Insight in psychosis: an elusive target

Insight is a quality which has been highly valued by most clinicians in the mental health field, largely because a strong link is assumed between good insight and better quality of life. Yet it is a complex construct, one which has not until recently been subjected to much critical scrutiny or adequately explicated. All too often, particularly in the field of psychosis, the term has been used as shorthand for the degree of congruence between the explanatory models and views on the mode and conditions of treatment of the clinician and the patient. Conflicts about these matters are ubiquitous in the care of psychotic patients. Recently, there has been a recognition that there are a number of dimensions to the construct, and that some of these relate to differences in attributional perspective. This has opened up the issue to more sophisticated research drawing on established but untapped psychological and neurobiological theories, and has formed a better framework for the development of more effective research and therapeutic strategies.