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Insight in psychosis: Standards, science, ethics and value judgment
1Christian Medical College, Vellore, Vellore, India.
The International Journal of Social Psychiatry
|May 16, 2017
Summary
Insight in psychosis is a personal narrative, not a predictor of outcomes. Current assessments neglect cultural context and personal values, necessitating a broader approach to understanding mental illness.
Area of Science:
- Psychiatry
- Clinical Psychology
- Cultural Psychiatry
Background:
- Current clinical assessment of insight in psychosis relies exclusively on biomedical models.
- This approach ignores crucial contextual, cultural, and value-based factors influencing a patient's understanding of their illness.
Purpose of the Study:
- To review recent Indian research on insight and explanatory models in psychosis.
- To re-evaluate the existing frameworks for assessing, diagnosing, and managing insight and explanatory models.
Main Methods:
- A comprehensive review of recent research from India focusing on insight and explanatory models in psychosis.
Main Results:
- Longitudinal data indicates that baseline insight and explanatory models do not predict schizophrenia's course, outcome, or treatment response.
- Psychosis severity and quality are the primary determinants of illness trajectory.
- Individuals with psychosis often hold multiple, evolving, and sometimes contradictory explanatory models, viewing insight as a personal narrative and coping mechanism.
Conclusions:
- Insight assessment inherently involves value judgments and commitments.
- A comprehensive approach is needed to evaluate awareness, attribution, and actions related to mental illness.
- The role of personal values in assessing insight within psychosis must be acknowledged.
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