If you don’t know, now you know…

I have become particularly interested in the concept of self-awareness in relation to mental disorders. This capacity for awareness or insight has many dimensions that are being investigated but the two most prominent domains in the current literature involve clinical insight (the understanding of the disorder, symptoms and need for treatment) and cognitive insight (the ability to reflect on thoughts and perceptions and modify them). Insight is an important construct to assess because of the prognostic and therapeutic consequences related to symptom severity, seeking and adhering to treatment, social attitude and global functioning. It is also a potential target for intervention to facilitate concurrent methods of treatment, whether pharmacological or psychological. Poor insight is highly prevalent in schizophrenia and related psychoses (Amador & Gorman, 1998; Lincoln et al., 2007). However, assessing this construct poses a lot of challenges because the very nature of it brings the validity of self-report into question. Research has tried to correlate insight with symptomatology, differentiate inpatients with psychosis from those without and provide consistency with other scales of insight. The level of insight can be viewed more objectively in psychosis when evaluated in tandem with measures of positive symptoms like the PANSS. However, I think that poor insight is also highly prevalent in personality disorders as a result of the extreme heterogeneity in presentation and the lack of consistency and clarity in diagnoses. Consequently, we cannot rely too heavily on self-reports and the nature/severity of symptoms is less evident through objective measures than in psychosis. In order to alleviate some of this difficulty, I think it’s important to consider a potential solution from a social perspective. The stigmatization of mental illness in society acts as a barrier for suffering individuals to recognize their symptoms. Although recent media campaigns are aimed at mental health awareness, I am frustrated by their limited focus on anxiety and depression. These disorders are the most common and more easily socialized which explains their priority but in order for society to ‘swallow the pill’ that is mental illness, we need to paint the whole picture. People suffering from personality disorders or psychosis often face the most harsh social environments and facilitating some insight for these individuals and those around them will have many positive therapeutic effects.

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References:

Amador, X. F., & Gorman, J. M. (1998). Psychopathologic domains and insight in schizophrenia. Psychiatr Clin North Am, 21(1), 27–42.

Lincoln, T. M., Lullmann, E., & Rief, W. (2007). Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophr Bull, 33(6), 1324–1342.