoms of the Mind: An Introduction to Descriptive Psychopathology), Andrew Sims explains insight, and its significance, as follows:

The doctor … needs to form an idea of his patient’s attitude to his illness, difficulties and prospects. To what extent does he have insight into his condition? Any illness of some severity will alter the patient’s world, and view of the world. … Insight is therefore highly complex as a function. It is the understanding of the individual about his own state of health, capacity and worth; it also relates this assessment of personal state to other people and the world outside. It is therefore essentially concerned with self and not-self and their inter-relatedness.

Modern treatments of insight in the scientific literature generally analyse insight as a variable and multi-dimensional construct.  To say that insight is variable means that insight is not simply present or absent but varies by degrees (someone might have ‘partial insight’ or ‘greater insight today than yesterday’).  To say that insight is a multidimensional construct means that it combines a number of distinguishable factors. 

The history of insight has also been a history of controversy.  Critics of the concept have included clinicians, ethicists, lawyers and service users.  In 1993, clinicians Rachel Perkins and Parimala Moodley wrote of “the arrogance of insight,” describing it as “an extremely crude concept that offers an extremely limited index of the way a person understands their distress and disturbance.”  Following Morant et al., disability rights lawyers Liz Brosnan and Eilionóir Flynn have written that “medical practitioners’ assumptions about lack of insight can inhibit meaningful dialogue, exaggerating inequalities between people’s experiential knowledge and the scientific knowledge base of practitioners.”  Laura Guidry-Grimes, a moral philosopher, has argued that the use of the concept of insight in mental health contexts raises “ethical complexities.”  A defence of the concept, when “used wisely,” has recently been provided by Anthony David and Kevin Ariyo.

Insight & Capacity

Insight & Capacity (Meaning)