From medical insight to narrative insight: insight as a support for the therapeutic relationship

ABSTRACT

The concept of insight in psychiatry (“medical insight”) rests on a medical definition. The results obtained under this conception are difficult to interpret. The objective of this study is to show that participants diagnosed with schizophrenic and schizoaffective disorders (S/SD) have an awareness of their difficulties that is both greater than and different from that which is assessed by a medical insight scale. We recruited 50 participants diagnosed with S/SD and 90 non-patients. All participants were administered a general psychopathology scale (the SCL-90-R). Participants with S/SD were also administered an expert rating scale for depression (CDSS) and an insight scale (Insight Q8). The participants with S/SD had little or no medical insight according to the Insight Q8. But depression as assessed by self-rating was strong correlated to an expert rating of depression, and participants with S/SD scored significantly higher on the general psychopathology scale than controls. Participants with S/SD are more aware of their difficulties than the insight scale indicates. The medical conception implicit in the scale does not leave room for the patients’ own explanatory models. The notion of subjective narrative insight may allow us to renew both the concept of insight and its role in psychiatry.

KEYWORDS:

• Insight
• narrative insight
• schizophrenia
• explanatory model

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Thanks to Pearson France - ECPA the editor of the french adaptation of the SCL90-R © 1994 Leonard R. Derogatis, PHD. All rights reserved. French adaptation © 2015 NCP Pearson, Inc. Adaptation and reproduction by Pearson France ECPA. With the SCL-90-R editors authorization.