Psychiatrists’ Accounts of “Insight”


Researchers in the U.K. examine how “insight” into schizophrenia is represented in psychiatrists’ accounts, finding “three dimensions of insight into schizophrenia in the data we collected: a sense of illness, criticism, and readiness to receive treatment. We argue that they are embodiments of the dominant medical perspective in the relations between patients and physicians. Whereas in the former two it is possessing and accepting psychiatric knowledge which constitutes having insight, in the latter it is unquestioning acceptance and trust in whatever treatment the doctor deems fit to administer.”

Abstract → 

Galasiński, D., Opaliński, K., “Psychiatrists’ Accounts of Insight,” Qualitative Health Research, online June 28, 2012



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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. My understanding of anosognosia is that it was a term coined to refer to patients who had incurred significant physical injuries, and were not aware of the injury. For example, someone who was in a car crash, and an arm is paralysed may be unaware/unable to recognise the paralysis.

    I assume that the above is an extremely rare scenario.

    However, this concept of anosognosia appears to have been stretched significantly beyond the scenario above, to basically include any psychiatric patient who disagrees. It’s the best legal/medical defence there is to justify curtailment of anothers’ rights.

    In reviewing my medical records, I was described as having “poor insight”. I can only assume this is because I didn’t blindly accept what Doctors told me to be true (which in fact turned out not to be true) and yet I’m the one with poor insight?

    The ones with poor insight were the ones who can’t apparently tell the difference between someone who is taking medication and someone who is not…and yet insist that taking the pills is a matter of life or death…

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    • I agree A. The term is so stretched it has become a catch-all when you want to support coercive interventions. It is used repeatedly by NAMI National, TAC, and our local Ohio NAMI features this pseudo-scientific word prominently in their rationale for expanding involuntary outpatient committment.

      Curiously, Peter Breggin has used the term in the past (I believe he uses the term ‘spellbinding’ now) to describe a persons inability to understand that they’re not “getting better” due to being on psychiatric drugs. The drugs have “blinded” them to themselves. This ties back to the news story on children and emotional development.

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        • I agree, I think Breggin’s use of the term “spellbinding” regarding psychiatric drug use is hyperbole that erodes credibility.

          There’s a much simpler and more plausible explanation than “spellbinding”: Cognitive dissonance.

          People believe the drugs are helping even though all they might experience is side effects because they are invested in the belief. This investment might be social (conformity to expectations of society, doctors, family, etc.), financial (going from doctor to doctor in search of a “cure”), or because they have sacrificed a chunk of their lives pursuing a chemical correction.

          It’s the same reason people have trouble letting go of bad investments — “I’ve put so much into it, I can’t give up on it now.”

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  2. I totally agree that the ones with poor insight are the psychiatrists themselves. Why is that? It is mainly because they don’t really want to know: they think they know already; they have been to medical school, you haven’t, therefore you are the one who doesn’t know. That is how their mind works. As it has been said on this website again and again: psychiatrists don’t listen, they need to be taught how to listen. I tried to tell them what brought my son’s psychosis on. I had been there; I saw it happen. But no! All the psychiatrists did was look at me with kind pitty-“Poor woman, she can’t accept that her son is mentally ill. Why don’t you leave it to the experts?”. The psychiatrists I had to deal with were all intelligent, well-meaning people,but insight into psychosis they certainly didn’t have. There was some mental block there which stopped them to understand what I was telling them. I don’t see how things can change without changing what young psychiatrists are taught at medical school. Also, all those official entries on the internet saying that “Schizophrenia is a severe mental illness due to chemical imbalance” need to be taken off or at least balanced out. Psychiatrists can be blind as bats.

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  3. Cigarette smoking is a lack of insight. Drinking alcohol too much is a lack of insight. Eating too much is a lack of insight.

    We have high taxes and smoking areas for smokers.
    Government tried to ban alcohol but couldn’t.
    They can’t ban food.

    When are people responsible for their choices to sin?

    “receive treatment” means take the “correct” legal drugs we are selling.

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  4. If you have insight to the point that you disagree with the doctor or, heaven forbid, become angered by the treatment you are getting, you are guaranteed to get an escalated psychiatric diagnosis, perhaps something with “delusions” or “agitation.”

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