Awareness and insight in psychopathology: An essential distinction?

Abstract

In psychiatry/clinical psychology, the language of psychopathology remains the main clinical and research tool as it seeks to capture the clinical phenomena underlying mental disorders. It is thus important periodically to review it in order to clarify and refine its relationship to its referent phenomena. This paper argues for a fundamental distinction to be made, in a technical sense, between awareness and insight as, respectively, the narrower and wider form of self-knowledge patients have concerning their conditions.This distinction is based on differences between “objects” of such self-knowledge. Where “objects” refer to impairment of function, as in the neurosciences, the corresponding phenomenon of self-knowledge (awareness) is narrow, based on a direct appraisal of impairment, and evaluated quantitatively . Where “objects” refer to mental symptoms/disorders, as in clinical psychology/psychiatry, the corresponding phenomena of self-knowledge (insight) are wide, based on both direct and indirect appraisals of change, and are evaluated quantitatively and qualitatively. The technical distinction between awareness and insight is important because it differentiates between structural differences in phenomena, indicative of differences in underlying mechanisms, and in turn suggesting the need to adopt different approaches to their study.