Lack of insight and conceptions of “mental illness” in schizophrenia, assessed in the third person through case vignettes

Abstract

Objective: The purpose of this study was to determine if persons with a diagnosis of schizophrenia lack insight into their illness because cognitive deficits prevent them from applying an internal schema of mental illness to themselves. The study examines the ability of subjects to “insightfully” classify a series of short, fictional vignettes from a third‐person perspective.

Method: Investigators wrote 20 one‐ to three‐sentence stories, 11 illustrating subtypes of psychotic symptoms, 3 illustrating non‐psychotic psychiatric diagnoses, 3 indicating medical problems, and 3 no illness. The investigators read these stories to a sample of inpatients with a diagnosis of schizophrenia and a random community sample control group, and asked if subjects considered the person in each story to be mentally ill.

Results: Subjects and controls were able to make accurate, fine distinctions among medical illness, no illness, and psychiatric illness categories.

Conclusions: Patients did not demonstrate a deficit in the cognitive processing of illness schema, yet still failed to relate their own illness schema to themselves. This would encourage further study of the relationship between insight, denial, the mental representation of the self, and the meaning of the “mental illness” label to persons with psychosis.

Keywords:

• psychosis
• insight
• anosognosia
• schizophrenia
• stigma