From diagnostic conformity to co-narration of self-insight in mental health care

Abstract

In mental health care, large differences in perspective between individuals with psychosis and professionals are an everyday reality. Such discrepancies become apparent in the substantial number of patients judged to lack illness insight. This Perspective argues that ‘illness insight’ typically refers to patient conformity to medical views rather than denoting true understanding into their condition. We outline limitations of the current conceptualization of illness insight (‘clinical insight’) and discuss an alternative, narrative understanding, drawing on literature from various academic disciplines. After addressing definitional ambiguities, etiological complexities and methodological inconsistencies inherent to the current understanding, this paper highlights several normative, cultural and ethical issues surrounding clinical insight. A narrative approach allows patients to find more meaningful explanations that resonate better with the complexity of their experiences and tackles other problems identified with clinical insight. We argue that narrative insight is inherently co-constructed, emphasizing the shared meaning-making process between individuals with psychosis and professionals. This Perspective seeks to identify the limitations of the ‘clinical insight’ construct discussing an alternative narrative approach for individuals with psychosis.