The excellent ABC Radio All in the Mind has just had an edition on delusions and insight – examining why people not only have wildly unusual psychotic experiences, but also why they don’t realise these experiences are in any way strange or unusual.
Several people are interviewed who have experienced delusions and psychosis, as well as psychologist Dr Xavier Amador who has extensively written and researched on the topic of insight.
He is co-editor of one of the key books in the field, Insight and Psychosis, and also runs workshops for friends and relatives of people with psychosis.
Insight is a tricky concept, because it is not clear exactly what the person is supposed to have insight into.
It is usually broken down into three factors:
* Does the person believe they have a mental illness?
* Does the person believe the symptoms they are experiencing are due to the mental illness?
* Does the person accept treatment?
Although someone who believes they are dead must be lacking insight into something, the last factor is particularly contentious and there is a degree to which ‘having insight’ is a measure of how much you agree with your psychiatrist.
For example, one measure of insight into the negative symptoms of schizophrenia is to ask the person to fill out a subjective rating of their symptoms, and compared it to the same rating completed by the psychiatrist.
The difference in score is supposed to represent the extent of the patients lack of insight, but it could just as easily represent the psychiatrist’s lack of insight into the patient’s condition.
It is also not clear how the lack of insight in psychotic mental illness links to lack of insight after brain injury – known as anosognosia.
This can be so striking that a person with paralysis or even blindness after brain injury may be completely unaware that they can no longer move or see.
All in the Mind discusses how it’s possible to help someone who believes there is nothing wrong with them, even when there’s a clear difference in the perception of reality.
Link to All in the Mind on insight and psychosis.
Mind Hacks 
Why don’t people “realise these experiences are in any way strange or unusual”?
“If I knew what a hallucination was I would know what reality was.”
Philip K Dick, in the essay ‘Will the Atomic Bomb Ever be Perfected, And if so, What becomes of Robert Heinlein?’
Any who *knows* what reality is? ; )
Daniel,
“These people” like any people trust their sensory perceptions. The system works like a computer…except with an emotional element, if the data is corrupted then emotions (anger, confusion, fear set in) making it even more difficult to distinguish between reliable and corrupted data.
Because people’s perceptions of situations vary so much then it is a very valid point that the discrepancies in the doctor & patient evaluations of the patient’s condition could just as easily be the fault of the doctor…who let’s face it, doesn’t spend a great deal of time with the patient so doesn’t really know what their real situation is.