Insight development in schizophrenia: the construction of dangerousness in relapse

Mental health professionals believe that lack of insight is a major problem in schizophrenia because it significantly interferes with adherence to medical treatment. Yet few researchers have attempted to ask people with schizophrenia for their views on how insight develops and impacts on their quality of life. We explored these questions in interviews and focus groups with 19 Canadian people who had been diagnosed with schizophrenia and identified as having good insight, and with New Zealand and Canadian treatment providers. We found that participants developed insight in three stages, which we labeled the period of chaos, the dynamic period, and the period of wisdom. Crises led participants to realize that their safety and their relationships with loved ones would continue to be dangerously imperiled unless they made sustained efforts to maintain wellness. We propose the Theory of Dangerousness to explain how participants developed and maintained their motivation to remain well.