Derek Braverman


In this presentation, I assess two new uses of the psychiatric construct of insight beyond its original scope. I argue there is insufficient justification for the continuation of either use, and I elucidate general lessons for establishing whether uses of non-diagnostic psychiatric constructs are justified.


Insight was originally characterized in the mid-19th century to explain the various ways people with psychosis lack awareness regarding their condition. Today, insight is standardly evaluated on three dimensions: awareness of one's mental illness, awareness that one's symptoms are pathological, and treatment adherence.


Insight is now an object of general psychiatric research, and insight assessments are used to guide evaluations for involuntary hospitalization. To ascertain whether these two uses are justified, I propose a minimal justificatory standard specific to each use. I then canvas the reasons adduced in favor of these uses, namely: correlations between a lack of insight and negative patient outcomes; insight's relevance to decision-making capacity; insight's intrinsic value as a species of self-knowledge; and the results of mechanistic research on insight. Ultimately, I contend that none of these putative justifications meets the minimal standard that would warrant the continuation of either use.


I conclude with two general points. First, I highlight how the minimal justificatory standards for different uses of the same construct may vary dramatically, especially between clinical and research applications. Second, I suggest that the theory-avoidance of contemporary psychiatry is a key factor that has allowed for unjustified uses of insight.