Narrative insight: rethinking insight in psychosis

Abstract

This paper revisits the epistemological and clinical foundations of insight into psychosis. After a brief introduction of its importance in psychiatry, we will explore the empirical data on ‘lack of insight’ in psychosis. To overcome the significant shortcomings of the prevailing view of insight, we are proposing to focus on the subjective dimension of insight and to conceptualize insight as a particular form of narrative production, which we call narrative insight. The narrative perspective emphasizes the subject, the process of insight formation and the importance of the audience, the intended effects and its pragmatic purposes. The narrative insight approach focuses not only on the content and the form of the narratives, but also on the temporal dimension and the potential specific phases of insight. We conclude by proposing specific topics for future research into the links between insight, clinical approaches to psychosis and culture.

Keywords:

• Psychosis
• insight
• illness narratives
• cultural psychiatry