On the Question of Insight in Psychosis

We are discussing psychoanalytic approaches to psychosis at a peculiar time in the history of our field. Let me quote from a recent article in Science on schizophrenia research:

Scientific leads have been a long time coming, in part because of the grip of psychoanalytic theories of mental illnesses which did not loosen until the 1970s when the revolution in biological psychiatry finally unseated psycho-social factors as the primary etiological suspects for schizophrenia. (Barnes, 1987, pp. 430-433)

Distortions of history sometimes are the result of the choice of the moment at which one thinks a particular story has its beginning. The search for the “organic” causes of schizophrenia has a much longer history than the psychoanalytic search for an understanding of the disorder, and the psychoanalytic approaches were the result of the failures of the organic approaches. New levels of biological sophistication should, however, not blind us to the dangers of reductionism and the premature jettisoning of the results of psychoanalytic work.

A review of current issues in biological research on schizophrenia demonstrates to what extent this research may be hampered by a lack of consensus on what is meant by psychosis and by schizophrenia, questions to which psychoanalytic work has much to contribute. When we study the question of insight in psychosis, into what are we seeking insight? Lest we, as psychoanalytic and psy-chodynamic investigators, by comparing our understanding with that of more biologically focused workers, develop feelings of inadequacy, it is important to consider the current state of biological research.

In the above-cited review article in Science, Kenneth Kendler says,