Quee, P. J., van der Meer, L., Bruggeman, R., de Haan, L., Krabbendam, L., Cahn, W., et al. (2011). Insight in psychosis: Relationship with neurocognition, social cognition and clinical symptoms depends on phase of illness.  Schizophrenia Bulletin,  37 (1):  29-37.Wiffen, B. D. R., O'Connor, J. A., Russo, M., Lopez-Morinigo, J. D., Ferraro, L., Sideli, L., et al. (2012). Are there specific neuropsychological deficits underlying poor insight in first episode psychosis?,  Schizophrenia Research,  135 (): .

“We don't see the world the way it is. We see the world the way we are.”

A challenge for clinicians and researchers working with individuals with psychosis is in understanding the deeply strange nature of psychotic experience. Psychotic interludes may involve a profound change in first-person experience, whereby objects and people in the world can take on an entirely new kind of meaning—one that is difficult to communicate and harder still for others to grasp. One important differentiating aspect of psychotic experience is that of insight—that is, whether the person is aware that their experiences are due to a mental disorder. A patient with insight is generally easier to work with, and good insight is linked to improved outcomes (McEvoy, 2004).

Though the clinical relevance of insight is well documented, research into the phenomena has provided mixed results. Quee et al. search for underlying factors of insight, in the neurocognitive, social cognitive, and clinical symptom domains. A regression analysis found that multiple factors are associated with insight, with all three of these domains playing a part in explaining variance. Another study by Wiffen et al. looked for specific deficits underlying poor insight, and found that poor insight related to worse performance on a wide variety of neuropsychological tasks, including verbal memory, category fluency, and general IQ. It is difficult to identify a single “key” factor that explains why some patients have insight and others do not.

One challenge in this area is agreeing on a meaningful definition of what insight is. The traditional definition has been “a correct attitude to morbid change in oneself” (Lewis, 1934), which does not offer much assistance for the researcher as it lacks definitions of correctness of attitude or what constitutes morbid change. More recent additions to the definition include “the recognition that one has a mental